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Prior studies have shown that atrial fibrillation (AF) following successful cavotricuspid isthmus (CTI) ablation of atrial flutter (AFL) can occur in 12%-54% of the patients. However, studies to report the risk factor for ischemic stroke after successful typical AFL ablation are limited, and the clear strategy of postablation antithrobotic therapy is not established. This study investigates the prevalence and risk factors for ischemic stroke after successful CTI ablation of typical AFL.
A retrospective analysis of 293 patients (age 56 ± 14) without valvular heart disease undergoing successful typical AFL ablation between January 1996 and May 2012 was performed. The incidence of and risk factors for ischemic stroke after ablation were evaluated.
: During follow-up period of 53 ± 46 months, stroke occurred in 18 patients (6%) after successful AFL ablation with an incidence of 14 strokes per 1000 person-years. The patients with stroke had significantly higher CHADS2 score (0.9 ± 1.1 vs. 1.9 ± 1.8, p=0.001), and history of transient ischemic attack (TIA)/stroke (5% vs. 28%, p=0.003) and cardiomyopathy (3% vs. 17%, p=0.030) more frequently than those without stroke. The occurrence of AF following successful CTI ablation was also higher in patients with stroke than without stroke (33% vs. 67%, p=0.004). In multivariate analysis, independent risk factors for stroke were high CHADS2 score (hazard ratio 1.673, 95% confidence interval 1.273 to 2.198, p<0.000) and cardiomyopathy (hazard ratio 6.968, 95% confidence interval 1.916 to 25.333, p=0.003). AF following successful CTI ablation (hazard ratio 2.134, 95% confidence interval 0.78 to 5.838, p=0.14) were not statistical correlated with stroke after ablation of typical AFL.
Patients with high CHADS2 score, history of TIA/stroke, cardiomyopathy and postprocedural AF undergoing successful ablation of typical AFL remain at an elevated and continued risk for stroke after AFL ablation. More rigorous monitoring for the occurrence of AF after AFL ablation and antithrombotic therapy might be considered in these patients.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Arrhythmias: Atrial Physiology and Ablation of Atrial Arrhythmias
Abstract Category: 6. Arrhythmias: Other
Presentation Number: 1238-53
- 2013 American College of Cardiology Foundation