Abstract 5684: Long-Term Outcomes after Catheter Ablation of Atrial Flutter: A Meta-Analysis

Abstract

Clinical outcomes after catheter ablation of atrial flutter (AFL) vary widely in reported literature. The puropose of this study was to analyze long-term outcomes after cathteter ablation of AFL using meta-analys. Meta-analysis was performed of articles published from 1988 – 2007 with outcomes after catheter ablation of cavotricuspid isthmus (CTI) dependent AFL. The analysis included 110 studies comprising 7946 patients (79% male, 59.8±0.5 years, 43% left atrial enlargement, 49% heart disease, 16±12 months follow up). The acute success rate was 97% (95% CI 95–98%) with cooled (8 –10mm tip or irrigated) radiofrequency catheters and 95% (94 –96%) when bidirectional CTI block was the endpoint. Recurrence rate of AFL was 4% (3– 6%) with cooled catheters. Use of bidirectional CTI block as ablation endpoint decreased AFL reccurrence to 8% (^−10%) versus 18% (14 –22%) without CTI as endpoint. AFL recurrence rate did not increase over time. Mortality was 3% (2– 4%) during follow up. The overall occurrence rate of atrial fibrillation (AF) after AFL ablation was 25% (21–29%). In patients with AF prior to ablation, AF occurred in 46% (41–51%) compared to 16% (11–22%) without AF prior to ablation. Five years after ablation, the AF rates were similar in those with and without AF prior to ablation (Figure ). Antiarrhythmic drug use post ablation was 28% (22–36%). The long term use of coumadin was not described. AF is common after AFL ablation and may limit the clinical utility of this procedure. 28% of patients require antiarrhythmic drugs after AFL ablation. AF before ablation may indicate a more advanced electrical disease.