LAUSR

BACKGROUND Predictors of long-term outcome and optimal catheter set for ablation of cavo-tricuspid isthmus (CTI) in patients with atrial flutter (AFL) are not well known. AIMS To identify predictors of events during outcome following ablation. METHODS We studied 741 patients (mean 62.2 [10.8] years, 248 females) who were followed for 4.4 [2.7] years. Two- vs three-electrode approach and clinical predictors of events during follow-up were analyzed. RESULTS Two-electrode approach was faster (62.5 [30.3] vs 101.4 [51] min, P < 0.001), with less fluoroscopy (13.1 [9.3] vs 20.3 [12.4] min, P < 0.001), cost-effective (8.29 [2.82] vs 11.89 [2.51] units, P < 0.001) and more effective (92.1% vs 86.1%), P = 0.012). Independent predictors for AFL recurrence were: Ca-blocker use (3.24 [1.64; 6.40]), mitral valve disease (MVD) (1.82 [1.12; 2.95]), previous stroke/TIA (2.38 [1.21; 4.65]), pulmonary artery dilatation (3.94 [1.22; 12.73]), previous pulmonary embolism (3.77 [1.14; 12.43]); for atrial fibrillation (AF): previous AF (6.054 [4.58; 8.00]), left atrial enlargement (1.43 [1.12; 1.81]), # of antiarrhythmic drugs (1.16 [1.05; 1.28]), MVD (1.28 [1.04; 1.58]); for pacemaker implantation: tachy-brady syndrome (6.17 [3.16; 12.05]), previous II/III0 atrio-ventricular block (29.40 [7.37; 117.28]), centrally acting hypotensive drugs (29.55 [6.14; 142.25]), aortic dilatation/aneurysm (2.58 [1.06; 6.30]), labile INR (3.45 [1.72; 6.93]), LBBB (4.70 [1.49; 14.82]), shortest RR interval during AFL (1.003 [1.001; 1.005]), previous cardiac surgery (2.69 [1.27; 5.70]), aortic valve disease (2.22 [1.08; 4.59]). CONCLUSION Ablation of CTI with minimal number of electrodes is safe and effective. There are specific predictors of events during long-term outcome.