Abstract 5684: Long-Term Outcomes after Catheter Ablation of Atrial Flutter: A Meta-Analysis
Clinical outcomes after catheter ablation of atrial flutter (AFL) vary widely in reported literature. The puropose of this study was to analyze long-term outcomes after cathteter ablation of AFL using meta-analys. Meta-analysis was performed of articles published from 1988 – 2007 with outcomes after catheter ablation of cavotricuspid isthmus (CTI) dependent AFL. The analysis included 110 studies comprising 7946 patients (79% male, 59.8±0.5 years, 43% left atrial enlargement, 49% heart disease, 16±12 months follow up). The acute success rate was 97% (95% CI 95–98%) with cooled (8 –10mm tip or irrigated) radiofrequency catheters and 95% (94 –96%) when bidirectional CTI block was the endpoint. Recurrence rate of AFL was 4% (3– 6%) with cooled catheters. Use of bidirectional CTI block as ablation endpoint decreased AFL reccurrence to 8% (^−10%) versus 18% (14 –22%) without CTI as endpoint. AFL recurrence rate did not increase over time. Mortality was 3% (2– 4%) during follow up. The overall occurrence rate of atrial fibrillation (AF) after AFL ablation was 25% (21–29%). In patients with AF prior to ablation, AF occurred in 46% (41–51%) compared to 16% (11–22%) without AF prior to ablation. Five years after ablation, the AF rates were similar in those with and without AF prior to ablation (Figure⇓). Antiarrhythmic drug use post ablation was 28% (22–36%). The long term use of coumadin was not described. AF is common after AFL ablation and may limit the clinical utility of this procedure. 28% of patients require antiarrhythmic drugs after AFL ablation. AF before ablation may indicate a more advanced electrical disease.