Introduction: Catheter ablation (CA) of typical atrial flutter (AFl) is the preferred treatment for typical AFl due to excellent long-term success. However, current guidelines recommend oral anticoagulation (OAC) based on established indices of stroke regardless of the perceived success of ablation. Methods: We identified all patients who underwent typical AFl ablation at our institute from 2011-2017. All patients continued OAC for at least 6 weeks post CA and underwent 24-hour Holter monitoring. OAC was discontinued if there was no evidence of recurrence at 6 weeks. In patients with low LVEF or prior Atrial Fibrillation episodes, OAC was continued for 6 months with repeat Holter monitoring at 6 months. Results: A total of 106 patients were included in our analysis, mean age was 64±14 years and 78.3% were male. Mean CHADSVaSC score was 3±1. OAC was discontinued by 6 weeks in 17% and at 1 year in 55.7%. OAC was continued indefinitely in 44.3%. Over a mean follow up period of 28.6±27.3 months, there was one ischemic stroke in the OAC discontinuation group and no ischemic events in the continued OAC group. There was a total of 3 major bleeding events, all in the OAC group. Conclusion: In patients undergoing successful atrial flutter ablation, a strategy of OAC discontinuation with close rhythm monitoring appears feasible. Benefit of continued OAC in this cohort may be outweighed by the adverse risk of bleeding. Further studies examining rhythm guided OAC can minimize unnecessary exposure to long term anticoagulation.
