Key result
Concurrent CTI ablation is linked to a ~30% lower risk of late atrial arrhythmia recurrence.
Why the study?
Limited information exists regarding the effects of concurrent atrial flutter on the long-term outcomes of rhythm control in patients with AF.
Does concurrent cavotricuspid isthmus ablation reduce the recurrence of atrial arrhythmia in patients with atrial fibrillation and typical atrial flutter undergoing cryoballoon ablation?
Cohort (n=1,907)
Yes
Does concurrent cavotricuspid isthmus ablation reduce the recurrence of atrial arrhythmia in patients with atrial fibrillation and typical atrial flutter undergoing cryoballoon ablation?
Hazard Ratio: 0.704 (95% CI 0.548–0.906)
Absolute Event Rate: 19.7% vs 29.9%
p-value: p=0.006
In patients undergoing cryoballoon ablation for atrial fibrillation, the presence of concurrent typical atrial flutter treated with cavotricuspid isthmus ablation is associated with a significantly lower risk of long-term atrial arrhythmia recurrence.
May support concurrent CTI ablation in AF with flutter; leaves open causal benefit pending randomized confirmation.
Typical atrial flutter commonly occurs in patients with atrial fibrillation (AF). Limited information exists regarding the effects of concurrent atrial flutter on the long-term outcomes of rhythm control. This study investigated the association between concurrent typical atrial flutter and cavotricuspid isthmus (CTI) ablation and the recurrence of atrial arrhythmia. The data were obtained from a multicenter registry of cryoballoon ablation for AF ( n = 2,689). Patients who were screened for typical atrial flutter were included in the analysis ( n = 1,907). All the patients with typical atrial flutter underwent CTI ablation. The primary endpoint was the late recurrence of atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia. Among the 1,907 patients, typical atrial flutter was detected in 493 patients (25.9%). Patients with concurrent atrial flutter had a lower incidence of persistent AF and a smaller size of the left atrium. Patients with atrial flutter had a significantly lower recurrence rate of atrial arrhythmia (19.7% vs. 29.9%, p < 0.001). In patients with atrial flutter, the recurrence rate of atrial tachycardia or atrial flutter was more frequent (7.3% vs. 4.7%, p = 0.028), but the recurrence rate of AF was significantly lower (17.0% vs. 29.4%, p < 0.001). Atrial flutter has been identified as an independent predictor of the primary endpoint (adjusted hazard ratio, 0.704; 95% confidence interval, 0.548–0.906; p = 0.006). Typical atrial flutter in patients with AF may serve as a positive marker of the recurrence of atrial arrhythmia, and performing CTI ablation in this population is associated with a reduced likelihood of AF recurrence. Performing routine screening and ablation procedures for coexisting atrial flutter may improve the clinical outcomes of AF.
No takes yet. Share an insight, caveat, or question.
Jeong et al. (2023) conducted a cohort in Drug-refractory atrial fibrillation (n=1,907). Concurrent typical atrial flutter and cavotricuspid isthmus ablation vs. No concurrent atrial flutter (pulmonary vein isolation only) was evaluated on Late recurrence of atrial arrhythmia (including AF, atrial flutter, and atrial tachycardia) 90 days after the blanking period (HR 0.704, 95% CI 0.548-0.906, p=0.006). Concurrent typical atrial flutter and cavotricuspid isthmus ablation was associated with a significantly lower risk of late atrial arrhythmia recurrence (adjusted HR 0.704) compared to patients without atrial flutter.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: