Key result
Implantable loop recorders detect new-onset AF in ~77% of patients after flutter ablation.
Why the study?
Although cavotricuspid isthmus ablation effectively prevents atrial flutter recurrence, atrial fibrillation may occur during follow-up, and its exact incidence, duration, timely occurrence, and associated symptoms remained to be defined.
Cohort (n=100)
Yes
Continuous cardiac monitoring reveals a high incidence (77%) of predominantly asymptomatic atrial fibrillation after typical atrial flutter ablation, suggesting a need for careful evaluation of anticoagulation strategies in this population.
High AF detection after flutter ablation may prompt anticoagulation review; extends intermittent monitoring data with continuous ILR quantification.
AIMS: In patients with atrial flutter (AFL), ablation of the cavotricuspid isthmus (CTI) is a highly effective procedure to prevent AFL recurrence, but atrial fibrillation (AF) may occur during follow-up. The presented FLUTFIB study was designed to identify the exact incidence, duration, timely occurrence, and associated symptoms of AF after CTI ablation using continuous cardiac monitoring via implantable loop recorders. METHODS AND RESULTS: One hundred patients with AFL without prior AF diagnosis were included after CTI ablation (mean age 69.7 ± 9.7 years, 18% female) and received an implantable loop recorder for AF detection. After a median follow-up of 24 months 77 patients (77%) were diagnosed with AF episodes. Median time to first AF occurrence was 180 (43-298) days. Episodes lasted longer than 1 h in most patients (45/77, 58%). Forty patients (52%) had AF-associated symptoms.Patients with and without AF development showed similar baseline characteristics and neither HATCH- nor CHA2DS2-VASc scores were predictive of future AF episodes. Oral anticoagulation (OAC) was stopped during FU in 32 patients (32%) and was re-initiated after AF detection in 15 patients (15%). No strokes or transient ischaemic attack episodes were observed during follow-up. CONCLUSION: This study represents the largest investigation using implantable loop recorders (ILRs) to detect AF after AFL ablation and shows a high incidence of AF episodes, most of them being asymptomatic and lasting longer than 1 h. In anticipation of trials determining the duration of AF episodes that should trigger OAC initiation, these results will help to guide anticoagulation management after CTI ablation.
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Attanasio et al. (2024) conducted a cohort in Atrial flutter without prior documented atrial fibrillation (n=100). Cavotricuspid isthmus ablation with continuous implantable loop recorder monitoring was evaluated on Atrial fibrillation lasting longer than 30 seconds. Continuous cardiac monitoring via implantable loop recorders detected new-onset atrial fibrillation in 77% of patients during a median 24-month follow-up after cavotricuspid isthmus ablation for typical atrial flutter.
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