0163: Management of long-term anticoagulant therapy after atrial flutter radiofrequency ablation according to associated atrial fibrillation and CHA2DS2-VASc score

Background Radiofrequency ablation (RFA) is the only curative treatment for typical atrial flutter (AFL) and allows stopping antiarrhythmic drugs. However, management of long-term anticoagulant therapy (LT ACT) remains unclear, especially in lone AFL successfully treated and CHA 2 DS 2 VASc score ≥1. Abstract 0163 – Table: Table Long-term anticoagulation therapy management A GROUP (N=74) B GROUP (N=63) C GROUP (N=17) AF YES (N [%]) NO (N [%]) YES (N[%]) NO (N [%]) YES (N [%]) NO (N [%]) TAC YES (N [%]) 14 (18.9) 11 (14.9) 29 (46) 20 (31.7) 4 (23.5) 0 (0) NO (N [%]) 2 (2.7) 43 (58.1) 3 (4.8) 7 (11.1) 6 (35.3) 5 (29.4) LTFUP (N [%]) 4 (5.4) 4 (6.4) 2 (11.8) AF: Atrial fibrillation ACT: anticoagulant therapy LTFUP: lost to follow up patient Aims Assessment of long-term ACT after AFL RFA according to associated atrial fibrillation (AF) and CHA 2 DS 2 VASc score. Methods From January 2012 to December 2013, patients who underwent RFA of cavotricuspid isthmus for typical atrial flutter in our centre were retrospectively included. Results Of 166 patients (137 men, mean age: 66.7±10years), 61 (36.7%) had a history of AF. The mean CHA 2 DS 2 VASc score was 2.49. The patients were classified according to theoretical indication of LT ACT (patients with a non rhythmic ACT indication excluded – N=12; 7.2%): group A (LT ACT unclear) included patients with CHA 2 DS 2 VASc score ≥1, successful RF ablation and without AF history (N=74); group B (LT ACT indicated) included patients with CHA 2 DS 2 VASc score ≥1, AF history and/or failed AFL RFA (N=63); group C (LT ACT not indicated)included patient with CHA 2 DS 2 VASc score=0 (N=17). During a mean follow up of 489±244 days, 45 (60.8), 10 (15.9%) and 11(64.7) patients stopped ACT respectively in group A, B and C differently according to AF onset (table). There were 8 (4.8%) hemorrhagic and 2 (1.2%) ischemic complications, all in patients with correct ACT management. The prevalence of AF during follow-up was 38%. Conclusion After successful AFL RF ablation, ACT was frequently stopped in the absence of associated AF. However, AF was frequent even inpatients with no AF history. Ischemic and hemorrhagic complications were rare. ACT should be regularly evaluated during follow-up especially according to CHA 2 DS 2 VASc score and new onset of AF.