Atrial fibrillation after radiofrequency ablation of atrial flutter:: preventive effect of angiotensin converting enzyme inhibitors, angiotensin II receptor blockers, and diuretics

Objectives: To determine risk factors for the development of atrial fibrillation (AF) after atrial flutter (AFL) ablation; and to study the relation between AF development and periprocedural drug use. Methods: AFL ablation was performed in 196 patients. The relation between AF occurrence and clinical, echocardiographic, and procedural factors and periprocedural drug use was analysed retrospectively by a Cox proportional hazard method. Results: After a median follow up of 2.2 years, 114 patients (58%) developed at least one AF episode. Factors associated with AF development were the presence of preprocedural AF, a history of cardioversion, and the number of antiarrhythmic drugs used before the procedure. Use of angiotensin converting enzyme (ACE) inhibitors/angiotensin II receptor blockers and diuretics was significantly associated by univariate and multivariate analyses with less development of AF. Conclusions: A high proportion of patients develop AF after AFL ablation. The incidence of AF is related to pre-ablation AF and its persistence. ACE inhibitors/angiotensin II receptor blockers and diuretics seem to protect against AF.