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Catheter ablation for atypical atrial flutter: characterization and recurrence predictors
Session:
Posters (Sessão 2 - Écran 1) - Arritmias - miscelânea
Speaker:
M. Inês Barradas
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.7 Arrhythmias, General – Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
M. Inês Barradas; Paulo Fonseca; João Almeida; Marco Oliveira; Helena Gonçalves; João Primo; Anabela Tavares; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white">Introduction: </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Atypical atrial flutter (AFLA) is a macro-reentrant atrial tachycardia not using the cavotricuspid isthmus<span style="background-color:white">. Due to recent innovations in technology, catheter ablation has emerged as the most viable option to treat AFLA. Data related to electrophysiologic characteristics and predictor prognostic factors is limited.</span></span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white">Methods: We performed a retrospective single-center review of all consecutive patients treated for AFLA ablation in our center from October 2008 to July 2022. </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">All patients underwent radiofrequency ablation with a 3D mapping system.</span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white">Our study aimed to analyze long-term outcomes after catheter ablation and to identify predictors for atrial arrhythmia (AA) recurrence (documented atrial fibrillation (AF), atrial tachycardia, or atrial flutter).</span></span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white">Results: From 64 patients (mean age 61.0 </span></span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212529"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white"> 11.28 years, 60.9% male and mean follow-up period (FUP) </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">58.5 </span></span><span style="font-size:11pt"><span style="font-family:Symbol">±</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> 47.79 months) <span style="color:black">32 (50.0%) had history of previous catheter ablation</span><span style="color:#212529"><span style="background-color:white"> (</span></span><span style="color:black">35.9% PVI</span><span style="color:#212529"><span style="background-color:white">), </span></span><span style="color:black">14 (21.9%) previous cardiac surgery</span><span style="color:#212529"><span style="background-color:white"> and </span></span><span style="color:black">18 (28.1%) corresponded to AFLA not related to ablation or previous cardiac surgery.</span><span style="color:#212529"><span style="background-color:white"> Most patients (79.7%) had paroxysmal AFLA, 50% concomitant AF, 50% were on anthyarrhytmic drugs (AAD) and 35.9% underwent previous electrical cardioversion (ECV). Mean left ventricular ejection fraction was 55.1 </span></span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212529"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white"> 10.44%, 25 (39.1%) patients had moderate to severe left atrial (LA) dilatation </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">and<span style="color:#212529"><span style="background-color:white"> 11 (17.2%) right atrial (RA) dilatation. Low-voltage areas (LVA) were identified in 38 (59.4%) patients. A total of 81 AFLA were present or induced (1.3 </span></span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212529"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white"> 0.74 AFLA per patient) and in 7 (10.9%) patients an atrial arrhythmia was not induced. The LA was involved in 70.3% and the RA in 29­.7%. The location of the circuit is described in table 1 as well as ablation details. Acute procedural success was achieved in 87.5%. AA recurrence occurred in 32.8% at 1 year, 35.9% at 2 years and 40.6% at FUP (14.1 </span></span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212529"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white"> 41.41 months after ablation), for which 3.1% had re-ablation (17.0 </span></span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212529"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white"> 23.99 months after index ablation), 5 (7.8%) ECV and 15 (23.4%) maintained or initiated AAD. 10 (15.6%) went to the emergency department (ED) due to AA (mean time since ablation until the first ED visit 31.4 </span></span></span></span><span style="font-size:11pt"><span style="font-family:Symbol"><span style="color:#212529"><span style="background-color:white">±</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white"> 69.07 months). One patient had an ischemic stroke and 6 patients cardiovascular (CV) hospitalization. There were 5 non-CV deaths and there were no CV deaths. </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white">Female gender was an independent predictor of AA recurrence (15 (60.0%) vs 11 (31.4%), hazard ratio (HR): 3.496 [95% CI: 1.761 – 200.000], p=0.046) as well as moderate or severe LA dilatation (</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">14 (51.9%) vs 3 (17.6%), HR 3.257 [95%CI 1.715 – 38.462], p=0.033<span style="color:#212529"><span style="background-color:white">). The presence of fibrosis or the ablation strategy were not associated with recurrence. </span></span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:"Times New Roman",serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#212529"><span style="background-color:white">Conclusion: AFLA most frequently originated in the LA, LVA were frequent, as well as the presence of structural changes and previous ablation or cardiac surgery. In our cohort study, female gender and the severity of LA dilatation were independent predictors of AA recurrence. </span></span></span></span></span></span></span></p>
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