The Never Old-Fashioned Right Atrial Flutter Revisited

Although major investigations on the AF risk after AFL ablation have been published, the natural history of right AFL after cardioversion is much less understood. The authors sought to the largest historical cohort on the subject in order to establish the true risk of AFL and AF recurrence after AFL DCCV. Overall, 860 individuals with atrial arrhythmias were included and underwent their first DCCV. The median time to recurrence was 3.4 months in the AF cohort (n=572), and 1.7 years in the AFL cohort (n=288). The overall recurrence of atrial arrhythmias was 96.0% for the AF group and 78.8% for the AFL group (p<0.001). In the AF group, most of the recurrent rhythm was AF (92.7%), while only a small percentage was AFL (7.3%). Conversely, the AFL cohort showed recurrence of AF in only 32.6% of cases and 67.4% reverted back to AFL. AFL recurrences represented 53% of the cases within the entire AFL population. the authors created a clinical predictive risk score for predicting recurrence risk after the first DCCV in this pure AFL population. the REAL-PDX risk score stratified by ≥3 vs. <3 in the AFL validation cohort (n=112) showed a significantly shorter median time to recurrence (125 vs. 800 days; p<0.001) and a higher risk of recurrence of atrial arrhythmia (HR: 3.74; 95% CI [1.93-7.24]).This study will certainly remain a benchmark in the field of right AFL natural history after DCCV.