Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms.

Lesh, Michael D.; Hare, George F. Van; Epstein, Laurence M.; Fitzpatrick, Adam P.; Scheinman, Melvin M.; Lee, R J; Kwasman, Michael; Grogin, Harlan R.; Griffin, Jerry C.

doi:10.1161/01.cir.89.3.1074

Cited by 420 publications

(167 citation statements)

References 47 publications

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“…Especially in patients with surgically corrected congenital heart disease (CHD) and atrial reentrant arrhythmias, identification of target sites is challenging, because reentrant circuits are complex, with multiple entrances and exit sites. 5 Target sites in these patients are often slow-conducting narrow isthmuses bordered by areas of scar tissue. 6 Voltage criteria have been developed to allow discrimination of these slow-conducting pathways from surrounding scar tissue areas.…”

mentioning

confidence: 99%

Voltage and activation mapping. how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease

Groot¹,

Schalij²,

Zeppenfeld³

et al. 2004

ACC Current Journal Review

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mentioning

confidence: 99%

Voltage and activation mapping. how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease

Groot¹,

Schalij²,

Zeppenfeld³

et al. 2004

ACC Current Journal Review

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“…R adiofrequency (RF) ablation is widely used [1][2][3][4][5][6][7] to cure symptomatic patients with common atrial flutter (AF). Some authors even propose that RF ablation could be used as a first line treatment in this clinical setting.…”

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confidence: 99%

Cavotricuspid Isthmus Mapping to Assess Bidirectional Block During Common Atrial Flutter Radiofrequency Ablation

Chen¹,

Chillou²,

Basiouny³

et al. 1999

Circulation

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Background-We sought to compare published methods to an alternative approach ascertaining cavotricuspid isthmus (CTI) block during atrial flutter ablation. Methods and Results-In 39 consecutive patients who underwent an atrial flutter ablation procedure, a 24-pole mapping catheter was positioned so that 2 adjacent dipoles were bracketing the targeted CTI line of block (LOB), with proximal dipoles lateral to the LOB and distal dipoles in the coronary sinus. Two pacing sites were lateral (positions A and B) and 2 were septal (positions C and D) to the LOB, with locations A and D closest to the LOB. A resulting CTI block was accepted when 3 criteria were fulfilled: (1) complete reversal of the right atrial depolarization on the 24-pole catheter when pacing in the coronary sinus, (2) conduction delays from A to D greater than from B to D, and (3) conduction delays from D to A greater than from C to A. A successful CTI block was obtained in all patients. Before CTI block was obtained, a progressive CTI conduction delay was observed in 11 patients (28.2%). During the procedure, the 3 criteria defined above were either all present or all absent. Conclusions-This study establishes that reversal of the atrial depolarization sequence up to the LOB is a definitive and mandatory criteria of successful atrial flutter ablation. (Circulation. 1999;100:2507-2513.)

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“…[1][2][3][4][5][6][7][8][9][10][11][12] During the evolution of this procedure, diverse approaches have been taken to the identification, location, and extent of target sites within the annular-eustachian ridge isthmus. Initial experience with the end points of flutter termination during radiofrequency energy application and subsequent noninduction of type I atrial flutter were associated with a variable risk of recurrence (10% to 30%).…”

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confidence: 99%

Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter

et al. 1998

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Background-The occurrence of atrial fibrillation after ablation of type I atrial flutter remains an important clinical problem. To gain further insight into the pathogenesis and significance of postablation atrial fibrillation, we examined the time to onset, determinants, and clinical course of atrial fibrillation after ablation of type I flutter in a large patient cohort. Methods and Results-Of 110 consecutive patients with ablation of type I atrial flutter, atrial fibrillation was documented in 28 (25%) during a mean follow-up of 20.1Ϯ9.2 months (cumulative probability of 12% at 1 month, 23% at 1 year, and 30% at 2 years). Among 17 clinical and procedural variables, only a history of spontaneous atrial fibrillation (relative risk 3.9, 95% confidence intervals 1.8 to 8.8, Pϭ0.001) and left ventricular ejection fraction Ͻ50% (relative risk 3.8, 95% confidence intervals 1.7 to 8.5, Pϭ0.001) were significant and independent predictors of subsequent atrial fibrillation. The presence of both these characteristics identified a high-risk group with a 74% occurrence of atrial fibrillation. Patients with only 1 of these characteristics were at intermediate risk (20%), and those with neither characteristic were at lowest risk (10%). The determinants and clinical course of atrial fibrillation did not differ between an early (Յ1 month) compared with a later onset. Atrial fibrillation was persistent and recurrent, requiring long-term therapy in 18 patients, including 12 of 19 (63%) with prior atrial fibrillation and left ventricular dysfunction. Conclusions-Atrial fibrillation after type I flutter ablation is primarily determined by the presence of a preexisting structural and electrophysiological substrate. These data should be considered in planning postablation management. The persistent risk of atrial fibrillation in this population also suggests a potentially important role for atrial fibrillation as a trigger rather than a consequence of type I atrial flutter. (Circulation. 1998;98:315-322.)

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Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms.

Cited by 420 publications

References 47 publications

Voltage and activation mapping. how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease

Voltage and activation mapping. how the recording technique affects the outcome of catheter ablation procedures in patients with congenital heart disease

Cavotricuspid Isthmus Mapping to Assess Bidirectional Block During Common Atrial Flutter Radiofrequency Ablation

Atrial Fibrillation After Radiofrequency Ablation of Type I Atrial Flutter

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