The data regarding the long-term efficacy of cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) ablation in terms of mortality and cardiovascular risk in AFL patients without AF history was still unclear. To determine the effectiveness of catheter ablation compared to conventional medical therapy for improving cardiovascular outcomes among patients with solitary AFL. We collected the data of 3,784 patients who were diagnosed with AFL without history of AF. After propensity matching for age, sex, comorbidities, and medications, we analyzed the outcome of total deaths, cardiac deaths, heart failure (HF), and AF admissions. Survival curve analysis showed that patients who had AFL ablation had a significantly better outcome in terms of total deaths, cardiovascular deaths, HF admissions, and AF admissions compared to medically treated patients (Figure). After adjusted with confounding factors, we identified that AFL ablation and future AF ablation reduced the risk for total deaths (HR: 0.68; 95% CI: 0.62-0.74, p< 0.001), cardiac deaths (HR: 0.78; 95% CI: 0.67-0.91, p=0.001), HF (HR 0.84; 95%: CI, 0.75-0.95, p=0.01), and AF admissions (HR 0.83; 95% CI 0.76-0.92, p<0.001). In patients who only received AFL ablation, we still found risk reduction of total death (HR: 0.65; 95% CI: 0.58-0.72, p<0.001), cardiac death (HR: 0.77; 95% CI: 0.64-0.92, p=0.003), and HF admissions (HR: 0.83; 95% CI: 0.72-0.96, p=0.01). AFL catheter ablation reduces the risk of total deaths, cardiac deaths, stroke admissions, HF admissions, and AF admissions in AFL patients without history of AF during a very long-term follow up.