Ablation of CTI-dependent flutter using different ablation technologies: acute and long-term outcome from the LEONARDO study

Maglia, Giampiero; Pentimalli, Francesco; Verlato, Roberto; Solimene, Francesco; Malacrida, Maurizio; Aspromonte, Vittorio; Bacino, Luca; Turrini, Pietro; Infusino, Tommaso; Greca, Carmelo La; Perego, Giovanni Battista; Papa, Andrea Antonio; Ruvo, Ermenegildo De; Zingarini, Gianluca; Devecchi, Chiara; Scaglione, Mariano; Tomasi, Corrado; Pirrotta, S.; Stabile, Giuseppe

doi:10.1007/s10840-023-01519-7

Cited by 3 publications

(1 citation statement)

References 21 publications

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“…Unlike atypical flutters where additionally to short post-pacing intervals (and concealed fusion) critical sites are required to be evaluated during electroanatomic mapping, by defining anatomic/scar boundaries with fragmented electrograms [ 101 ], in typical flutters the presence of abnormal electrograms has only been demonstrated very occasionally before ablation, in a limited number of patients [ 102 , 103 ], and its significance is uncertain [ 104 , 105 , 106 , 107 ]. The use of high-density mapping could add new data, not observed with a conventional catheter.…”

Section: Electrophysiological Study and Ablation Techniquesmentioning

confidence: 99%

Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation

Abdala-Lizarraga,

Quesada-Ocete,

Quesada-Ocete

et al. 2024

Rev. Cardiovasc. Med.

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The demonstration of a peritricuspid circular movement with a zone of slow conduction in the cavotricuspid isthmus, together with the high efficacy of linear ablation and widely accepted acute endpoints, has established typical flutter as a disease with a well-defined physiopathology and treatment. However, certain aspects regarding its deeper physiopathology, ablation targets, and methods for verifying the results remain to be clarified. While current research efforts have primarily been focused on the advancement of effective ablation techniques, it is crucial to continue exploring the intricate electrophysiological, ultrastructural, and pharmacological pathways that underlie the development of atrial flutter. This ongoing investigation is essential for the development of targeted preventive strategies that can act upon the specific mechanisms responsible for the initiation and maintenance of this arrhythmia. In this work, we will discuss less ascertained aspects alongside the most widely recognized general data, as well as the most recent or less commonly used contributions regarding the electrophysiological evaluation and ablation of typical atrial flutter. Regarding electrophysiological characteristics, one of the most intriguing findings is the presence of low voltage zones in some of these patients together with the presence of a functional, unidirectional line of block between the two vena cava. It is theorized that episodes of paroxysmal atrial fibrillation can trigger this line of block, which may then allow the onset of stable atrial flutter. Without this, the patient will either remain in atrial fibrillation or return to sinus rhythm. Another of the most important pending tasks is identifying patients at risk of developing post-ablation atrial fibrillation. Discriminating between individuals who will experience a complete arrhythmia cure and those who will develop atrial fibrillation after flutter ablation, remains essential given the important prognostic and therapeutic implications. From the initial X-ray guided linear cavotricuspid ablation, several alternatives have arisen in the last decade: electrophysiological criteria-directed point applications based on entrainment mapping, applications directed by maximum voltage criteria or by wavefront speed and maximum voltage criteria (omnipolar mapping). Electro-anatomical navigation systems offer substantial support in all three strategies. Finally, the electrophysiological techniques to confirm the success of the procedure are reviewed.

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Section: Electrophysiological Study and Ablation Techniquesmentioning

confidence: 99%

Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation

Abdala-Lizarraga,

Quesada-Ocete,

Quesada-Ocete

et al. 2024

Rev. Cardiovasc. Med.

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Isthmus-dependent right atrial flutter

Jilek,

Gleirscher,

Strzelczyk

et al. 2023

Herzschr Elektrophys

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Exploring Inflammatory Markers and Risk Factors Associated with Pericarditis Development after Ablation for Atrial Fibrillation

Yakut,

Konte,

Ozeke

2024

JCM

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Background: This study aimed to explore the association between inflammatory markers and the occurrence of post-atrial fibrillation (AF) ablation pericarditis (PAP), while also examining the PAP’s incidence and contributing factors. Methods: A retrospective cohort study was conducted between January 2021 and November 2023, including patients who underwent successful AF ablation. Inflammatory markers of interest included the systemic immune-inflammation index (SII), the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR). Results: Among the 231 patients examined, 22 (9.52%) were classified as suspected PAP, and 14 (6.06%) as definitive PAP. The median age was 58 years, with no age difference between groups. Males comprised 51.52% of the sample, with male sex frequency significantly higher in the suspected PAP group relative to the other groups (p = 0.007). Multivariable logistic regression indicated that AF duration (p = 0.026) and cavotricuspid isthmus (CTI) ablation (p = 0.001) were associated with definitive PAP, whereas analysis for any pericarditis (suspected or definitive PAP) revealed independent relationships with CTI ablation (p = 0.003) and sleep apnea (p = 0.008). SII, NLR, and PLR were not associated with PAP. Conclusions: Prolonged AF duration, CTI ablation, and sleep apnea are risk factors for PAP. The inflammatory markers (SII, NLR, and PLR) showed no association, warranting further investigation into other markers.

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Ablation of CTI-dependent flutter using different ablation technologies: acute and long-term outcome from the LEONARDO study

Cited by 3 publications

References 21 publications

Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation

Cavotricuspid Isthmus-Dependent Atrial Flutter. Beyond Simple Linear Ablation

Isthmus-dependent right atrial flutter

Exploring Inflammatory Markers and Risk Factors Associated with Pericarditis Development after Ablation for Atrial Fibrillation

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