Abstract 17041: Outcomes After Atrial Fibrillation Ablation With and Without CTI Ablation: Insights From the UC San Diego AF Ablation Registry

Abstract

Introduction: Pulmonary vein isolation (PVI) is a well-established therapy for patients with drug refractory atrial fibrillation (AF). However, it remains unclear whether prophylactic cavotricuspid isthmus (CTI) ablation at the time of PVI improves long-term freedom from AF. Several studies have examined short term outcomes, but none beyond several years post procedure. Methods: We performed a retrospective study of all patients who underwent first-time radiofrequency catheter ablation enrolled in the UC San Diego AF Ablation Registry. The primary outcome was freedom from atrial arrhythmias on or off anti-arrhythmic drugs (AAD). Results: Of 534 total patients, 63 (11.8%) underwent pulmonary vein isolation (PVI) without CTI ablation, 471 (88.2%) underwent PVI with CTI ablation. Median follow-up duration was 3.9 (0.4 - 6.8) years. CTI ablation did not improve freedom from atrial arrhythmias in those with either paroxysmal AF [Adjusted Hazard Ratio (AHR) 1.15 (95% CI 0.59-2.24) for CTI vs non-CTI ablation] or persistent AF [AHR 0.82 (95% CI 0.38-1.77) for CTI vs non-CTI ablation]. Among all patients, there were also no differences in procedural complications [AHR 1.09 (95% CI 0.33-3.62) for CTI vs. non-CTI ablation] or all-cause mortality [AHR 1.12 (95% CI 0.57-2.23) for CTI vs. non-CTI ablation]. Conclusion: In this registry analysis, prophylactic CTI ablation at the time of first PVI did not improve freedom from recurrent atrial arrhythmias at 5 years among those with paroxysmal or persistent AF as compared to PVI alone.