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Development of Atrial Fibrillation after Cavotricuspid Isthmus-Dependent Atrial Flutter ablation: analysis of incidence and risk factors in a portuguese tertiary care center.
Session:
SESSÃO DE POSTERS 29 - FIBRILHAÇÃO AURICULAR: DA PREVENÇÃO À INTERVENÇÃO
Speaker:
Maria João Primo
Congress:
CPC 2025
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.8 Atrial Fibrillation - Clinical
Session Type:
Cartazes
FP Number:
---
Authors:
Maria João Primo; Natália António; Carolina Saleiro; Pedro Sousa; Inês Brito e Cruz; Rita Bertão Ventura; Didier Martinez; Luís Elvas; Lino Gonçalves
Abstract
<p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong><br /> Cavotricuspid isthmus (CTI) ablation is a highly successful procedure for the treatment of typical atrial flutter (AFL). However, these patients have a high incidence of new onset atrial fibrillation (AF) post-ablation. This study aims to evaluate the incidence, timing and predictors of AF development following successful ICT ablation. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong><br /> We conducted a retrospective cohort study involving patients who underwent successful catheter ablation for typical AFL at a tertiary hospital, between January 2019 and December 2023. Patients with prior history of AF or incomplete follow-up information were excluded. Only patients with a minimum follow up period of 12 months after FLA ablation were included in the study. Baseline characteristics, procedural details, and follow-up outcomes were collected from electronic health records. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The primary outcome was the development of new-onset AF, assessed through routine follow-up visits and ECG and 24-hours Holter monitoring. Secondary endpoints were determining the predictors of AF development post ICT ablation. Non-parametric statistical tests, as well as logistic regression were used to estimate AF incidence and to try to identify associated risk factors.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong><br /> Overall, 121 patients were included, with a mean age of 65.0 ± 10.6 years, the majority being male (85.1%). Persistent typical AFL was documented in 68% of patients, while 25.6% had records of paroxysmal AFL. Three-dimensional electroanatomical mapping systems were used in only 24% of the procedures and all CTI ablations employed radiofrequency energy. During follow up, 14 patients (11.6%) developed atrial fibrillation. The median time to AF onset was approximately 18 months post-ablation (interquartile range: 6–50 months). Eleven of these patients developed paroxysmal AF and 3 of them showed persistent AF.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Univariate analysis of comorbidities showed an association between hypertension (x²(1)=6,927, p=0.013) and dyslipidaemia (x²(1)=9,185, p=0.003) and the development of AF post FLA ablation. However, adjusting for confounders, logistic regression did not identify significant independent predictors of AF development.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong><br /> Despite successful ablation of typical AFL, a significant proportion of patients develop AF. AFL patients with hypertension and dyslipidaemia should benefit from a closer follow up for early detection of AF. However, further investigation is needed to determine significant risk factors that influence AF development. </span></span></p>
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