Although CTI ablation is highly effective for treating typical AFL, new-onset AF remains a frequent complication. A retrospective study published in The American Journal of Cardiology evaluated predictors of AF after CTI ablation in patients without prior AF.

The analysis included 153 patients treated between 2016 and 2022 at the Medical College of Georgia. Over a median follow-up of 264 days, 44 patients (29%) developed new-onset AF. AF occurred more often in men, in those with hypertension, and in those with higher LAVI values (40.6 ± 12.2 vs 34.2 ± 9.5 mL/m², P < 0.001).

On multivariable Cox regression, female sex (hazard ratio [HR] 0.31, 95% confidence interval [CI] 0.12–0.76, P = 0.011) and prior cardiac surgery (HR 0.22, 95% CI 0.07–0.72, P = 0.013) were independently protective. Higher LAVI trended toward greater AF risk (HR 1.02, 95% CI 1.00–1.05, P = 0.08).

These results indicate that almost one-third of AFL patients develop AF after CTI ablation. Identifying individuals with male sex, elevated LAVI, or no prior cardiac surgery may help guide targeted rhythm surveillance and inform the decision to perform concomitant AF ablation in selected patients