Key result
Catheter ablation for post-transplant atrial flutter links to ~5.6 years longer median survival versus medical management.
Why the study?
Atrial flutter is the most common arrhythmia post cardiac transplantation, but data on catheter ablation outcomes in this population are lacking.
Does catheter ablation improve survival in patients with late onset atrial flutter post cardiac transplantation compared to medical management?
Observational (n=68)
No
Does catheter ablation improve survival in patients with late onset atrial flutter post cardiac transplantation compared to medical management?
Absolute Event Rate: 11.34% vs 5.79%
p-value: p=0.026
Catheter ablation for late-onset atrial flutter post-cardiac transplantation is associated with significantly improved median survival compared to historical medical management.
May support ablation consideration in post-transplant atrial flutter; leaves open need for randomized confirmation of survival benefit.
BACKGROUND: Atrial flutter is the most common arrhythmia post cardiac transplantation. Observational studies in the non-transplant population have shown prognostic benefit with catheter ablation; however, there are no data in the heart transplant population. OBJECTIVES: This study evaluated the experience of catheter ablation in atrial flutter post cardiac transplantation. METHODS: A retrospective review of experience of late onset atrial flutter at the Freeman Hospital, Newcastle-upon-Tyne, UK, between 1985 and January 2020. RESULTS: Sixty eight of the 722 patients who survived 6 months post cardiac transplantation developed late atrial flutter giving an incidence of 9.4%. Thirty-two patients were managed with ablation with treatment largely determined by time of flutter onset. Kaplan Meier estimates for arrhythmia free survival post first ablation for organized atrial arrhythmias was 83.3% at 1 year. Kaplan-Meier estimates for median survival post onset of atrial arrhythmias treated with ablation was 11.34 years (95% CI 8.00-14.57), compared to 5.79 years in patients managed medically (95%CI 2.26-9.32) (P = .026). CONCLUSIONS: Atrial flutter is an important late complication of cardiac transplantation. Patients treated with ablation in the modern era had increased survival compared to a historical cohort.
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Taylor et al. (2021) conducted an observational in Atrial flutter post cardiac transplantation (n=68). Catheter ablation vs. Medical management was evaluated on Median survival post onset of atrial arrhythmias (p=0.026). Catheter ablation for late-onset atrial flutter post cardiac transplantation was associated with increased median survival compared to medical management (11.34 vs 5.79 years; P=0.026).
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