Catheter ablation of cavotricuspid isthmus-dependent atrial flutter achieved an overall acute success rate of 91.1% (95% CI, 89.5-92.4), with a 33.6% occurrence rate of subsequent atrial fibrillation.
Meta-Analysis (n=10,719)
What are the long-term clinical outcomes, including success, recurrence, and incident atrial fibrillation, after catheter ablation of cavotricuspid isthmus-dependent atrial flutter?
Catheter ablation for cavotricuspid isthmus-dependent atrial flutter is highly successful and safe, though post-ablation atrial fibrillation remains common, occurring in roughly one-third of patients.
BACKGROUND: Despite the success of catheter ablation of cavotricuspid isthmus-dependent atrial flutter (AFL), important postablation outcomes are ill-defined. The purpose of our study was to analyze long-term outcomes after catheter ablation of cavotricuspid isthmus-dependent AFL. METHODS AND RESULTS: A meta-analysis was performed of articles reporting clinical outcomes after catheter ablation of AFL published between January 1988 and July 2008. The analysis included 158 studies comprising 10 719 patients (79% men, 59.8+/-0.5 years old, 46% left atrial enlargement, 46% heart disease, 42% with history of atrial fibrillation, 14.3+/-0.4 months of follow-up). The overall acute success rate adjusted for reporting bias was 91.1% (95% CI, 89.5 to 92.4), 92.7% (95% CI, 90.0 to 94.8) for 8- to 10-mm tip/or irrigated radiofrequency catheters, and 87.9% (95% CI, 84.2 to 90.9) for 4- to 6-mm tip catheters (P>0.05). Atrial flutter recurrence rates were significantly reduced by use of 8- to 10-mm tip or irrigated radiofrequency catheters (6.7% versus 13.8%, P<0.05) and by use of bidirectional cavotricuspid isthmus block as a procedural end point (9.3% versus 23.6%, P<0.05). The AFL recurrence rate did not increase over time. The overall occurrence rate of atrial fibrillation after AFL ablation was 33.6% (95% CI, 29.7 to 37.3) but was 52.7% (95% CI, 47.8 to 57.6) in patients with a history of atrial fibrillation before ablation and 23.1% (95% CI, 17.5 to 29.9) in those without atrial fibrillation before ablation (P<0.05). The incidence of atrial fibrillation increased over time in both groups; however, 5 years after ablation, the incidence of atrial fibrillation was similar in those with and without atrial fibrillation before ablation. The acute complication rate was 2.6% (95% CI, 2 to 3). The mortality rate during follow-up was 3.3% (95% CI, 2.4 to 4.5). Antiarrhythmic drug use after ablation was 31.6% (95% CI, 25.6 to 37.8). The long-term use of coumadin was 65.9%, (95% CI, 43.8 to 82.8). Quality of life data were very limited. CONCLUSIONS: AFL ablation is safe and effective. Ablation technology and procedural end points have greater influences on AFL recurrences than on acute ablation success rates. Atrial fibrillation is common after AFL ablation. Almost one third of patients take antiarrhythmic drugs after AFL ablation. Atrial fibrillation before AFL ablation may indicate a more advanced state of electric disease.
Pérez et al. (2009) conducted a meta-analysis in Cavotricuspid isthmus-dependent atrial flutter (n=10,719). Catheter ablation was evaluated on Overall acute success rate adjusted for reporting bias (95% CI 89.5 to 92.4). Catheter ablation of cavotricuspid isthmus-dependent atrial flutter achieved an overall acute success rate of 91.1% (95% CI, 89.5-92.4), with a 33.6% occurrence rate of subsequent atrial fibrillation.