Prophylactic pulmonary vein isolation in patients with typical atrial flutter and heart failure.

Background: Heart failure (HF) readmission rates remain a concern in patients with typical atrial flutter (AFL) and HF, even after cavotricuspid isthmus (CTI) ablation.

Objective: This study aimed to explore whether additional prophylactic circumferential pulmonary vein isolation (CPVI) could improve hard outcomes among patients with AFL and HF.

Methods: In this prospective, nonrandomized, controlled study, patients with AFL and HF were consecutively enrolled from 9 centers. Patients received either CTI ablation + CPVI (CTI + CPVI group, n = 42) or CTI ablation alone (CTI-alone group, n = 39). The primary endpoint was a composite of death from any cause or hospitalization for worsening HF.

Results: Baseline characteristics were balanced between the 2 groups. During a mean follow-up of 40.2 ± 12.9 months, the primary endpoint occurred in fewer patients in the CTI + CPVI group than in the CTI-alone group (13 patients [31.0%] vs 22 patients [56.1%]; adjusted hazard ratio 0.37; 95% confidence interval 0.17-0.82; P = .014). Fewer patients in the CTI + CPVI group were hospitalized for worsening HF (11 patients [26.2%] vs 19 patients [48.7%]; adjusted hazard ratio 0.40; 95% confidence interval 0.17-0.94; P = .037).

Conclusion: In this prospective, nonrandomized, controlled study of patients with AFL and HF, prophylactic CPVI was associated with a significantly lower rate of a composite of death from any cause or hospitalization for worsening HF than CTI ablation alone. However, randomized trial verification is required.