Mikkel Giehm-Reese1, Mads Brix Kronborg2, Peter Lukac2, Steen Buus Kristiansen2, Jan Møller Nielsen2, Arne Johannessen3, Peter Karl Jacobsen4, Mogens Stig Djurhuus5, Sam Riahi6, Peter Steen Hansen7, Jens Cosedis Nielsen2. 1. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. Electronic address: mikkelgr@clin.au.dk. 2. Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark. 3. Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark. 4. Department of Cardiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark. 5. Department of Cardiology-B, Odense University Hospital, Odense, Denmark. 6. Department of Cardiology and AF study group, Aalborg University Hospital, Aalborg, Denmark. 7. Department of Cardiology, Mølholm Private Hospital, Vejle, Denmark.
Abstract
BACKGROUND: Cavo tricuspid isthmus ablation (CTIA) is considered an effective first-line treatment for typical atrial flutter (AFL). However, many patients develop atrial fibrillation (AF) after successful CTIA. Knowledge about recurrent arrhythmia after CTIA mainly comes from small cohort studies with limited follow-up. OBJECTIVE: To describe incidences of re-ablation for AFL and ablation for AF after first-time CTIA in a nation-wide cohort. METHODS: In the Danish National Ablation Registry we identified patients undergoing first-time CTIA during 2010-2016. Subsequent CTIA and AF-ablation procedures were identified until March 1st, 2018. We collected information on patient comorbidities in the Danish National Patient Registry. RESULTS: We identified 2409 patients undergoing first-time CTIA. Median age was 66 (IQR 58-72) years, 1952 (81%) were men, and 78 (3%) patients had a history of previous ablation for AF. Acute procedural success was achieved in 2288 (95%) patients. During mean follow-up of 4.0 ± 1.7 years, 242 (10%) patients underwent CTI re-ablation and 326 (13.5%) underwent ablation for AF. Baseline characteristics associated with CTI re-ablation included prolonged procedural time, unsuccessful index CTIA, age <75 years and CHA2DS2-VASc score <2. Hypertension, history of AF-ablation, age <65 years use of a contact force sensing catheter and CHA2DS2-VASc score <2 were associated with later ablation for AF. CONCLUSION: In a nation-wide cohort undergoing first-time CTIA for AFL, 10% of patients underwent CTI re-ablation and 13.5% ablation for AF during mean follow-up of 4.0 ± 1.7 years. Probability of a second procedure was higher in younger patients with less comorbidities.
BACKGROUND: Cavo tricuspid isthmus ablation (CTIA) is considered an effective first-line treatment for typical atrial flutter (AFL). However, many patients develop atrial fibrillation (AF) after successful CTIA. Knowledge about recurrent arrhythmia after CTIA mainly comes from small cohort studies with limited follow-up. OBJECTIVE: To describe incidences of re-ablation for AFL and ablation for AF after first-time CTIA in a nation-wide cohort. METHODS: In the Danish National Ablation Registry we identified patients undergoing first-time CTIA during 2010-2016. Subsequent CTIA and AF-ablation procedures were identified until March 1st, 2018. We collected information on patient comorbidities in the Danish National Patient Registry. RESULTS: We identified 2409 patients undergoing first-time CTIA. Median age was 66 (IQR 58-72) years, 1952 (81%) were men, and 78 (3%) patients had a history of previous ablation for AF. Acute procedural success was achieved in 2288 (95%) patients. During mean follow-up of 4.0 ± 1.7 years, 242 (10%) patients underwent CTI re-ablation and 326 (13.5%) underwent ablation for AF. Baseline characteristics associated with CTI re-ablation included prolonged procedural time, unsuccessful index CTIA, age <75 years and CHA2DS2-VASc score <2. Hypertension, history of AF-ablation, age <65 years use of a contact force sensing catheter and CHA2DS2-VASc score <2 were associated with later ablation for AF. CONCLUSION: In a nation-wide cohort undergoing first-time CTIA for AFL, 10% of patients underwent CTI re-ablation and 13.5% ablation for AF during mean follow-up of 4.0 ± 1.7 years. Probability of a second procedure was higher in younger patients with less comorbidities.
Authors: Matthew K Rowe; Andrew Claughton; Jason Davis; Lauren Yee; Gerald C Kaye; Kieran Dauber; John Hill; Paul A Gould Journal: J Arrhythm Date: 2021-12-09