Early Cavotricuspid Isthmus Ablation Reduces Long-Term AF, Heart Failure, and Stroke in Patients with AFL

Abstract 2279542, presented at Western Atrial Fibrillation Symposium 2026

Patients with atrial flutter (AFL) are at an increased risk of adverse events including atrial fibrillation (AF), heart failure, and stroke among others. However, the effect of cavotricuspid isthmus ablation on the incidence of these events in patients with AFL remains unknown.Using the TriNetX network (2010-2025) we identified patients that underwent cavotricuspid isthmus (CTI) ablation within 3 months of diagnosis (n = 2875) and compared them to patients that did not receive CTI (n = 16914). Propensity score matching (1:1) was performed for demographics, medications and comorbidities. We assessed patients for development of AF, other arrhythmias (PAC, PVC, Sick sinus syndrome), heart failure, and ischemic stroke over a 10 year follow up period. Cox regression and Kaplan–Meier survival analyses were used to estimate hazard ratios (HR) with 95% confidence intervals (CI).2875 patients remained in each group after matching. Patients that underwent CTI within 3 months of AFL diagnosis had significantly less incidence of AF (HR: 0.896, CI: 0.803 – 0.999, p = 0.048), HF (HR: 0.701, CI: 0.594 – 0.828, p < 0.001), and ischemic stroke (HR: 0.733, CI: 0.541 – 0.994, p = 0.045). However, these patients also had an increase in other arrhythmias (HR: 1.271, CI: 1.084-1.491, p = 0.003).Patients with a new diagnosis of AFL should be encouraged to undergo CTI within 3 months of diagnosis.