Disease progression after ablation for atrial flutter compared with atrial fibrillation: A nationwide cohort study

Summary Aims The aim of this study was to study the risk of death and development of arrhythmia and/or subsequently heart failure after an atrial flutter ablation procedure compared with an atrial fibrillation (AF) ablation procedure. Methods This observational study is based on data from Danish nationwide health databases. Patients with a first‐time ablation procedure for either atrial flutter or AF in the period 2000‐2016 were included. Rates of renewed arrhythmia, heart failure or death were compared and reported as adjusted hazard ratios (HR). Results The study population consisted of 2,004 and 3,803 patients with an incident atrial flutter or AF ablation procedure, respectively. All‐cause mortality among atrial flutter patients was significantly higher compared with the AF group (HR 1.80, 95% confidence interval [CI] 1.39‐2.35). The incidence of renewed arrhythmia without heart failure was lower in atrial flutter (HR 0.76, 95% CI 0.69‐0.84). Renewed atrial flutter ablation and pacemaker implantations were significantly more frequent (HR 2.42, 95% CI 2.02‐2.91 and HR 1.42, 95% CI 1.13‐1.79, respectively) in atrial flutter compared with AF. The risk of heart failure was higher for atrial flutter, both after the initial ablation (HR 1.48, 95% CI 1.08‐2.03), and after a further arrhythmia management event (HR 1.98, 95% CI 1.33‐2.94). Conclusion There was a higher mortality risk after atrial flutter ablation procedures compared with patients undergoing AF ablation. Rates of heart failure and further renewed (non‐AF) arrhythmia management were higher in atrial flutter.