Abstract
Atrial flutter ablation is associated with a high rate of acute procedural success and symptom improvement. The relationship between ablation and other clinical outcomes has been limited to small studies primarily conducted at academic centers. We sought to determine if catheter ablation of atrial flutter is associated with reductions in healthcare utilization, atrial fibrillation, or stroke in a large, real world population. California Healthcare Cost and Utilization Project databases were used to identify patients undergoing atrial flutter ablation between 2005 and 2009. The adjusted association between atrial flutter ablation and healthcare utilization, atrial fibrillation, or stroke was investigated using Cox proportional hazards models. Among 33,004 patients with a diagnosis of atrial flutter observed for a median of 2.1 years, 2,733 (8.2%) underwent catheter ablation. Atrial flutter ablation significantly lowered the adjusted risk of inpatient hospitalization (HR 0.88, 95% CI 0.84–0.92, p<0.001), emergency department visits (HR 0.60, 95% CI 0.54–0.65, p<0.001), and overall hospital-based healthcare utilization (HR 0.94, 95% CI 0.90–0.98, p = 0.001). Atrial flutter ablation was also associated with a statistically significant 11% reduction in the adjusted hazard of atrial fibrillation (HR 0.89, 95% CI 0.81–0.97, p = 0.01). Risk of acute stroke was not significantly reduced after ablation (HR 1.09, 95% CI 0.81–1.45, p = 0.57). In a large, real world population, atrial flutter ablation was associated with significant reductions in hospital-based healthcare utilization and a reduced risk of atrial fibrillation. These findings support the early use of catheter ablation for the treatment of atrial flutter.
Highlights
The efficacy of endocardial catheter ablation for the treatment of atrial flutter (AFL) is well established
AFL Ablation and Healthcare Utilization A total of 135,614 healthcare encounters were observed among all atrial flutter patients with a median of 3 (IQR 2 to 6) visits per patient
In multivariate analysis adjusting for patient demographics and comorbidities, AFL ablation resulted in a significantly increased hazard of an ambulatory surgery encounter (HR 1.63, 95% CI 1.54 to 1.73, p,0.001)
Summary
The efficacy of endocardial catheter ablation for the treatment of atrial flutter (AFL) is well established. The impact of AFL ablation on other arrhythmia related clinical outcomes, is less clear. Previous investigations have found an association between AFL ablation and a reduction in subsequent healthcare visits, these small studies have been limited to single academic centers [5,6] or to carefully selected randomized trial participants [3]. While one randomized trial demonstrated less atrial fibrillation (AF) after AFL ablation [3], this finding was not replicated in a second study [4]. AFL ablation could potentially reduce the risk of thromboembolic stroke through maintenance of sinus rhythm, prior investigations have not been powered to assess for differences in this endpoint
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