What is the clinical evidence from this study?

Study design: Cohort. Population: Pulmonary hypertension and atrial flutter (n=68). Intervention: Radiofrequency catheter ablation. Primary outcome: Recurrent atrial flutter (associated with RAVi per 10 ml/m2) (HR 1.064, 95% CI 1.011-1.120, p=0.018).

October 14, 2024Open Access

The impact of right atrial volume on ablation outcomes in patients with pulmonary hypertension and atrial flutter

LDLei DingXijing Hospital HZHongda ZhangChinese Academy of Medical Sciences & Peking Union Medical College CDCong DaiFirst Hospital of China Medical University

Key Result

In patients with pulmonary hypertension, an increased right atrial volume index was independently associated with recurrent atrial flutter after catheter ablation (HR 1.064 per 10 ml/m2).

Study Design

Type

Cohort (n=68)

Multicenter

Structured PICO

What are the recurrence rate and risk factors for recurrent atrial flutter in patients with pulmonary hypertension after catheter ablation?

Population

68 patients with pulmonary hypertension (mean age 44.0 ± 13.0 years, 36.8% male) who underwent atrial flutter ablation at a single center in China. 63.2% had congenital heart disease-associated PH and 30.9% had idiopathic PAH.

Intervention

Radiofrequency catheter ablation for atrial flutter

Outcome

Recurrence of atrial flutter (symptomatic or asymptomatic ECG-documented AFL with a stable TCL longer than 30s) at median 17.5 months follow-uphard clinical

In patients with pulmonary hypertension undergoing catheter ablation for atrial flutter, immediate ablation success and lower right atrial volume index (<166.64 ml/m2) are associated with improved long-term freedom from recurrent atrial flutter.

Main Result

Effect estimate: HR 1.064 (95% CI 1.011-1.120)

p-value: p=0.018

Limitations

Single-center study with a relatively small number of patients
Bidirectional conduction block was not systematically checked in cases of non-CTI-related AFL
Unable to find significant differences between specific types of PH as predictive factors of recurrence due to population heterogeneity and size

Abstract

Catheter ablation has evolved as a safe treatment for atrial flutter (AFL) in patients with pulmonary hypertension (PH), and the recurrence of AFL may accelerate clinical decompensation. The aim of this study was to determine the recurrence rate and risk factors for recurrent AFL in PH patients after ablation. All PH patients who underwent AFL ablation at Fuwai Hospital between May 2015 and December 2020 were followed up. The recurrence rate and risk factors for recurrence were analyzed. A total of 68 PH patients (mean age 44.0 ± 13.0 years, 36.8% male) were enrolled. The majority patients diagnosed PH had congenital heart disease-associated PH (63.2%), and 30.9% had idiopathic pulmonary arterial hypertension. At baseline, most patients (80.9%) had only cavotricuspid isthmus (CTI)-related AFL; the occurrence of non-CTI-related AFL among patients was 8.8%, and 10.3% of the patients had both types of AFL. During a median follow-up of 17.5 months, 22 patients developed at least one recurrent AFL episode (AFL-free survival: 76.5% at 1 year). The immediate success of ablation (HR 0.061, 95% CI 0.009 to 0.438; P = 0.005) and the right atrial volume index (RAVi, per 10 ml/m2; HR 1.064, 95% CI 1.011 to 1.120; P = 0.018) were associated with long-term ablation outcomes in PH patients. With 166.64 ml/m2 as a cutoff value, AFL-free survival was significantly greater in patients whose RAVi was < 166.64 ml/m2 (log-rank P = 0.024). The immediate success of ablation and the RAVi are associated with recurrent AFL. Patients with a RAVi ≥ 166.64 ml/m2 are likely experience recurrence.

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