Outcome of the elective or online radiofrequency ablation of typical atrial flutter.

Background: Radiofrequency ablation of the cavotricuspid isthmus is currently the first-choice treatment of typical atrial flutter and usually it is performed electively. The purpose of this study was to see whether performing on-line ablation has similar clinical results compared to the conventional strategy.

Methods: Consecutive patients (465) who underwent ablation of the cavotricuspid isthmus for typical atrial flutter (AFL) at our electrophysiology laboratory in the 2008-2017 decade were studied. We evaluated the acute and long-term clinical outcomes of those who were treated electively (337) compared to those who had online ablation (128), that is within 24 hours of presenting to the Department of Cardiology. In patients treated on an emergency basis, a transesophageal echocardiogram was performed to rule atrial thrombi when needed.

Results: No significant intraprocedural difference was observed between the 2 patient groups, with comparable acute electrophysiological success (99% vs. 98%) and serious complications. Even at the subsequent 4-year follow-up, there were no significant differences in the recurrence of typical AFL, onset of atrial fibrillation and other clinical events.

Conclusions: Online ablation of typical atrial flutter performed at the time of the clinical presentation of the arrhythmia, was shown to be comparable in terms of procedural safety and clinical efficacy in the short and long term compared to an elective ablation strategy.