Evaluation of risk factors for long-term atrial fibrillation development in patients undergoing typical atrial flutter ablation: a multi-center pilot study

Abstract Background/Introduction Atrial flutter (AFL) and atrial fibrillation (AF) are the most commonly detected supraventricular arrhythmia and share similar pathophysiological mechanisms (1). After the successful ablation of AFL, AF frequently occurs in such patients in the long-term follow up (2). As emphasized in some studies, some mechanisms seem to predispose to the development of AF in AFL patients and approximately 20% of such kind of patients have accompanying AFL (3). Purpose We aim to analyze independent risk factors that predict the development of AF in patients who underwent typical AFL ablation. Methods Our study was designed as multi-center, cross-sectional and retrospective. A total of 442 patients who underwent typical AFL ablation at 3 different centers between January 1, 2018 and January 1, 2022 were included retrospectively. The patients after the ablation procedure were divided into those who developed AF and those who did not. The patients were followed up for an average of 12 (4-20) months. In the post-procedure period, atrial arrhythmias were investigated with 24-hour Holter and ECG at 1st month, 6th month, 12th month and at 6-month intervals thereafter. Results AF developed in 206 (46.6%) patients in the long-term follow-up. Age, hypertension (HT), obstructive sleep apnea syndrome (OSAS), previous cerebrovascular accident (CVA), left atrium antero-posterior diameter, severe mitral regurgitation, hemoglobin, blood glucose and HbA1c values were found to be significant in univariable analysis. According to multivariable analysis, HT (p=0.014; HR: 1.483 (1.084 – 2.030)), OSAS (p=0.008; HR: 1.520 (1.117 – 2.068)) and previous CVA (p=0.038; HR: 1.749) (1,031 – 2,968)) were independently associated with the development of AF in AFL patients who underwent ablation procedure. Conclusion In the present study, we found that HT, OSAS and previous CVA were independently correlated with the development of AF in the long-term follow-up of patients who underwent typical AFL ablation. We consider that AFL patients with such risk factors should be followed-up closely following cavo-tricuspid isthmus ablation for the development of AF. Univariable and Multivariable Analyzes Kaplan - Meier Curves