Prophylactic pulmonary vein isolation in patients with typical atrial flutter and heart failure

Heart failure (HF) readmission rates remain a concern in patients with typical atrial flutter (AFL) and HF, even after cavotricuspid isthmus (CTI) ablation.

This study aimed to explore whether additional prophylactic circumferential pulmonary vein isolation (CPVI) could improve hard outcomes among patients with AFL and HF.

In this prospective, nonrandomized, controlled study, patients with AFL and HF were consecutively enrolled from 9 centers. Patients received either CTI ablation + CPVI (CTI + CPVI group, n = 42) or CTI ablation alone (CTI-alone group, n = 39). The primary endpoint was a composite of death from any cause or hospitalization for worsening HF.

Baseline characteristics were balanced between the 2 groups. During a mean follow-up of 40.2 ± 12.9 months, the primary endpoint occurred in fewer patients in the CTI + CPVI group than in the CTI-alone group (13 patients [31.0%] vs 22 patients [56.1%]; adjusted hazard ratio 0.37; 95% confidence interval 0.17-0.82; P = .014). Fewer patients in the CTI + CPVI group were hospitalized for worsening HF (11 patients [26.2%] vs 19 patients [48.7%]; adjusted hazard ratio 0.40; 95% confidence interval 0.17-0.94; P = .037).

In this prospective, nonrandomized, controlled study of patients with AFL and HF, prophylactic CPVI was associated with a significantly lower rate of a composite of death from any cause or hospitalization for worsening HF than CTI ablation alone. However, randomized trial verification is required.