Refining HATCH Score with Atrial Myopathy for Predicting New-Onset Atrial Fibrillation after Atrial Flutter Ablation

Abstract

Objectives: To determine markers of atrial myopathy to HATCH score ( hypertension, age > 75 years, transient ischemic attack/stroke, chronic obstructive pulmonary disease, and heart failure) can improve prediction of new-onset atrial fibrillation (AF) after ablation of typical atrial flutter (AFL).Background: It is unclear if oral anticoagulation therapy needs to be stopped or continued after successful ablation of AFL due to concern regarding incidence of new-onset AF. These practices potentially expose the substantial proportion of patients who do not develop AF to medication costs and bleeding risk. The available risk prediction models are inadequate to identify a truly low risk patient. Methods: The study included 208 consecutive patients who underwent successful ablation of typical AFL from 2006 to 2014 at Minneapolis VA Medical Center and University hospital. Patients with history of AF prior to ablation were excluded. Results: Among the 208 patients, 76 (36.5%) developed new-onset AF post AFL ablation. Mean follow up duration was 62{±}31.8 months. HATCH score was not associated with new-onset AF. When adding atrial myopathy (presence of at least one of the following: PTFV1 >5000 µV*ms, interatrial block determined by biphasic inferior p wave with duration >120ms, left atrium (LA) diameter >44 mm, or LA index >3 mm/m2 ) to HATCH score (HATCH-A), the combination was independently associated with new-onset AF. The AF incidence between HATCH-A score of 0-1 and > 2 were 6.7% and 40.5%, respectively (odds ratio 9.04, p=0.004). Conclusions: Adding atrial myopathy to HATCH score improved predictability of new-onset AF after typical AFL ablation.