Catheter ablation of atrial flutter: A survey focusing on post ablation oral anticoagulation management and ECG monitoring.

Abstract

A considerable amount of patients with typical atrial flutter develop atrial fibrillation after cavotricuspid isthmus (CTI) ablation. No uniform recommendations are available to guide anticoagulation regimes or electrocardiogram (ECG) monitoring strategies after this procedure. We conducted a web-based survey in electrophysiology (EP) centers in Germany, Switzerland, and Austria. Responses were received from 47 centers. The survey was designed to investigate variations in management of the following: ablation strategy, oral anticoagulation (OAC) management, and ECG monitoring after successful CTI ablation. More than 55% of the participating centers assume that at least every third patient will develop atrial fibrillation during follow-up. Despite this assumption, most EP experts (81%) would still stop OAC after CTI ablation even in patients with higher CHADS2-VA2SC-score, or even perform CTI in asymptomatic patients with the purpose to stop OAC (52%). Most experts agree that ECG monitoring is necessary during follow-up. A majority still rely on short-term monitoring tools like resting ECGs (7%) or Holter ECGs (43%), while continuous monitoring by implantable loop recorders (10%) are rarely used for postablation OAC management. A majority of the centers stop OAC in patients with higher CHADS2-VA2SC-score after CTI ablation. There is evidence that this practice might not be safe and lead to an increased number of ischemic strokes during follow-up. This reflects the need for prospective studies to allow for clear guidelines regarding these issues.