SPC365

Withdrawal of anti-arrhythmic therapy after cavo-tricuspid isthmus ablation of typical atrial flutter

Session: Posters - C. Arrhythmias and Device Therapy
Speaker: Catarina Oliveira

Congress: CPC 2021
Topic: C. Arrhythmias and Device Therapy
Theme: 06. Supraventricular Tachycardia (non-AF)
Subtheme: 06.4 Supraventricular Tachycardia (non-AF) - Treatment
Session Type: Posters
FP Number: ---
Authors: Catarina Simões De Oliveira; Tiago Rodrigues; Nelson Cunha; Pedro Silvério António; Sara Couto Pereira; Beatriz Valente Silva; Joana Brito; Pedro Alves da Silva; Beatriz Garcia; Ana Margarida Martins; Maria do Céu Barreiros; Gustavo Lima da Silva; Luís Carpinteiro; Nuno Cortez Dias; Fausto j. Pinto; João de Sousa

<p style="text-align:justify"><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif"><strong>Introduction</strong></span></span></span><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif">: Medical management of typical atrial flutter (AFL) is sometimes unsuccessful and may have adverse effects. Symptom control using radiofrequency cavo-tricuspid isthmus ablation (CTA) is a feasable alternative, given the fact that it is a simple procedure with a low rate of complications. However, in some patients (pts), new atrial arrhythmias may develop and the decision of anti-arrhythmic therapy (AAT) withdrawal is usually patient-based.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif"><strong>Purpose:</strong></span></span></span><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif"> To predict the recurrence of atrial arrhythmias (AR) after CTI ablation between pts that suspended AAT and those that maintained AAT.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif"><strong>Methods: </strong></span></span></span><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif">Single-center retrospective study of pts with typical AFL submitted to ablation between 2015 and 2019. Pts clinical characteristics, current and follow up therapy were collected. Holter and/or 7-day event loop recorder were performed during the follow up to identify AR. For statistical analysis, we applied Chi-square, Mann-Whitney and Cox regression to identify predictors of AR.&nbsp;</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif"><strong>Results: </strong></span></span></span><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif">CTA ablation was performed in 476 pts (mean age: 66.3 &plusmn; 11.7 years, 79.8% males). At time of ablation most pts were in EHRA II class (70.8%) and 44.6% of pts had at least mild left atrial dilatation on transthoracic echocardiography. The mean follow up time was 2.8 years.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif">Two-hundred sixty-nine pts (57,6%) were under anti-arrhythmic therapy (AAT) before the ablation. After the procedure, 58 pts withdrawn AAT before AR and 8 pts after AR. During the follow-up period, 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="color:#000000"><span style="font-family:Cambria,serif">There were no statistically significant differences regarding AR between pts that maintained and suspended AAT (p=NS). Concerning the pts that suspended AAT, thyroid disfunction (p=0.012), higher CHADs-VASc score (p=0.033), ischemic cardiomyopathy (p=0.001) and tobacco abuse (p=0.005) were predictors of AR, being the last two also independent predictors (HR 0.243; 95%CI 0.76-0.778, p=0.017; HR 4.449; 95%CI 1.128-17.553, p=0.033, respectively).&nbsp;&nbsp;</span></span></span></p>

<p><span style="font-size:10.5pt"><span style="color:#000000"><span style="font-family:Cambria,serif"><strong>Conclusion: </strong></span></span></span><span style="font-size:11pt"><span style="color:#000000"><span style="font-family:Cambria,serif">After CTA ablation, AF is the most frequent recurrent arrhythmia. Interestingly, the withdrawn of AAT didn&rsquo;t seem to predict the recurrence of arrhythmic events. The decision interrupt AAT must be individualized regarding patients&rsquo; clinical characteristics.</span></span></span></p>