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Will it be Back? Predicting Recurrence After Left Atrial Flutter Ablation
Session:
SESSÃO DE POSTERS 53 - FIBRILHAÇÃO AURICULAR E ARRITMIAS AURICULARES COMPLEXAS
Speaker:
Daniel Inácio Cazeiro
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
06. Supraventricular Tachycardia (non-AF)
Subtheme:
06.4 Supraventricular Tachycardia (non-AF) - Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Daniel Inácio Cazeiro; Joana Brito; Miguel Azaredo Raposo; Catarina Gregório; Ana Abrantes; Sara Neto; Afonso Nunes Ferreira; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez-Dias; Fausto J. Pinto; João de Sousa
Abstract
<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Introduction:</strong></span></span><br /> <span style="font-size:11pt"><span style="color:#000000">In recent years, catheter ablation has become a promising treatment for patients with atypical atrial flutter (AFl), driven by advancements in technology and a deeper understanding of arrhythmia mechanisms. However, its long-term effectiveness and the factors predicting recurrence remain inadequately understood.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Purpose:</strong></span></span><br /> <span style="font-size:11pt"><span style="color:#000000">To evaluate the efficacy of atypical AFl ablation and identify predictors of recurrence.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Methods:</strong></span></span><br /> <span style="font-size:11pt"><span style="color:#000000">We conducted a single-center, retrospective study of consecutive patients who underwent left atrium AFl ablation. A systematic, predefined high-resolution mapping workflow was employed to characterize the mechanism of the arrhythmia and guide the ablation strategy. Clinical, echocardiographic, and AFl substrate and mapping characteristics were evaluated as risk factors for atrial arrhythmic relapse during follow-up, assessed using Cox regression and Kaplan-Meier survival analysis.</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Results:</strong></span></span><br /> <span style="font-size:11pt"><span style="color:#000000">From 2015 to 2024, 128 patients were included (mean age: 68 years, 58% male). Fifty-two percent had undergone previous pulmonary vein isolation, and previous left atrial linear ablation had been performed in 16%. Overall acute success was high, with 92% conversion to sinus rhythm after the first ablation set. However, AFl recurrence was 24% and 49% at 1 and 3 years, respectively. The only two predictors of arrhythmic relapse on univariate analysis were left ventricular ejection fraction (LVEF) <40% (HR 2.191, 95% CI: 1.124–3.870, p=0.007) and the presence of atrial scar outside the AFl shared isthmus (HR 1.997, 95% CI: 1.123-3.550). Strikingly, left atrial volume had no influence on arrhythmic recurrence. We then assessed the incremental impact of having none, one, or both of the identified risk factors. Having one of these criteria increased the risk of relapse (HR 1.259, 95% CI: 0.653-2.427, p=NS) and the presence of both increased the risk by 4-fold (HR 4.395, 95% CI: 2.135-9.049, p<0.001).</span></span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><span style="color:#000000"><strong>Conclusion:</strong></span></span><br /> <span style="font-size:11pt"><span style="color:#000000">Two key risk factors were identified for arrhythmic relapse after AFl ablation: reduced LVEF and the presence of left atrial scar outside the shared isthmus. Interestingly, the risk of atrial arrhythmic relapse increased 4-fold with the presence of both features, while left atrial volume had no impact on recurrences.</span></span></span></p>
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