SPC365

Anticoagulation after cavotricuspid isthmus-dependent atrial flutter ablation: essential or overused?

Session: SESSÃO DE POSTERS 29 - FIBRILHAÇÃO AURICULAR: DA PREVENÇÃO À INTERVENÇÃO
Speaker: Helena Sofia Santos Moreira

Congress: CPC 2025
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type: Cartazes
FP Number: ---
Authors: Helena Sofia Santos Moreira; Pedro Mangas Palma; Miguel Rocha; Ana Isabel Pinho; Luís Santos; Cátia Oliveira; Rui André Rodrigues; Ana Lebreiro

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Introduction:</strong> Catheter ablation is the standard treatment for cavotricuspid isthmus-dependent atrial flutter (AFL), however, the benefit of long-term anticoagulation post-AFL ablation, particularly in low thromboembolic risk patients (pts), remains uncertain. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Purpose:</strong> To describe the thromboembolic risk and anticoagulation status in pts post-AFL catheter ablation and their association with relevant clinical outcomes. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Methods:</strong> Retrospective single-center analysis of pts who underwent first-time typical </span><span style="font-size:11.0pt">AFL radiofrequency ablation between 2017 and 2024. Data was based on medical records review. The primary composite endpoint included all-cause mortality, cardiovascular hospitalizations, major bleeding or ischemic events. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Results: </strong>A total of 187 pts were included, mostly male (n=136, 72.7%) with a mean age of 64&plusmn;13 pts. Cardiovascular risk factors were predominant: most pts had arterial hypertension (n=101, 54%) and more than one-fourth had diabetes mellitus (n=53, 28.3%). Nearly half had structural heart disease (n=75, 41.1%; p=0.55), with congenital heart disease as the most common diagnosis (n=26, 37.7%). Regarding other comorbidities, 4.3% (n=8) had advanced chronic kidney disease and 10.2% (n=19) had an history of malignancies. Only one case of acute unsuccessful ablation was reported, and no major peri-procedural complications occurred. Mean CHA<sub>2</sub>DS<sub>2</sub>-VA score at discharge was 2&plusmn;1 points: 26.7% (n=50) with 0 points, 19.3% (n=36) with 1 point and 59.4% (n=101) with &ge; 2 points. All pts were discharged on anticoagulation regardless of CHA<sub>2</sub>DS<sub>2</sub>-VA score, 92.5% (n=173) with direct oral anticoagulants.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">At the time of first clinical revaluation, anticoagulation was only discontinued in 8.6% (n=16), 8&plusmn;6 months post-ablation, with clinicians&rsquo; decision to suspend anticoagulation solely driven by evidence of sinus rhythm (in standard 12-lead electrocardiogram) and a CHA<sub>2</sub>DS<sub>2</sub>-VA score of 0 points in all pts. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">At mean follow-up of 27&plusmn;22 months, the primary endpoint occurred in 11% (n=20), similarly across all CHA<sub>2</sub>DS<sub>2</sub>-VA scores (p=0.53).&nbsp;&nbsp;</span></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">Notably, there were no significant differences between anticoagulation status regarding the primary outcome (p=0.26) or the time to its occurrence (log-rank 0.92) - Figure 1 (group A: discontinued anticoagulation; group B: on anticoagulation). </span></span></span><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt">Analysing individual components, similar results were observed, including ischemic (n=1, 1.1%; p=0.83) and bleeding events (n=5, 2.7%; p=0.06).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><span style="font-size:11.0pt"><strong>Conclusion:</strong> In our cohort only a slight proportion of pts discontinued anticoagulation post-AFL ablation, however,&nbsp;CHA<sub>2</sub>DS<sub>2</sub>-VA score and anticoagulation status after typical AFL ablation did not significantly impact clinical outcomes. These findings suggest that current risk stratification tools and the benefit of long-term anticoagulation in this population may benefit from further evaluation and refinement.</span></span></span></p>