Impact of catheter ablation in patients with atrial flutter and concurrent heart failure

Jani, Chinmay; Arora, Shilpkumar; Zuzek, Zachary; Jaswaney, Rahul; Thakkar, Samarthkumar; Patel, Harsh; Lahewala, Sopan; Arora, Nirav; Deshmukh, Abhishek; Viles-González, Juan F.; Sahadevan, Jayakumar; Hoit, Brian D.; Mackall, Judith A.

doi:10.1016/j.hroo.2020.11.005

Cited by 6 publications

(4 citation statements)

References 32 publications

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“…The current data underscores a substantial reduction in all-cause mortality, the rates of hospitalization, and TIA/stroke among individuals experiencing concomitant heart failure and AF who have undergone ablation procedures. Based on the available data, it is highly likely that similar trends would be observed among patients with concomitant heart failure and AFL [40].…”

Section: Age-related Changes Effectmentioning

confidence: 81%

Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment

Borkowski,

Nazarenko,

Mangeshkar

et al. 2023

Cureus

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The prevalence of atrial flutter (AFL) is increasing among the elderly population, and managing this condition presents specific challenges within this demographic. As patients age, they often exhibit reduced responsiveness to conservative treatment, necessitating a more invasive approach. We present a case of a 93-year-old female who presented to the hospital with acute decompensated heart failure (ADHF) and AFL. A year prior, she was diagnosed with arrhythmia-induced cardiomyopathy. Despite recovering her ejection fraction (EF) through guideline-directed medical therapy (GDMT), her EF deteriorated again. The patient declined invasive management for her arrhythmia on multiple occasions. Managing such patients is challenging since the approach with pharmacotherapy alone often fails to maintain sinus rhythm or adequately control the ventricular rate. Growing evidence shows that invasive management, especially ablation, may be a safe and effective procedure for this patient population. Furthermore, the studies suggest that ablation may yield particular benefits for patients with simultaneous heart failure and atrial fibrillation/AFL (AF/AFL). Unfortunately, limited data exist regarding the invasive management of AFL in the elderly. Therefore, this case report aims to provide a comprehensive review of the current evidence regarding the safety and efficacy of ablation as a therapeutic option for AFL in elderly patients, with a particular focus on how patients with concomitant heart failure may benefit from ablation.

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Section: Age-related Changes Effectmentioning

confidence: 81%

Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment

Borkowski,

Nazarenko,

Mangeshkar

et al. 2023

Cureus

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“…Finally, regarding the impact of CTIA on cardiovascular mortality Yugo et al ( 28 ) reported a significantly reduced mortality in a long-term follow-up in patients with typical AFL independent of any HF after CTI ablation. Thakkar et al ( 29 ) showed similar ratios in AFL patients with HFpEF constellation, whereas Jani et al ( 30 ) demonstrated statistically significantly better survival within 1 year after CTI ablation only in HFrEF and not in HFpEF patients. Our results in HFrEF and HFmrEF patients fit seamlessly into the previous data ( Figure 7A ).…”

Section: Discussionmentioning

confidence: 93%

Impact of cavotricuspid isthmus ablation for typical atrial flutter and heart failure in the elderly—results of a retrospective multi-center study

Boxhammer

Bellamine

Szendey

et al. 2023

Front. Cardiovasc. Med.

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IntroductionWhile in the CASTLE-AF trial, in patients with atrial fibrillation and heart failure with reduced ejection fraction, interventional therapy using pulmonary vein isolation was associated with outcome improvement, data on cavotricuspid isthmus ablation (CTIA) in atrial flutter (AFL) in the elderly is rare.MethodsWe included 96 patients between 60 and 85 years with typical AFL and heart failure with reduced or mildly reduced ejection fraction (HFrEF/HFmrEF) treated in two medical centers. 48 patients underwent an electrophysiological study with CTIA, whereas 48 patients received rate or rhythm control and guideline-compliant heart failure therapy. Patients were followed up for 2 years, with emphasis on left ventricular ejection fraction (LVEF) over time. Primary endpoints were cardiovascular mortality and hospitalization for cardiac causes.ResultsPatients with CTIA showed a significant increase in LVEF after 1 (p < 0.001) and 2 years (p < 0.001) in contrast to baseline LVEF. Improvement of LVEF in the CTIA group was associated with significantly lower 2-year mortality (p = 0.003). In the multivariate regression analysis, CTIA remained the relevant factor associated with LVEF improvement (HR: 2.845 CI:95% 1.044–7.755; p = 0.041). Elderly patients (≥ 70 years) further benefited from CTIA, since they showed a significantly reduced rehospitalization (p = 0.042) and mortality rate after 2 years (p = 0.013).ConclusionsCTIA in patients with typical AFL and HFrEF/HFmrEF was associated with significant improvement of LVEF and reduced mortality rates after 2 years. Patient age should not be a primary exclusion criterion for CTIA, since patients ≥70 years also seem to benefit from intervention in terms of mortality and hospitalization.

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“…9 In a retrospective study conducted by Jani et al, AFL ablation was associated with improved ACM and heart failure admission rates in a subset cohort of patients with both AFL and heart failure with reduced ejection fraction. 10 All of these observations suggest that early CTI RFCA may lead to superior ACM outcomes among patients with tAFL.…”

Section: Discussionmentioning

confidence: 98%

Impact of Ablation during Index Hospitalization on All-Cause Mortality in Patients with Typical Atrial Flutter: Insights from National Multicenter Database

2023

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We sought to assess the impact of ablation during index hospitalization (IH) on all-cause mortality (ACM) in patients presenting with newly diagnosed typical atrial flutter (tAFL) as compared with patients without ablation, irrespective of optimal rate or rhythm control medications.We identified patients with newly diagnosed tAFL in the TriNetX Research Network between January 20, 2010, and January 20, 2021. Using International Classification of Diseases, 10th revision (ICD-10) codes, patients were stratified into those who had undergone ablation during IH and those who did not undergo the procedure. Results were assessed using propensity score matching (PSM) analysis as well as Kaplan–Meier curves.A total of 12,986 (N) patients (aged 35–85 years) met our inclusion criteria. Of those, 3,665 had undergone ablation during IH compared with 9,321 patients who did not. Patients in the ablation group (mean age 64.3 ± 10.1 years) had a higher prevalence of hypertension (80 vs. 78.3%, p = 0.02), respectively. PSM created two well-matched groups of 3,652/3,652 patients each with an ACM of ablation of 4.5 versus 7.8% (p = 0.01) at 6 months, 6.6 versus 11.4% (p = 0.01) at 12 months, and 14.5 versus 20.9% (p < 0.001) at 36 months of follow-up. Survival data were confirmed through Kaplan–Meier analysis using a log-rank test.From a large, federated, multicenter population database, we report significant survival benefit of ablation during IH in patients presenting with new tAFL diagnosis. Kaplan–Meier mortality curves confirmed survival advantage with ablation at 6, 12, and 36 months of follow-up in this cohort.

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Impact of catheter ablation in patients with atrial flutter and concurrent heart failure

Cited by 6 publications

References 32 publications

Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment

Atrial Flutter in the Elderly Patient: The Growing Role of Ablation in Treatment

Impact of cavotricuspid isthmus ablation for typical atrial flutter and heart failure in the elderly—results of a retrospective multi-center study

Impact of Ablation during Index Hospitalization on All-Cause Mortality in Patients with Typical Atrial Flutter: Insights from National Multicenter Database

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