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Long-term mortality and cardiovascular outcomes in patients with atrial flutter after catheter ablation

Dony Yugo1,2, Yun Yu Chen1,3, Yenn Jiang Lin1,4

  • 1Heart Rhythm Center, Taipei Veterans General Hospital, Taipei, Taiwa.

Europace : European Pacing, Arrhythmias, and Cardiac Electrophysiology : Journal of the Working Groups on Cardiac Pacing, Arrhythmias, and Cardiac Cellular Electrophysiology of the European Society of Cardiology
|December 23, 2021
PubMed

Insights

Catheter ablation for atrial flutter (AFL) in patients without prior atrial fibrillation (AF) significantly reduces long-term mortality and cardiovascular events compared to medical therapy alone.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Interventions

Background:

  • Long-term cardiovascular outcomes after catheter ablation for atrial flutter (AFL) without a history of atrial fibrillation (AF) are not well-established.
  • Previous studies have not comprehensively compared catheter ablation to medical therapy for AFL in this specific patient population.

Purpose of the Study:

  • To compare the long-term all-cause mortality and cardiovascular outcomes in patients with AFL undergoing catheter ablation versus those receiving medical therapy.
  • To evaluate the effectiveness of catheter ablation in reducing major adverse cardiovascular events in AFL patients without prior AF.

Main Methods:

  • A retrospective study using the Health Insurance Database identified patients with typical AFL who underwent catheter ablation.
  • Propensity score matching was used to create a comparable control group of AFL patients who did not undergo ablation, excluding those with prior AF diagnosis.
  • Multivariable Cox regression analysis assessed hazard ratios for all-cause mortality, cardiovascular death, heart failure hospitalization, and stroke over a mean follow-up of approximately 8 years.

Main Results:

  • The study included 3784 patients (1892 per group) with a mean follow-up of over 7.8 years.
  • Catheter ablation for AFL was associated with a significantly lower risk of all-cause mortality (HR: 0.68, P < 0.001).
  • Ablation also reduced risks of cardiovascular deaths (HR: 0.78, P = 0.001), heart failure hospitalizations (HR: 0.84, P = 0.01), and stroke (HR: 0.80, P = 0.01).

Conclusions:

  • Catheter ablation for typical and atypical atrial flutter in patients without a history of atrial fibrillation is associated with improved long-term cardiovascular outcomes.
  • These findings support catheter ablation as a superior treatment strategy compared to medical therapy for reducing mortality and major adverse cardiovascular events in this patient cohort.
Abstract

Keywords:
AblationAtrial fibrillationAtrial flutterCardiovascular outcome

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