Outcomes of Radiofrequency Ablation for Atrial Fibrillation and Atrial Flutter in Constrictive Pericarditis

Background: Constrictive pericarditis (CP) may be complicated by atrial fibrillation (AF) or atrial flutter (AFL). The role and long-term outcomes of transcatheter radiofrequency ablation (RFA) for CP-associated AF/AFL remain unclear, particularly in patients with or without pericardiectomy. Methods: In this retrospective single-center study, 34 CP patients with AF/AFL undergoing RFA between February 2019 and February 2024 at Beijing Anzhen Hospital, Capital Medical University were analyzed. Patients were stratified by pericardiectomy. Results: At a median follow-up of 36 months, 10/34 (29.4%) experienced arrhythmia recurrence. It occurred in 8/23 (34.8%) with pericardiectomy versus 2/11 (18.2%) without pericardiectomy ( P = 0.32). 6 out of 8 patients with AFL had recurrence. Post-RFA diastolic function improved in the pericardiectomy group; no major complications were observed. Conclusions: RFA is feasible for CP-associated AF/AFL, with a substantial proportion achieving arrhythmia freedom, while patients with AFL had more propensity for the recurrence. Pericardiectomy may be associated with differential diastolic functional improvement.