Abstract 3374: Predictors of Clinically Relevant Atrial Flutter Following Ablation of Atrial Fibrillation
Background: While catheter ablation of atrial fibrillation (AF) can be highly effective in eliminating atrial fibrillation, aggressive intervention can be followed by the occurrence of atrial flutter (AFL) during the blanking period which is clinically irrelevant. In long term, it would be of enormous utility to predict who would or wouldn’t develop clinically significant AFL. The predictors of significant atrial flutter have not been established.
Methods: We studied 371 patients undergoing ablative intervention at Mayo Clinic with 12.5+/− 8.3 months. 35 (9%) had clinically significant AFL and 93 (25%) had clinically significant AF, 12(3%) had both AFL and AF over long term follow-up, 243(66%) had no arrhythmia. The baseline characteristics of this patient population were 306 (82%) were male with age of 55 ± 11, LA size 44 ± 4, LV EF 58 ± 10, AF duration 6.5 ± 5.8. Of these patients 74 underwent Pulmonary Vein Isolation (PVI) and 297 underwent a Wide area circumferential ablation (WACA).
Results: Predictors of clinically significant AFL in long term follow-up were Persistent/Permanent AF HR 2.04 CI (1.02 − 4.06) p=0.04, WACA 8.49, with CI (2.00–36.93), p=0.004, inducible AFL with HR 2.18 CI (1.06 − 4.48) and reduced ejection fraction (LVEF) HR 0.97 CI (0.94 − 1.00) p=0.05. Age, history of AFL prior to ablation and LA size were not associated with clinically significant AFL. Multivariate analysis revealed that WACA was the only significant predictor of clinically significant AFL.
Conclusion: Clinically significant AFL in long term follow up is predicted by the procedure type. Once adjusting for procedure type, inducible AFL, persistent AF and low LVEF are not related to developing AFL in the follow-up period. WACA is an independent predictor of clinically significant AFL.