Introduction
Patients undergoing cavotricuspid isthmus (CTI) ablation of typical
right atrial flutter (AFL) frequently develop new-onset atrial
fibrillation (AF) within three years after
ablation.1-3 Previous studies investigating risk
factors for incident AF after AFL ablation have yielded inconsistent
results, and have not commonly included detailed echocardiographic data,
or electrophysiology study data.4-6 Recently, the
HATCH score, a risk score incorporating hypertension, age
>75 years old, stroke/transient ischemic attack, chronic
obstructive pulmonary disease, and heart failure, has been proposed as a
predictor of AF after AFL ablation,7-8 but its utility
in clinical decision making remains unclear. Multiple randomized trials
have demonstrated the benefit of prophylactic pulmonary vein isolation
(PVI) for patients undergoing CTI dependent AFL
ablation.9-13 However, prophylactic PVI during AFL
ablation is not widely performed, and not included in clinical
guidelines.14 Patients at greatest risk of developing
incident AF after AFL ablation may derive the greatest benefit from
either prophylactic PVI, or intensified monitoring to guide
anticoagulation therapy.9-12 We aimed to investigate
risk factors, including detailed echocardiography data, and invasive
electrophysiology study data, for development of incident AF following
AFL ablation.