Practice Patterns for Anticoagulation Monitoring Post Successful Typical Flutter Ablation and Related Outcomes: An ITHACA-Database Study

Heart Rhythm. 2026 Apr 15:S1547-5271(26)02252-6. doi: 10.1016/j.hrthm.2026.04.005. Online ahead of print.

ABSTRACT

BACKGROUND: The optimal atrial fibrillation (AF) monitoring and anticoagulation (AC) strategies remain unclear for patients post typical atrial flutter (tAFL) ablation.

OBJECTIVE: To document real-world management of patients post AFL ablation.

METHODS: In this contemporary cross-sectional analysis patients undergoing tAFL ablation without a history of AF at Northwell Health from 2015 -2024 were identified in the ITHACA-database [median follow-up 5.4 years].

RESULTS: A total of 1,236 patients (66.4 ± 12.0 years, 21.0% female, median CHA₂DS₂-VASc 3.0) underwent tAFL ablation, 36.4% (451/1,236), were diagnosed with AF after a median of 2.2 years. AC was continued in 63.0% of patients post tAFl, those with CHA₂DS₂-VASc ≥3 were 32% more likely to continue AC. Most patients were monitored via standard of care (71.8%), 15.0% had an implantable pacing device and 13.2% had an implantable loop recorder (ILR). Patients with CHA₂DS₂-VASc ≥3, were 27% more likely to have ILR. ILRs led to a higher rate of AF detection (55.2%) and a shorter time to diagnosis (19 months). Strokes occurred in patients (18,1.5%) with high CHA₂DS₂-VASc (4.3) even while on AC (55.6%), with most diagnosed with AF (72.2%).

CONCLUSION: This 5.4-year real-world analysis reveals that most clinicians continue AC post tAFL ablation despite its 2B indication. ILRs offer an alternative and more effective method for monitoring patients who discontinue AC. AF was asymptomatic in most patients, yet it was found in the majority of those who experienced a stroke, 55.6% of whom were maintained on AC at the time of the event.

PMID:41997386 | DOI:10.1016/j.hrthm.2026.04.005