PO-01-090 ABLATION OF TYPICAL RIGHT ATRIAL FLUTTER THROUGH THE ARM: EVALUATION OF SAFETY, FEASIBILITY, AND EFFICACY – THE ARM AFLUTTER STUDY

Abstract

Typical atrial flutter ablation (AFLA) has become a common procedure usually performed through the femoral vein. Case reports have described ablation via the arm which may allow for a safer procedure and reduced recovery time. We aimed to evaluate the safety, feasibility, and efficacy of AFLA via the Arm approach (AA) vs Femoral approach (FA). Patients were randomly assigned 1:1 to either FA or AA for EP study and AFLA. The primary endpoint was length of recovery time after the procedure. The secondary endpoints were success rates for achieving bidirectional block across the cavotricuspid isthmus, procedure complications, and recurrence rates of atrial flutter at 1 month follow-up. Outcomes with continuous variables were compared between groups using a Mann Whitney U test. Categorical outcomes were compared between groups using a chi-square analysis or Fisher’s exact test. Patients (N=16; aged 64.4±11.3yr; 81.3% Male) were randomized to either AA (n=7) or FA (n=9). There were no significant differences in baseline patient characteristics or medications at the time of ablation. With regard to the primary endpoint, recovery time was significantly less in AA (median, IQR=137.0, 27.0 min) compared to FA (median, IQR=265.0, 49.0 min; P=.004, U=4.00). Bidirectional block was achieved for all patients in both groups, however time to achieve bidirectional block was longer in AA (median, IQR=73.0, 65.0 min) compared to FA (median, IQR=37.0, 31.0 min; P=.026, U=10.50). There were no complications in either group, and there were no recurrences of atrial flutter at 1 month follow-up. In a small sample, AFLA from the arm was a feasible, safe approach with shorter recovery time to discharge without recurrence at 1 month. Achieving bidirectional block required more time in AA compared to FA likely due to operator learning curve, and lack of appropriately designed sheaths and catheters for use in the arm. Results from these data will be confirmed in a larger, adequately powered study with 6 and 12 month follow-up.