Akademik Veri Yönetim Sistemi
ESC Congress 2022, Barcelona, İspanya, 26 - 29 Ağustos 2022, cilt.43, ss.450
Background: Typical cavotricuspid isthmus (CTI) dependent atrial flutter
(Afl) may develop spontaneously in patients undergoing atrial fibrillation
(AF) ablation and it is also responsible for a significant portion of recurrences after AF ablation. In this situation, the second ablation for typical Afl
is frequently needed. If the predictors of typical Afl can be known in such
patients, CTI ablation for typical Afl can also be performed in the same
session as AF ablation. Thus, the risks and increased costs of the second
ablation procedure can be avoided. There is insufficient data related to the
predictors of typical Afl in patients undergoing AF ablation.
Purpose: In this study, we aimed to investigate the predictors of typical Afl
in patients undergoing catheter ablation for AF.
Methods: In this retrospective study, we consecutively enrolled 135 patients with AF undergoing index catheter ablation. Patients who did not
come for regular follow-ups after ablation were excluded. Thus, 131 patients
were included. The patients were divided into two groups according to spontaneous typical Afl development before or after AF ablation. They were
compared in terms of baseline characteristics and procedural features.
Results: The mean age of the patients was 58 (48–62), 65 of them (49.6%)
were male, and typical Afl was observed in 20 patients (15.2%). The frequency
of male gender was higher (80.0% vs 44.1%, p=0.003), the left ventricular (LV) ejection fraction was lower (56.2±10.9% vs 60.7±6.7%, p=0.015),
LV end-diastolic diameter was higher [50.0 (48.2–53.0) vs 47.0 (44.0–
49.0), p<0.001), the left atrium diameter was higher (41.4±4.5 vs 38.4±4.5,
p=0.008), and the right atrium (RA) diameter was higher (41.6±3.5 vs
36.8±3.7, p<0.001) in patients with typical Afl than in those without it (Figure 1a). Laboratory measurements, drug use, and procedural characteristics were similar between groups. A logistic regression analysis demonstrated that male gender [OR: 4.5, 95% CI: 1.01–20.03, p=0.048) and the
RA diameter [OR: 1.57, 95% CI: 1.22–2.02, p<0.001] were independent
predictors of the presence of typical Afl (Figure 1b). A Receiver Operating
Characteristic curve showed that the optimal cut-off value of the RA diameter
to predict the presence of typical atrial flutter was 40.5 mm (AUC: 0.843,
sensitivity %80, specificity %85, p<0.001) (Figure 2).
Conclusion: A RA diameter greater than 40.5 mm may predict the presence of typical spontaneous Afl in patients undergoing catheter ablation for
AF. This information can help to identify patients who would benefit from
CTI ablation in the same session as AF ablation.