Cavotricuspid Isthmus: Anatomy, Electrophysiology, and Long‐Term Outcome of Radiofrequency Ablation

Abstract

The cavotricuspid isthmus (CTI) had a complex architecture with an anisotropic conduction property. An incremental pacing from the low right atrial isthmus produced a conduction delay and block, and initiated atrial flutter. Radiofrequency catheter ablation of the CTI was very effective in eliminating the typical atrial flutter. However, atrial fibrillation often occurred after ablation of the isthmus and needs further treatment.

Catheter Ablation for Atrial Arrhythmias in Patients With Cardiac Amyloidosis

“…Next, a significant proportion of CA‐A patients underwent ablations for typical AFL or AT (8 of 13), for which results are typically better than atrial fibrillation ablation procedures . Interestingly, ablation times (used as a measure of technical complexity) were much longer in duration than would be expected (usually between 10 and 50 minutes), suggesting perhaps additional difficulty with ablation in patients with CA . Furthermore, a significant fraction of patients in the CA‐A group received antiarrhythmic medications for sinus rhythm maintenance, indicating that a combination of catheter‐based and medical therapies may be needed to effectively control symptoms in this group of patients.…”

Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

“…In cases of typical atrial flutter, the cava tricuspid isthmus was targeted using standard protocol as previously described [9]. Interruption was validated with differential pacing.…”

Atrial Flutter: Diagnosis and Management strategies

“…The pectinates, spare the myocardium just in atrial part of the tricuspid valve and makes the smooth portion of the CTI which is referred to as the vestibular portion. Of note, the septal part of the CTI is adjacent to the posterior extensions of the AV node as well as the middle cardiac vein [5,6]. This anatomic proximity explains the higher risk of AV block if ablation is done in the septal aspect.…”