Radio-Frequency Ablation of Atrial Flutter: Long-Term Results and Predictive Value of Cavo-Tricuspid Isthmus Bidirectional Block as Determined by a Simplified Technique

Abstract

Objectives: Complete bidirectional cavo-tricuspid isthmus (CTI) block is mandatory for radio-frequency (RF) ablation of typical atrial flutter (AF). CTI block can be assessed by a simplified method using two catheters and the technique of differential pacing, but long-term results in large series are poorly known. Methods: CTI RF ablation was performed in 255 consecutive patients with typical AF, using one quadripolar catheter, and the ablation catheter, in association with the technique of differential pacing. Results: Procedural success, as defined by documentation of complete bidirectional CTI block using limited activation mapping, positive differential pacing together with termination of ongoing AF, was achieved in 80% of patients. AF recurred in 37 patients (14%) over a mean follow-up period of 15 ± 9 months. Two hundred and forty-one patients (94%) were finally cured, with 1.1 procedures/patient. The recurrence rate was related to the achievement of complete CTI bidirectional block (12% vs. 29%, p = 0.01). Conclusions: Long-term results of CTI ablation, employing a simplified method using the differential pacing technique, are similar to those for the standard methods using multipolar catheters. Therefore, this technique compares favorably to other established methods for such common RF procedures, especially due to its lower cost.

The Electroanatomic Mechanisms of Atrial Tachycardia in Patients with Tetralogy of Fallot and Double Outlet Right Ventricle

“…It is also significantly easier to demonstrate conduction block across a newly created CTI ablation line in comparison to one that has been created on the RA free wall. While it has not been demonstrated to be of value in predicting the recurrence of IART in patients with CHD, the use of bidirectional block has been shown to be a better endpoint for a successful atrial flutter ablation compared to the previously used endpoints of tachycardia termination during ablation or lack of inducibility 22 …”

Interest of waiting time for spontaneous early reconnection after cavotricuspid isthmus ablation: A monocentric randomized trial

“…Different validation methods of BCB have been published . However, despite these validation methods, several studies and national registries suggest that RF ablation of AFl is still associated with a 10% recurrence rate . Most of these recurrences are associated with very early CTI conduction recovery after RF application .…”

“…[7][8][9][10] However, despite these validation methods, several studies and national registries suggest that RF ablation of AFl is still associated with a 10% recurrence rate. [11][12][13] Most of these recurrences are associated with very early CTI conduction recovery after RF application. [14][15][16] Despite the lack of any long-term study with clinical follow-up, it is currently recommended to observe a period of 30 minutes after RF application in order to check for early reconduction and reablation if necessary.…”

A Two-Catheter Technique for Ablating Atrial Flutter? Sometimes the Simplest Recipes Make for the Best Cooking

“…In this issue of Cardiology , Maury et al [5] describe a simplified technique for ablation of atrial flutter involving insertion of just 2 catheters: a reference recording catheter and a steerable mapping/ablation catheter. Thus, only 2 femoral venous sheaths were used to ablate atrial flutter utilizing this modified technique.…”

“…Let us also remember that atrial flutter is not a disease exclusive to developed countries. The simplified flutter ablation technique described by Maury et al [5] , along with reprocessed catheters, will make an atrial flutter ablation procedure one of the most cost-effective cardiac procedures now available and should allow legions of poorer patients the chance to achieve cure of their atrial flutter.…”