Recurrent atrial flutter ablation and incidence of atrial fibrillation ablation after first-time ablation for typical atrial flutter: A nation-wide Danish cohort study

BACKGROUND: Cavo tricuspid isthmus ablation (CTIA) is considered an effective first-line treatment for typical atrial flutter (AFL). However, many patients develop atrial fibrillation (AF) after successful CTIA. Knowledge about recurrent arrhythmia after CTIA mainly comes from small cohort studies with limited follow-up.

OBJECTIVE: To describe incidences of re-ablation for AFL and ablation for AF after first-time CTIA in a nation-wide cohort.

METHODS: In the Danish National Ablation Registry we identified patients undergoing first-time CTIA during 2010-2016. Subsequent CTIA and AF-ablation procedures were identified until March 1st, 2018. We collected information on patient comorbidities in the Danish National Patient Registry.

RESULTS: We identified 2409 patients undergoing first-time CTIA. Median age was 66 (IQR 58-72) years, 1952 (81%) were men, and 78 (3%) patients had a history of previous ablation for AF. Acute procedural success was achieved in 2288 (95%) patients. During mean follow-up of 4.0±1.7years, 242 (10%) patients underwent CTI re-ablation and 326 (13.5%) underwent ablation for AF. Baseline characteristics associated with CTI re-ablation included prolonged procedural time, unsuccessful index CTIA, age <75years and CHA2DS2-VASc score <2. Hypertension, history of AF-ablation, age <65years use of a contact force sensing catheter and CHA2DS2-VASc score <2 were associated with later ablation for AF.

CONCLUSION: In a nation-wide cohort undergoing first-time CTIA for AFL, 10% of patients underwent CTI re-ablation and 13.5% ablation for AF during mean follow-up of 4.0±1.7years. Probability of a second procedure was higher in younger patients with less comorbidities.