This article is more than 5 years old. Information may no longer be current.
Long-term anticoagulation after radiofrequency ablation of atrial flutter may benefit some patients
After successful radiofrequency ablation of typical atrial flutter, patients remain at an increased risk for developing atrial fibrillation and stroke, according to findings published in the International Journal of Cardiology.
“The risk of developing AF is particularly relevant in those patients with a prior history of AF or [left atrial] enlargement, whereas the risk of developing stroke is higher in those who presented AF and specifically in those with high values of CHA2DS2-VASc score,” the researchers wrote.
Sergio Raposeiras-Roubín, MD, PhD, of the department of cardiology, University Clinical Hospital of Santiago de Compostela, Spain, and colleagues studied 393 patients (mean age, 64.4 ± 11.2 years) with typical atrial flutter (116 with history of AF) who underwent successful radiofrequency ablation. After the procedure, 230 patients (58.5%) continued on oral anticoagulation therapy.
The investigators looked for incidence of, and risk factors for, new-onset AF and ischemic stroke to determine which patients might benefit from long-term anticoagulation. Minimum follow-up was 1 year (interquartile range, 5.1-9.1 years)
Overall, 215 patients (54.7%) developed AF after radiofrequency ablation. Of those, 130 patients had new-onset AF (33.1%). The strongest predictor of AF was prior AF (HR = 2.18, 95% CI, 1.66-2.88).
Based on univariate analysis, new-onset AF predictors included: diabetes (HR = 1.49; 95% CI, 1.01-2.22); chronic obstructive pulmonary disease (HR = 1.72; 95% CI, 1.17-2.51); left atrial enlargement, defined as diameter of at least 40 mm (HR = 2.61; 95% CI, 1.64–4.13); and CHA2DS2-VASc score (HR = 1.14; 95% CI, 1.04-1.3).
However, multivariate analysis showed the only predictor for new-onset AF was left atrial enlargement (HR = 2.65, 95% CI 1.67-4.2).
Overall, 22 (5.6%) patients developed ischemic stroke after radiofrequency ablation, for an incidence rate of 8.4 strokes per 1,000 person-years. Of those patients, 15 (68.2%) had previous AF.
Among patients with stroke, CHA2DS2-VASc score also showed good predictive capability (HR = 1.49; 95% CI 1.12-1.98). At the time of procedure, 17 patients (77.3%) had a score of at least 2 points, four patients (18.2%) had a score of 1 point, and one patient had a score of 0.
“This information is clinically helpful in selecting patients for close arrhythmia surveillance after [radiofrequency ablation] of [typical atrial flutter], and may indirectly suggest continuation of systemic anticoagulation in those selected patients who are likely to develop AF and who have subsequently a higher risk of stroke.” – Allegra Tiver
Disclosure: Raposeiras-Roubín reports no relevant financial disclosures.