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Advancements in atypical atrial flutter ablation: Impact of evolving techniques and technologies on outcomes
Session:
SESSÃO DE POSTERS 53 - FIBRILHAÇÃO AURICULAR E ARRITMIAS AURICULARES COMPLEXAS
Speaker:
Maria Rita Lima
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:
Maria Rita Giestas Lima; Ana Rita Bello; Daniel Gomes; Guilherme Flor; Daniel Matos; Gustavo Rodrigues; Pedro Galvão Santos; Francisco Moscoso Costa; Pedro Carmo; Diogo Cavaco; Francisco Bello Morgado; Pedro Adragão
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Introduction</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">Atypical atrial flutter (AFLA) is a macro-reentrant atrial tachycardia commonly associated with atrial fibrillation (AF). While novel technologies, including advanced mapping systems and energy sources, are now available, data comparing their benefits to older systems remain limited. </span></span></span></p> <p style="text-align:justify"><strong><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">Aim</span></span></span></strong></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">To compare peri-procedural differences in AFLA ablation before and after 2020, and AFLA/AF recurrence rate.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Methods</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">Single-centre retrospective study including all consecutive patients who underwent AFLA ablation between 2015-2024. Clinical, echocardiographic and peri-procedural characteristics were collected from clinical records. We divided patients into two groups: pre-2020 (group 1) and post-2020 (group 2). The study endpoints were defined as a composite of AFLA or AF recurrence documented by ECG/24-h Holter.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Results</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">Overall, 108 consecutive patients were included–median age of 66years, 67 (62%) male, mean CHA2DS2-VA score 2±2, and 66% with history of AF ablation. Most patients received anti-arrhythmic drugs pre-ablation: beta-blockers (61%), amiodarone (40%), sotalol (9%), flecainide (7%), and propafenone (6%). 46% of patients underwent ablation before 2020, while 54% underwent it after 2020. </span></span></span> <span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">Concomitant AF ablation rates were comparable between the groups (p=0.422). Group 1 had a higher median fluoroscopy time (11 <em>vs</em> 8min, p<0.001), but the median procedural time did not differ significantly between groups (3±1 <em>vs</em> 2.4±1hrs, p=0.173). Energy application was more frequently performed on the mitral isthmus (46 <em>vs</em> 21%, p=0.005) and roof line (46 <em>vs</em> 28%, p=0.047) in group 1. The use of Lasso and Orion catheters was higher in group 1 (40 <em>vs</em> 7%, p<0.001; 30 <em>vs</em> 7%, p=0.002, respectively), as was the use of the IntellNav and Rhythmia systems (22 <em>vs</em> 3%, p=0.003; 28 <em>vs</em> 5%, p=0.001, respectively). Conversely, the CARTO system (86 <em>vs</em> 60%, p=0.002) was more commonly used in group 2. Acute termination of AFLA during energy applications was more frequent in group 2 (88 <em>vs</em> 64%, p=0.003), while patients in group 1 required electric cardioversion at the end of the procedure more often (36 <em>vs</em> 16%, p=0.014). Recurrence rates of AFLA/AF were higher in group 1 (68 <em>vs</em> 40%, p=0.003).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">In group 1, the only predictor of AFLA/AF recurrence was AFLA inducibility post-ablation (<strong>Figure 1A</strong>). </span></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">In group 2, AFLA inducibility was predictor of AFLA/AF recurrence, while concomitant AF ablation and isolation of pulmonary veins were protectors (<strong>Figure 1A</strong>). In multivariate analysis, only AFLA inducibility was predictor of AFLA/AF recurrence (<strong>Figure 1B</strong>).</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong><span style="font-family:"Times New Roman",serif">Conclusion</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-family:"Times New Roman",serif">This study demonstrates improved procedural success and lower recurrence rates of AFLA/AF in patients undergoing ablation after 2020, likely driven by advancements in technology. AFLA inducibility post-ablation was a key predictor of recurrence, emphasizing the need for effective arrhythmia termination and inducibility at the end of the procedure.</span></span></span></p>
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