Association of Typical Atrial Flutter and Cavotricuspid Isthmus Ablation on Clinical Recurrence after Cryoballoon Ablation for Atrial Fibrillation

초록

Introduction | Objectives: Typical atrial flutter commonly coexists in patient with atrial fibrillation (AF). Less is established about the effect of concurrent atrial flutter on long-term outcomes of rhythm control. This study investigated the association of concurrent typical atrial flutter and cavotricuspid isthmus (CTI) ablation on recurrence of atrial arrhythmia. Methods: Data was obtained from a multicenter registry of cryoballoon ablation for AF (n = 2689). Patients who were screened of typical atrial flutter were included for analysis (n = 1907). All patients detected with typical atrial flutter received CTI ablation. Primary endpoint was the late recurrence of atrial arrhythmia including AF, atrial flutter, and atrial tachycardia. Results: Among 1907 patients, typical atrial flutter was detected in 493 patients (25.9%). Patients with concurrent atrial flutter had lower proportion of persistent AF and had smaller left atrium. Patients with atrial flutter resulted significantly lower recurrence of atrial arrhythmia (19.7 vs. 29.9%, p < .001). In patients with atrial flutter, recurrence of atrial tachycardia or atrial flutter was more frequent (7.3 vs. 4.7%, p = .028), but recurrence of AF was significantly lower (17.0 vs. 29.4%, p < .001). Presence of 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 = .006). Conclusions: In patients with AF, presence of typical atrial flutter is a favorable marker for atrial arrhythmia recurrence, and CTI ablation in this population is associated with lower recurrence of AF. Routine screening and ablation for coexisting atrial flutter may improve clinical outcome of AF.