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Prospective Evaluation of a Standardized Screening for Atrial Fibrillation after Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

Philipp Krisai, Laurent Roten, Ivan Zeljkovic, Nikola Pavlovic, Peter Ammann, Tobias Reichlin, Eric Auf Der Maur, Olivia Streicher, Sven Knecht, Michael Kühne, Stefan Osswald, Jan Novak & Christian Sticherling

abstract

AIMS
We aimed to prospectively investigate the effectiveness of a standardized follow-up for AF-detection after common atrial flutter (cAFL) ablation.

METHODS
A total of 309 patients after cAFL ablation without known AF, from 5 centers, and at least one completed, standardized follow-up at 3, 6 and 12 months, including a 24 h Holter-electrocardiogram (ECG), were included. The primary outcome was incident atrial fibrillation (AF), or atrial tachycardia (AT). Predictors were investigated by Cox proportional-hazards models.

RESULTS
The mean age was 67.9 years; 15.2% were female and the mean CHADS-VASc (Congestive heart failure, Hypertension, Age, Diabetes, Stroke, Vascular disease, Sex category) score was 2.4 points. The great majority of patients (90.3%) were anticoagulated. Over a mean follow-up of 12.2 months with a standardized approach, AF/AT was detected in 73 patients, corresponding to 11.7% at 3 months, 18.4% at 6 months and 28.2% at 12 months of follow-up. AF was found in 64 patients, AT in 9 and both in 2 patients. Occurrence of AF was recorded in 40 (60.6%) patients by Holter-ECG and in the remaining 26 (39.4%) by clinical follow-up only. There was no difference in male versus female ( = 0.08), or in younger versus older patients ( = 0.96) for AF/AT detection. Only coronary artery disease (hazard ratio [95% confidence intervals] 1.03 [1.01-1.05], = 0.01) was associated with the primary outcome.

CONCLUSIONS
AF or AT was detected in a large proportion of cAFL patients after cavotricuspid-isthmus (CTI) ablation, using a standardized follow-up over 1 year. This standardized screening can be easily implemented with high patient acceptance. The high proportion of post-ablation AF needs to be taken into consideration when deciding on long-term oral anticoagulation.
   
citation Krisai P, Roten L, Zeljkovic I, Pavlovic N, Ammann P, Reichlin T, Auf Der Maur E, Streicher O, Knecht S, Kühne M, Osswald S, Novak J, Sticherling C. Prospective Evaluation of a Standardized Screening for Atrial Fibrillation after Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter. J Clin Med 2021; 10:.
   
type journal paper/review (English)
date of publishing 28-09-2021
journal title J Clin Med (10/19)
ISSN print 2077-0383
PubMed 34640470
DOI 10.3390/jcm10194453