(P110) ATRIAL FLUTTER ASSESSMENT IN THE VANCOUVER COASTAL ACUTE HEART FAILURE (VOCAL-AHF) REGISTRY

Background: The interplay between atrial fibrillation (AF) and heart failure (HF) has been extensively studied, however there is limited data regarding atrial flutter (AFL) and HF with respect to epidemiology, management, and processes of care. We performed a retrospective cohort study combined with quality assurance to identify the care gaps in patients with AFL and HF.

METHODS AND RESULTS: The cohort comprised 1,866 patients discharged following unplanned hospitalizations (n=2,429) with a primary diagnosis of HF between 2015-2019 from two tertiary Vancouver hospitals. Complete data was available for 2,194 hospitalizations. All ECGs during hospitalization were reviewed for verification and subclassification of AFL into typical or atypical. Management data was collected via manual chart abstraction. 203 (9.3%) of the 2,194 hospitalizations involved 178 unique patients with a documented prior history of AFL. The presenting rhythm on admission was AFL, AF, and sinus rhythm in 97 (47.8%), 59 (29.0%), and 41 (20.2%) of hospitalizations respectively. A total of 115 (56.7%) hospitalizations had AFL documented on at least one ECG during the hospitalization with a breakdown of 81 (70.4%) typical and 34 (29.6%) atypical. History of co-existing AF was present in 145 (71%) of total AFL patient hospitalizations. Acute management during admission predominantly involved rate control (n=98, 85.2%) as opposed to rhythm control (n=17, 14.8%). Those undergoing a rhythm control approach were managed with either electrical cardioversion (n=10, 59%), antiarrhythmic drug therapy (n=3, 18%), or in-hospital ablation (n=4, 24%).

Conclusion: Despite the established success rates of electrical cardioversion and cavotricuspid isthmus ablation in restoring sinus rhythm, still a large majority of patients were managed with a rate control strategy in a contemporary cohort. Rhythm control strategies including transesophageal echocardiogram-guided cardioversion and in-patient ablation are resource intensive which may be a limiting factor.