CHA2DS2-VA and non-CHA2DS2-VA components as predictors of mortality after cavotricuspid isthmus ablation: a clinical tool for long-term risk stratification.

INTRODUCTION

Typical atrial flutter (AFL) is associated with considerable morbidity and mortality despite high procedural success rates of cavotricuspid isthmus (CTI) ablation. While the CHA₂DS₂-VA score is widely used for thromboembolic risk assessment in atrial fibrillation, its prognostic value for long-term survival after CTI ablation remains unclear. Our objective therefore was to evaluate the association between the CHA₂DS₂-VA score, its individual components, and non-CHA₂DS₂-VA comorbidities with all-cause mortality following CTI ablation for typical AFL.

METHODS

We retrospectively analyzed clinical and mortality data from 249 consecutive patients who underwent successful CTI ablation between July 2017 and December 2021. Kaplan-Meier survival analysis, Cox regression, and time-dependent ROC analyses were performed to evaluate predictors of all-cause mortality.

RESULTS

During a mean follow-up of 1771 ± 635 days, 27% of patients died. Mortality increased progressively with higher CHA₂DS₂-VA scores, corresponding to a stepwise decline in survival (log-rank p < 0.001). A CHA₂DS₂-VA score ≥3 was identified as the optimal threshold for mortality prediction, with annual mortality rates of 1.4% versus 9.9% in patients with scores <3 and ≥3, respectively (p < 0.001). The CHA₂DS₂-VA score demonstrated good discriminative ability (c-index = 0.73). In multivariable analysis, the CHA₂DS₂-VA score remained an independent predictor of all-cause mortality (HR 1.48, 95% CI 1.26 -1.75, p < 0.001). Among non-CHA₂DS₂-VA variables, pulmonary disease and obstructive sleep apnoea independently predicted adverse long-term survival, whereas female sex was not significantly associated with mortality.

DISCUSSION: The CHA₂DS₂-VA score is an independent predictor of long-term all-cause mortality after CTI ablation for typical AFL, extending its clinical utility beyond thromboembolic risk assessment. Incorporation of selected non-CHA₂DS₂-VA comorbidities may further refine risk stratification and support individualized follow-up strategies.