Catheter ablation of atrial flutter in patients with severe pulmonary arterial hypertension achieved an 86% acute success rate and significantly reduced systolic pulmonary artery pressure (P=0.004).
Observational (n=12)
Does catheter ablation of atrial flutter improve outcomes and hemodynamics in patients with severe pulmonary arterial hypertension?
Catheter ablation of atrial flutter in patients with severe pulmonary arterial hypertension is feasible and associated with significant reductions in pulmonary pressures and BNP, though overall 1-year mortality in this population remains high.
BACKGROUND: Radiofrequency ablation is first-line therapy for atrial flutter (AFL). There are no studies of ablation in patients with severe pulmonary arterial hypertension (PAH). METHODS: Consecutive patients with severe PAH (systolic pulmonary artery pressure >60 mmHg) and AFL referred for ablation were evaluated. Patients with complex congenital heart disease were excluded. RESULTS: A total of 14 AFL ablation procedures were undertaken in 12 patients. A total of 75% of patients were female; mean age 49 ± 12 years. SPAP prior to ablation was 99 ± 35 mmHg. Baseline 6-minute walk distance was 295 ± 118 m. ECG demonstrated a typical AFL pattern in only 42% of cases. Baseline AFL cycle length was longer in PAH patients compared to controls (295 ± 53 ms vs 252 ± 35 ms, P = 0.006). Cavotricuspid isthmus dependence was verified in 86% of cases. Acute success was obtained in 86% of procedures. SPAP decreased from 114 ± 44 mmHg to 82 ± 38 mmHg after ablation (P = 0.004). BNP levels were lower postablation (787 ± 832 pg/mL vs 522 ± 745 pg/mL, P = 0.02). Complications were seen in 14%. A total of 80% (8/10) of patients were free of AFL at 3 months; 75% (6/8) at 1 year. CONCLUSION: Ablation of AFL in severe PAH patients is feasible, with good short- and intermediate-term success rates. The ECG pattern is not a reliable marker of isthmus dependence. The SPAP and BNP levels may decrease postablation. AFL may be a marker of poor outcomes in patients with PAH with a 1-year mortality rate of 42% in this study. This rate is higher than expected in the general PAH population.
Bradfield et al. (Tue,) conducted a observational in Severe pulmonary arterial hypertension and atrial flutter (n=12). Radiofrequency catheter ablation was evaluated on Acute procedural success. Catheter ablation of atrial flutter in patients with severe pulmonary arterial hypertension achieved an 86% acute success rate and significantly reduced systolic pulmonary artery pressure (P=0.004).
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