Diagonal Earlobe Crease and the Risk of New-Onset Atrial Fibrillation After Cavotricuspid Isthmus Ablation in Patients with Typical Atrial Flutter

<b>B</b><b>ackground:</b> Atrial fibrillation (AF) frequently develops in patients with atrial flutter (AFL), even after successful cavotricuspid isthmus (CTI) ablation. Identifying simple clinical markers for early detection is crucial. Diagonal earlobe crease (ELC), also known as Frank's sign, has been proposed as a marker of aging and cardiovascular risk. This study investigates the association between ELC and the risk of new-onset AF following CTI ablation in patients with AFL. <b>Methods:</b> We conducted a retrospective cohort study of 292 patients without a prior history of AF who underwent CTI ablation for typical AFL between 2015 and 2024. The presence of ELC was assessed at baseline CTI ablation. The primary outcome was the occurrence of new-onset AF during follow-up, stratified according to the presence of ELC. The median follow-up duration was 49 months, with a minimum follow-up of 6 months. <b>Results:</b> Among the 292 patients, 72 (24.7%) exhibited ELC. Patients with ELC were older (59 ± 11 years vs. 55 ± 14 years, <i>p</i> = 0.05). During the follow-up period, new-onset AF occurred in 31 patients with ELC (43.1%) and 65 patients without ELC (29.5%) (<i>p</i> = 0.03). Kaplan-Meier analysis demonstrated that the occurrence of AF was significantly higher in the ELC group than in the non-ELC group (log-rank test, <i>p</i> = 0.013). Multivariate analysis revealed that ELC was independently associated with an increased risk of AF (hazard ratio 1.67, 95% confidence interval 1.03-2.72, <i>p</i> = 0.039). <b>Conclusions:</b> The presence of ELC is associated with a higher risk of new-onset AF following CTI ablation in patients with AFL. ELC may serve as a simple, non-invasive clinical marker to identify patients who may benefit from closer rhythm surveillance after AFL ablation.