Abstract 14893: Rehospitalization Following Catheter Ablation in Co-Existent Atrial Fibrillation and Flutter: Results From a Randomized Study
Introduction: Available ablation options for co-existent AF and AFL are PVAI alone or AFL ablation alone or a combined approach (PVAI + AFL ablation) with variable results. The frequency of rehospitalization and repeat ablations in this population is not well explored yet. This analysis aimed to examine the repeat hospitalization rates for all-cause as well as for arrhythmia recurrence in patients comorbid with AF and AFL.
Methods: Three-hundred sixty patients, undergoing AF ablation with history of paroxysmal AF and right-AFL, were enrolled in this prospective randomized single-blinded study. Of the 182 patients randomized to group 1 (PVAI±AFL), 124 received AF ablation (PVAI) and 58/182 had PVAI+AFL ablation. The decision to perform PVAI+AFL ablation was taken if the patient presented with right-sided isthmus dependent flutter at ablation or during catheter manipulation or if the above flutter was provoked by isoproterenol challenge. All patients randomized to group 2 received AFL ablation only (n=178). Patients were blinded to the procedure assignment. All patients were followed up for at least 1 year after ablation with ECG, cardiology evaluation and Holter monitoring to detect arrhythmia recurrence.
Results: Of 360 patients with coexistent AF and AFL, AF±AFL ablation was performed in 182 (group 1: 61±10 years, 76% male, 59±8 LVEF, 29±5 BMI, 19% CAD, LA diameter 42.6±7) and only the flutter ablation was done in 178 patients (group 2: 62±9 years, 76% male, 58±10 LVEF, 28±6 BMI, 14% CAD, LA diameter 42.1±8). At 30-day of index procedure, the all cause hospitalization was 2.2% in group 1 and 12.4% in group 2 (p<.001). The arrhythmia related re-admission rate at 1 year was substantially low in group 1 (2.7%) compared to group 2 (12.9%), p<.001. At 20±9 month of the index procedure, 6.6% patients in group 1 and 30.9% patients in group 2 required hospitalization for all causes. Twenty eight percent of the patients in group 1 and 68% in group 2 received a second procedure.
Conclusion: In patients with coexistent AF and AFL, the all-cause rehospitalization as well as that due to arrhythmia recurrence is significantly lower following PVAI±AFL ablation than flutter ablation alone.
- © 2013 by American Heart Association, Inc.