SPC365

Predictors of arrhythmic recurrence after typical atrial flutter ablation

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: Pedro Alves Da Silva

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 06. Supraventricular Tachycardia (non-AF)
Subtheme: 06.6 Supraventricular Tachycardia (non-AF) - Clinical
Session Type: Posters
FP Number: ---
Authors: Pedro Alves Da Silva; Tiago Rodrigues; Nelson Cunha; Pedro Silvério António; Sara Couto Pereira; Joana Brito; Beatriz Valente Silva; Catarina Oliveira; Ana Beatriz Garcia; Ana Margarida Martins; Ana Bernardes; Gustavo Silva; Nuno Cortez-Dias; Fausto j. Pinto; João de Sousa

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">: Cavo-tricuspid isthmus ablation (CTA) is the first line treatment for adequate rhythm control in patients (pts) with typical atrial flutter (AFL). However the burden of arrhythmic recurrence after CTA is unknown.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Purpose:</strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"> We aimed to identify predictors of arrhythmic recurrence (AR) after CTA.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Single-center retrospective study of patients (pts) submitted to CTA between 2015 and 2019, comprising three groups: I &ndash; pts with lone AFL; II &ndash; patients with AFL and prior AF submitted to CTA only; and III &ndash; patients with AFL and prior AF submitted to IVP and CTA. Clinical records and Holter and/or 7-day event loop recorder were performed during the follow up, to determine the AR (defined as typical/atypical AFL and atrial fibrillation (AF)). Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using uni- and multivariate Cox regression analyses.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">A total of 476 pts (66&plusmn;12 years, 80% males) underwent CTA: group I &ndash; 284 pts (60%), II &ndash; 109 pts (23%) and III &ndash; 83 pts (17%). Baseline characteristics were similar between groups, except for age with group I pts being older (68&plusmn;12, 67&plusmn;11, 61&plusmn;11, p&lt;0.03).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">Before the CTA ablation, 269 pts (57,6%) were under anti-arrhythmic therapy (AAT), which was suspended in 58 pts before and in 8 pts after AR. During a median follow-up period of 2.8 year, we observed AR of typical AFL in 17 pts (3.6%), atypical AFL in 35 pts (7.4%) and AF in 118 pts (24.8%).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">On our population of study, peripheral arterial disease (PAD, p=0.024), cerebrovascular disease (p=0.049), obstructive sleep apnea (OSA, p=0.009) and thyroid disfunction (p=0.005) were predictors of AR on univariate analysis, being the last two also independent predictors (HR 0.57; 95%CI 0.368-0.882, p=0.012 and HR 0.589; 95%CI 0.380-0.913, p=0.018, respectively). The withdrawn of AAT didn&rsquo;t seem to predict AR (p=NS).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">We did not find predictors of recurrence of typical AFL. Regarding occurrence of atypical AFL, only a higher body mass index (BMI, p=0.005) was a predictor of this arrhythmia (more frequent with BMI between 25 and 30).&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">In group I, PAD (p&lt;0.001), OSA (p=0.03), thyroid disfunction (p=0.038) and a higher CHADs-VASc score (p=0.003) were predictors of AR. On multivariate analysis, only PAD (HR 0.434; 95%CI 0.196-0.964, p=0.04) and OSA (HR 0.46; 95%CI 0.249-0.849, p=0.013) were independent predictors. In patients with AF we did not find predictors of AR.&nbsp;&nbsp;</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">After CTA ablation, AF is the most frequent recurrent arrhythmia, being thyroid disfunction, OSA and PAD predictors of recurrence. The withdrawal&nbsp;of AAT didn&rsquo;t predict the recurrence of arrhythmic events. The decision to stop anticoagulation and arrhythmic therapy must be individualized regarding patients&rsquo; clinical characteristics.</span></span></span></p>

<p>&nbsp;</p>