A retrospective evaluation of catheter ablation in atrial flutter post cardiac transplantation.

Background Atrial flutter is the most common arrhythmia post cardiac transplantation. Observational studies in the non transplant population have shown prognostic benefit with catheter ablation, however there are no data in the heart transplant population. Objectives This study evaluated the experience of catheter ablation in atrial flutter post cardiac transplantation. Methods A retrospective review of experience of late onset atrial flutter at the Freeman Hospital, Newcastle-upon-Tyne, United Kingdom, between 1985 and January 2020. Results Sixty eight of the 722 patients who survived 6 months post cardiac transplantation developed late atrial flutter giving an incidence of 9.4%. Thirty two patients were managed with ablation with treatment largely determined by time of flutter onset. Kaplan Meier estimates for arrhythmia free survival post first ablation for organised atrial arrhythmias was 83.3% at 1 year. Kaplan-Meier estimates for median survival post onset of atrial arrhythmias treated with ablation was 11.34 years (95% CI 8.00-14.57), compared to 5.79 years in patients managed medically (95%CI 2.26-9.32) (p = 0.026). Conclusions Atrial flutter is an important late complication of cardiac transplantation. Patients treated with ablation in the modern era had increased survival compared to a historical cohort. This article is protected by copyright. All rights reserved.