Reduction in Atrial Flutter Ablation Time by Targeting Maximum Voltage: Results of a Prospective Randomized Clinical Trial

Gula, Lorne J.; Redfearn, Damián P.; Veenhuyzen, George D.; Krahn, Andrew D.; Yee, Raymond; Klein, George J.; Skanes, Allan C.

doi:10.1111/j.1540-8167.2009.01511.x

Cited by 37 publications

(48 citation statements)

References 24 publications

(37 reference statements)

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“…Redfearn et al described an ablation strategy that targets MVE in CTI ablation (ie, critical conducting bundles) that has demonstrated similar success rates to the traditional anatomical CTI line formation (the so-called ''drag'' technique), but which necessitates fewer ablation lesions and lower radiation exposure times. 8,9 In our cohorts, the number of lesions required to achieve bidirectional block was 8.3 ± 7.6 in the CF group and 13.2 ± 9 in the control (non-CF) group.…”

Section: Discussionmentioning

confidence: 99%

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Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Boles

Gül

Fitzpatrick

et al. 2017

JICRM

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ABSTRACT. The application of optimum contact force (CF) can be used to improve ablation procedure success and safety. The lesion size index (LSI) is a novel dimensionless contact force parameter that allows for an accurate estimation of lesion volume in real time by integrating contact force (grams), duration (seconds) and power (watts). The aim was to correlate LSI values with current contact force parameters to achieve successful and safe bidirectional block of the cavotricuspid isthmus (CTI) using a maximum voltage-guided (MVG) ablation strategy. Fifteen consecutive patients (age 69±7.9 years, nine males) with symptomatic atrial flutter (AFL) were evaluated and compared with 23 control (age 66.3 ± 10.4 years, 16 males) non-contact forceguided ablation cases. Irrigated-tip force-sensing ablation catheters (TactiCath Quartzt, St. Jude Medical, St. Paul, MN, USA) were used in the CF group to achieve the primary endpoint of complete bidirectional block of the isthmus. In the CF group, a total of 233 radiofrequency (RF) applications were examined. A mean LSI of 6.4 ± 1.0 correlated with a force-time integral (FTI) of 581.2±230.9 g/s and an average CF of 13.9±4.9 g concurrently. Intraprocedural, fluoroscopy time and RF time demonstrated lower trends in the CF group, but no significance with respect to these trends was observed. The secondary endpoint of no reconnection within 20 min after the procedure was equally attained in both groups, and, likewise, the level of safety was comparable. An LSI value of 45 represents a new effective parameter in MVG ablation for the cavotricuspid region that demonstrates a safe profile. Guidance of CTI ablation using LSI and other contact force parameters of CF 13.9 ± 4.9 g and FTI 581.2 ± 230.9 g/s demonstrated highly effective and safe outcomes.

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Section: Discussionmentioning

confidence: 99%

“…This method has the advantages of requiring significantly less RF ablation time and procedure time, as it does not necessitate the completion of the CTI line anatomically, as is done in the traditional ''drag'' technique. 8,9 Modern RF CTI ablation techniques for typical AFL have already been shown to be safe and effective.…”

Section: Introductionmentioning

confidence: 99%

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Boles

Gül

Fitzpatrick

et al. 2017

JICRM

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“…For typical flutter, the maximum voltage-guided RF was applied until complete bidirectional block was achieved as previously described. 8 RF energy was delivered at a predefined target power of 35-40 W with irrigation at 25 ml/min with NaCl 0.9%. Atrial tachycardia was performed similarly with the power determined by location.…”

Section: Contact Force and Ablation Proceduresmentioning

confidence: 99%

Dynamic Ranges of Contact Force During Radiofrequency Ablation

Boles¹,

Enríquez²,

Riegert³

et al. 2016

JICRM

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ABSTRACT. The aim was to assess the dynamic range for contact force (CF df ) in order to achieve an effective lesion according to anatomic variables under conscious sedation. We retrospectively studied 674 radiofrequency (RF) lesions (21 procedures) at Kingston General Hospital. Consecutive patients employing a CF catheter were recruited. A force-sensing catheter was used to continuously record CF data and force-time integral (FTI) during each lesion. The CF df represents the difference between the highest and lowest recorded contact force for each RF application. Out of 674 lesions examined, we included 438 (65%). The CF df was significantly greater in the left atrium than in the right (36.6±20.3 versus 28.7±16.4, po0.01). Except in the cavotricuspid isthmus, the FTI lesions equal or are more than 400 g/s required higher CF df in all anatomical locations, and these differences reached statistical difference on the right atrial free wall, left atrial posterior wall, and right pulmonary vein antrum (p ¼ 0.011, 0.007, and o0.001). Yet, higher CF df is an independent predictor for less successful lesions in stepwise regression model. Left atrial enlargement above 46 mm was associated with lower CF df , CF av , and CF max (p ¼ 0.04, o0.001, and 0.02 respectively). This study represents the first detailed assessment of CF df in conscious sedation patients. Significant variations in the CF df were associated with different anatomic locations. We found that the greater the dynamic range the less likely the lesion would reach 400 g/s. Smaller atria were associated with higher dynamic ranges and greater peak and average forces.KEYWORDS. Average contact force, dynamic range for contact force, force time integral, maximum contact force, radiofrequency ablation.

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“…“This ablation approach operates on the hypothesis that the muscle bundles in CTI act like a variably thick sheet of tissue and block can be obtained without ablation of the entire isthmus by targeting only the functionally important muscle bundles” [44]. The same group in a prospective, randomized trial demonstrated that using the voltage-guided technique for CTI ablation significantly reduces RFA time and the number of ablation lesions in comparison with the anatomically-guided strategy although without “ a significant reduction in procedure or fluoroscopy time” [45]. Other studies have supported these results [46-48].…”

Section: Tools Facilitating Rfa Of the Ctimentioning

confidence: 99%

Novel Strategies in the Ablation of Typical Atrial Flutter: Role of Intracardiac Echocardiography

Bencsik

2014

CCR

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Radiofrequency ablation (RFA) of the cavo-tricuspid isthmus (CTI) is one of the most frequently performed procedures in electrophysiology. Despite a high success rate, ablation of the CTI can be unusually difficult in some cases. Multiple tools like angiography, 3D mapping, remote navigation and intracardiac echocardiography (ICE) have been introduced to facilitate typical flutter ablation. This review article summarizes the clinical value of different strategies and tools used for CTI ablation focusing on the importance of approaches utilizing ICE.

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Reduction in Atrial Flutter Ablation Time by Targeting Maximum Voltage: Results of a Prospective Randomized Clinical Trial

Abstract: Ablation for atrial flutter using an MVG technique results in significantly less ablation requirements than the traditional approach, potentially by concentrating ablation lesions on the muscle bundles responsible for transisthmus conduction.

Cited by 37 publications

References 24 publications

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Lesion Size Index in Maximum Voltage-Guided Cavotricuspid Ablation for Atrial Flutter

Dynamic Ranges of Contact Force During Radiofrequency Ablation

Novel Strategies in the Ablation of Typical Atrial Flutter: Role of Intracardiac Echocardiography

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