Reablation common after cavo tricuspid isthmus ablation

Reablation for atrial flutter and ablation for atrial fibrillation (AF) remain relatively common after cavo tricuspid isthmus ablation (CTIA), a recent study has found.

The study included 2,409 patients (median age, 66 years; 81 percent male) undergoing their first CTIA procedure between 2010 and 2016. Incidences of repeat CTIA or ablation for AF were documented until 1 March 2018. Majority of the population (n=2,288; 95 percent) achieved acute procedural success; 13 participants (0.5 percent) experienced complications.

Over a mean follow-up duration of 4.0±1.7 years, 242 patients required repeat CTIA, yielding a rate of 10 percent. Slightly more patients required ablation for AF (13.5 percent; n=326). Thirty-eight (2 percent) underwent both procedures.

Cox regression analysis found that patients who had longer operation times for the first CTIA procedure (hazard ratio [HR], 1.003, 95 percent confidence interval [CI], 1.001–1.006; p=0.01) and having an unsuccessful initial operation (HR, 3.42, 95 percent CI, 2.10–5.55; p<0.0001) were significantly more likely to need repeat procedures. Older age was likewise significantly associated (≥75 vs <65 years: HR, 0.66, 95 percent CI, 0.44–0.97; p=0.04).

In comparison, the use of a contact force sensing catheter emerged as a significant risk factor for having to undergo ablation for AF (HR, 1.43, 95 percent CI, 1.13–1.81; p=0.003). Other pertinent factors were the presence of valvular heart disease (HR, 0.39, 95 percent CI, 0.21–0.72; p=0.002) and known AF prior to CTIA (HR, 1.71, 95 percent CI, 1.07–2.73; p=0.02).