Anticoagulation after typical atrial flutter ablation: Systematic review and meta-analysis

Area of Science:

• Cardiology
• Electrophysiology
• Evidence Synthesis

Background:

• Cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL) is highly effective in restoring sinus rhythm.
• Successful AFL ablation may lead to discontinuation of oral anticoagulation (OA).
• The necessity of OA post-ablation for preventing thromboembolic events (TE) requires systematic evaluation.

Purpose of the Study:

• To systematically review the clinical impact of OA on TE incidence after typical AFL ablation.
• To assess the association between OA and TE events in patients undergoing AFL ablation.

Main Methods:

• A systematic search of controlled studies was conducted in MEDLINE, CENTRAL, and PsycINFO databases up to June 2021.
• A meta-analysis of TE events (ischemic stroke or systemic embolism) was performed.
• Evidence quality was assessed using the GRADE framework.

Main Results:

• Eight observational studies with 4870 patients were included.
• OA did not significantly reduce TE events (RR 1.18, 95% CI 0.59-2.36; GRADE very low).
• OA was associated with lower all-cause mortality (RR 0.24, 95% CI 0.17-0.32; GRADE low) but not significantly different bleeding events (RR 2.16, 95% CI 0.43-10.97; GRADE low).

Conclusions:

• Current evidence regarding OA's role in preventing TE after typical AFL ablation lacks robustness.
• The data does not definitively link OA use post-ablation with reduced TE.
• Further high-quality research is needed to clarify the benefits and risks of OA in this patient population.