Abstract 16369: Typical Atrial Flutter with and without Known Atrial Fibrillation: Benefit on Morbidity and Mortality After Cavotricuspid Isthmus Radiofrequency Catheter Ablation in a Controlled Nonrandomized Long-Term Study
BACKGROUND: Cavotricuspid isthmus radiofrequency catheter ablation (CTI RFA) is recommended for typical atrial flutter since it is safe and effective to maintain sinus rhythm. Whether the benefit brought by CTI RFA on long term outcomes is different in patients with known atrial fibrillation (AF) associated with atrial flutter is poorly known.
METHODS: We examined the clinical course of 8,962 consecutive patients with AF and/or atrial flutter. The outcomes in 875 patients with CTI RFA for typical atrial flutter (in whom 334 [38%] had a pre-ablation history of AF) were compared with those in other patients.
RESULTS: Complete CTI block was successfully obtained in 97% of the patients. Median follow-up was 934±1134 days. Death (n=1,155), stroke/thromboembolic events (n=715) or bleeding events (n=791) were recorded in 2,035/8,962 patients. Kaplan-Meier analysis showed that patients who underwent CTI RFA had longer survival than other patients (p<0.0001) and higher net clinical benefit (freedom from combined death, stroke, thromboembolic and bleeding events, p<0.0001). Using cox proportional-hazards model, results remained significant after adjustment for age, CHADS2 and HAS BLED scores, use of cardiovascular medications and other confounders. Patients in the CTI RFA group with atrial flutter alone had a lower risk of all-cause mortality (hazard ratios [HR] = 0.43, 95% confidence interval [CI], 0.29-0.63; p<0.0001), of stroke/thromboembolic events (HR=0.41, 95% CI, 0.24-0.68, p=0.0005) resulting in a significant net clinical benefit (HR=0.51, 95% CI, 0.39-0.67; p<0.0001) compared to patients not treated with CTI RFA. These results were similar in patients with atrial flutter with known AF for all-cause mortality (HR = 0.25, 95% CI, 0.14-0.45; p<0.0001), stroke/thromboembolic events (HR=0.50, 95% CI, 0.30-0.84; p=0.008) and net clinical benefit (HR=0.47, 95% CI, 0.34-0.64; p<0.0001).
CONCLUSIONS: Atrial flutter with CTI RFA is independently associated with a lower mortality and morbidity as compared with other sustained atrial arrhythmias such as atrial fibrillation. These results are not affected by the presence of known AF associated with atrial flutter at baseline.
- © 2012 by American Heart Association, Inc.