Arrhythmias & electrophysiologyCross-sectional study
Practice patterns for anticoagulation monitoring after successful typical flutter ablation and related outcomes: An ITHACA-Database study
- contemporary cross-sectional analysis
Authors' conclusion
This 5.4-year real-world analysis reveals that most clinicians continue AC after 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; however, it was found in most patients who experienced a stroke, 55.6% of whom were maintained on AC at the time of the event.
Study context
- Population
- Patients undergoing typical atrial flutter (tAFL) ablation without a history of atrial fibrillation (AF) at Northwell Health from 2015 to 2024, identified in the Investigational NorTHwell Atrial Fibrillation Catheter Ablation-databasepatients who underwent tAFL ablation
- Participants
- 1,236 patients
- Exposure
- standard of care vs implantable pacing device vs implantable loop recorder (ILR)
Main finding
As reported in the abstract
AF diagnosed after tAFL ablation · median of 2.2 years
Diagnosed with AF
36.4% (451/1236)
Observational data: associations, not effects.
Further findings
Monitoring strategy
| Outcome | standard of care | implantable pacing device | implantable loop recorder (ILR) |
|---|---|---|---|
| AF detection with ILR | |||
| AF detection rate | Not reported in the abstract | Not reported in the abstract | 55.2% |
| time to diagnosis | Not reported in the abstract | Not reported in the abstract | 19 months |
- Monitoring strategy — CHA2DS2-VASc ≥3 more likely to have ILR
- 27%
Anticoagulation (AC) continued after tAFl
- AC continued
- 63.0%
- CHA2DS2-VASc ≥3 more likely to continue AC
- 32%
Safety
Stroke
- Strokes occurred in patients
- 18,1.5%
- CHA2DS2-VASc of those with stroke
- 4.3
- of those with stroke, on AC
- 55.6%
- of those with stroke, diagnosed with AF
- 72.2%
Original publication
Practice patterns for anticoagulation monitoring after successful typical flutter ablation and related outcomes: An ITHACA-Database study. Heart Rhythm. Published 15 April 2026. doi:10.1016/j.hrthm.2026.04.005
Summarised from the published abstract; every number is checked against it