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. 2024 Apr;11(2):883-892.
doi: 10.1002/ehf2.14659. Epub 2024 Jan 10.

Radiofrequency catheter ablation for pulmonary hypertension patients with atrial flutter

Aikai Zhang  1 , Lei Ding  1 , Hongda Zhang  1 , Lijie Mi  1 , Fengyuan Yu  1 , Min Tang  1
Affiliations

Radiofrequency catheter ablation for pulmonary hypertension patients with atrial flutter

Aikai Zhang et al. ESC Heart Fail. 2024 Apr.

Abstract

Aims: We aimed to evaluate the effects of radiofrequency catheter ablation (RFCA) and the factors influencing mortality after RFCA in patients with pulmonary hypertension (PH) and atrial flutter (AFL).

Methods and results: Fifty-eight consecutive PH patients with AFL who underwent an electrophysiological study and RFCA between April 2013 and August 2021 were selected for this study. In the study population, pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) was the most common type of PH (n = 34, 59%), followed by idiopathic pulmonary arterial hypertension (IPAH) (n = 19, 33%). Typical atrial flutter was the most common type of atrial flutter (n = 50, 86.2%). Sinus rhythm was restored in 53 (91.4%) patients during RFCA. After a mean follow-up of 33.8 months, AFL recurred in a total of 22 patients. Nine of them underwent repeat RFCA, and the site of the repeat ablation was not exactly the same as the first. At a median follow-up of 34.6 months after the last ablation, none of the patients who underwent repeat RFCA experienced AFL recurrence, and all of these patients survived. There were no procedure-related complications during hospitalization or follow-up. Univariate Cox regression analysis suggested that AFL recurrence after the last ablation was not associated with all-cause mortality. NT-proBNP (HR: 1.00024, 95% CI: 1.00008-1.00041, P = 0.004), pulmonary artery systolic pressure (PASP) (HR: 1.048, 95% CI: 1.020-1.076, P = 0.001), and IPAH (vs.

Pah-chd, hr: 7.720, 95% CI: 1.437-41.483, P = 0.017) were independent predictors of all-cause mortality in PH patients with AFL after RFCA. Receiver operating characteristic (ROC) curve analysis revealed that the area under the curve (AUC) of PASP for predicting all-cause mortality was 0.708. There was no significant difference in the Kaplan-Meier curves for all-cause mortality between patients with AFL recurrence after the last ablation and those without recurrence (P = 0.851). Patients with higher PASP (≥110 mmHg) and IPAH showed the lower survival rate in Kaplan-Meier curves.

Conclusion: Repeat ablation was safe and feasible in patients with recurrent AFL and can maintain sinus rhythm. AFL recurrence was not associated with all-cause mortality, and patients with high PASP or IPAH were at higher risk for adverse outcomes.

Keywords: Atrial flutter; Pulmonary hypertension; Radiofrequency catheter ablation.

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Conflict of interest statement

All authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Classification of pulmonary hypertension and atrial flutter among the study population.
Figure 2
Figure 2
The predictive efficacy of PASP for all‐cause mortality was evaluated by the ROC curve analysis.
Figure 3
Figure 3
Kaplan–Meier analysis of all‐cause mortality in recurrence condition (A), PASP (B) and PH types (C). AFL, atrial flutter; IPAH, idiopathic pulmonary arterial hypertension; PAH‐CHD, pulmonary arterial hypertension associated with congenital heart disease; PASP, pulmonary artery systolic pressure.
See this image and copyright information in PMC

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