Abstract 14526: The Effect of Radiofrequency Catheter Ablation of Typical Atrial Flutter on Cardiac Chambers' Size and Function

Abstract

Introduction: Cavo-tricuspid isthmus (CTI) dependent atrial flutter (AFL) is one of the most common atrial arrhythmias involving the right atrium (RA) for which radiofrequency catheter ablation has been widely used as a therapy of choice. However, there is limited data on the effect of this intervention on cardiac size and function. Hypothesis: CTI dependent ablation for patients with AFL will improve tricuspid valve function, biatrial enlargement, and ventricular function. Methods: A retrospective study was conducted on 468 patients who underwent CTI dependent ablation for clinical typical AFL at a single institution between 2010 and 2019. After patients with congenital or rheumatic heart disease, heart transplant recipients, or those without baseline echocardiogram were excluded, 211 patients remained in the analysis. Echocardiographic data were analyzed at baseline prior to ablation, and at early follow-up within 1-year post-ablation. Follow-up echocardiographic data was available for 130 patients. Results: Of the 211 patients with CTI-AFL, 200 had typical counterclockwise flutter. The mean age was 64.2±12.1 years old with 12% (n=26) female. The average left ventricular (LV) ejection fraction (EF) significantly improved on follow-up echo (45.55±14.26 to 49±14.4%, p=0.0075), of which 63 (48%) patients had an improvement in EF of 5% or more and 19 (25%) patients had an increased EF of 20% or more. The prevalence of moderate to severe tricuspid regurgitation (TR) was 24% (n=50) at baseline and 18% (n=22) at follow-up with no significant difference (p=0.27). However, 30% (n=39) of the patients had one grade or more improvement in their TR within the 1-year follow-up. Echocardiography also showed improvement of RA size in 48.6%, and left atrial (LA) size in 48.2% of the patients. Conclusions: Patients who underwent CTI dependent AFL ablation showed an improvement in cardiac size and function at follow-up evaluation. Although longer-term results are unknown, these findings suggest that restoration of sinus rhythm from atrial flutter is associated with improvement in TR severity, RA size, LA size, and LVEF.