![]() ![]() One patient had chronic AFL preceding LVAD implant. All 8 patients had the HMII LVAD implanted: BTT in 4 patients and DT in the other 4. Persistent AFL was defined as flutter lasting >7 days or requiring antiarrhythmic therapy or nonpharmacologic means (cardioversion or catheter ablation) for termination. Of these, 8 patients (mean age, 57☑2 years 7 men and 1 woman) developed persistent AFL. Methods and Resultsįrom January 2011 to April 2012, 102 patients with ongoing LVAD support either as DT or BTT were followed at our tertiary care center. #PERSISTENT TYPICAL ATRIAL FLUTTER ICD 10 SERIES#7 We hereby report a series of consecutive Heart Mate II (HMII Thoratec Corporation, Pleasanton, CA) LVAD patients who developed AFL with decompensated RHF and the outcomes associated with endocardial radiofrequency catheter ablation in this population. 7 Radiofrequency catheter ablation has been shown to be far superior to antiarrhythmics for typical AFL, with cure rates approaching 95% and minimal risk of procedural complications. In such patients, in addition to medical therapy, restoration and maintenance of sinus rhythm could potentially improve symptoms of right ventricular (RV) failure and help maintain optimal LVAD function.Īntiarrhythmic therapy has been disappointing for maintenance of sinus rhythm in AFL. 4- 6 Persistent atrial arrhythmias, such as atrial flutter (AFL), while well tolerated by the LVAD-supported left ventricle, can cause loss of atrioventricular (AV) synchrony resulting in impaired ventricular filling and decompensated right heart failure (RHF). 1- 3 LVAD recipients, however, are at an increased risk for developing both atrial and ventricular arrhythmias, secondary to either pre-existing abnormal electrical substrate or complex electrical remodeling following LVAD implantation. Left ventricular (LV) assist device (LVAD) therapy, either as bridge to transplantation (BTT) or as destination therapy (DT), has emerged as a promising treatment modality to maximize survival and minimize morbidity in patients with end-stage heart failure. Catheter ablation of AFL in LVAD patients is safe and highly effective, resulting in immediate and significant improvement in symptoms of RHF, and should be considered first-line therapy for AFL in these patients. #PERSISTENT TYPICAL ATRIAL FLUTTER ICD 10 FREE#During a mean follow-up of 9±5 months, all patients remained free of atrial flutter. Complete resolution of symptoms and signs of RHF with improved quality of life were noted in all. Seven patients underwent electrophysiology testing where mapping confirmed typical counterclockwise AFL (mean AFL cycle length, 252±49 ms) and radiofrequency ablation of cavotricuspid isthmus restored sinus rhythm in all patients. Three patients developed recurrent syncope, 2 had inappropriate implantable cardioverter-defibrillator shocks, and 6 had new or escalating need for inotropes. Eight patients with HMII LVAD (mean age, 57☑2 years) had medically refractory AFL, with 7 developing de novo AFL after LVAD implant (onset range, 2 days–22 months post-implant). The authors report the largest series of HeartMate II (HMII) patients who developed AFL with decompensated RHF, which successfully resolved with AFL ablation. Persistent atrial flutter (AFL) in left ventricular assist device (LVAD) recipients can result in loss of AV synchrony, impaired ventricular filling and right heart failure (RHF). ![]()
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