Long-term follow-up of patients with pulmonary hypertension after catheter ablation of atrial fibrillation and atrial tachycardia.

INTRODUCTION

The previously published randomized trial comparing an extensive (targeting both clinical arrhythmia and bi-atrial arrhythmogenic substrate) and a limited (clinical arrhythmia only) approach to catheter ablation in patients with pulmonary hypertension did not demonstrate a significant difference in atrial tachyarrhythmia (ATA) recurrence during the one-year follow-up. This study presents the long-term results of these patients.

METHODS

Participants enrolled in the randomized trial (NCT04053361) were further followed and checked for ATA recurrence and all-cause mortality. Follow-up was primarily clinically driven, as the protocol for this secondary analysis was not fully prespecified.

RESULTS

A total of 74 patients [41 males, median age 71 years (IQR: 61; 75)] were randomized to the extended (N = 36) and limited (N = 38) ablation groups and followed for a median of 45 and 41 months, respectively. The ATAs recurred in 22 (61%) patients after extended vs. 19 (50%) patients after limited ablation [hazard ratio (HR) 1.22, 95% confidence interval (CI): 0.66-2.3]. There were 21 (58%) deaths in the extended ablation group, and 22 (58%) patients died during follow-up after the limited ablation (HR: 0.74, 95% CI: 0.39-1.4). No recurrence of typical atrial flutter was noted among the 23 patients treated by the ablation of the cavo-tricuspid isthmus.

CONCLUSION

Extensive catheter ablation in patients with pulmonary hypertension did not reduce ATA recurrence during the routine follow-up of more than 40 months. Cavo-tricuspid isthmus ablation appears effective in preventing recurrence of typical atrial flutter, even in this high-risk population. Given the exploratory nature of these analyses, further research is needed.