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

Marchandise, Sébastien; Scavée, Christophe; Barbraud, Cynthia; Meester, Christophe de; Bagalwa, Mittérand Balola; Goesaert, Cédric; Reis-Pinheiro, Ivone; Waroux, Jean-Benoît le Polain de

doi:10.1111/pace.13207

Cited by 3 publications

(3 citation statements)

References 21 publications

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“…8 Acute recovery of CTI conduction after a waiting period, following the documentation of bidirectional CTI block, is related to higher AFL recurrence rate in the long term. 14 Additionally, adenosine administration can help unmask dormant transisthmus conduction, known to precede recovery of permanent CTI conduction. 15 In our study, we incorporated these two approaches to compare the acute procedural efficacy of CTI ablation using two different target FTI values during sequential spot lesion deployment.…”

Section: Discussionmentioning

confidence: 99%

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Cavotricuspid isthmus ablation guided by force‐time integral – A randomized study

Asvestas

Sousonis

Kotsovolis

et al. 2022

Clinical Cardiology

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Background Force‐time integral (FTI) is an ablation marker of lesion quality and transmurality. A target FTI of 400 gram‐seconds (gs) has been shown to improve durability of pulmonary vein isolation, following atrial fibrillation ablation. However, relevant targets for cavotricuspid isthmus (CTI) ablation are lacking. Hypothesis We sought to investigate whether CTI ablation with 600 gs FTI lesions is associated with reduced rate of transisthmus conduction recovery compared to 400 gs lesions. Methods Fifty patients with CTI‐dependent flutter were randomized to ablation using 400 gs (FTI400 group, n = 26) or 600 gs FTI lesions (FTI600 group, n = 24). The study endpoint was spontaneous or adenosine‐mediated recovery of transisthmus conduction, after a 20‐min waiting period. Results The study endpoint occurred in five patients (19.2%) in group FTI400 and in four patients (16.7%) in group FTI600, p = .81. First‐pass CTI block was similar in both groups (50% in FTI400 vs. 54.2% in FTI600, p = .77). There were no differences in the total number of lesions, total ablation time, procedure time and fluoroscopy duration between the two groups. There were no major complications in any group. In the total population, patients not achieving first‐pass CTI block had significantly higher rate of acute CTI conduction recovery, compared to those with first‐pass block (29.2% vs. 7.7% respectively, p = .048). Conclusions CTI ablation using 600 gs FTI lesions is not associated with reduced spontaneous or adenosine‐mediated recurrence of transisthmus conduction, compared to 400 gs lesions.

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Section: Discussionmentioning

confidence: 99%

“…Acute recovery of CTI conduction after a waiting period, following the documentation of bidirectional CTI block, is related to higher AFL recurrence rate in the long term 14 . Additionally, adenosine administration can help unmask dormant transisthmus conduction, known to precede recovery of permanent CTI conduction 15 .…”

Section: Discussionmentioning

confidence: 99%

Cavotricuspid isthmus ablation guided by force‐time integral – A randomized study

Asvestas

Sousonis

Kotsovolis

et al. 2022

Clinical Cardiology

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“…When this line was completed, the presence of BDB was assessed by counterclockwise and clockwise activation maps pacing from the proximal CS or the ablation catheter (positioned laterally to the CTI line) respectively. If BDB was present after this first ablation line and persisted after a waiting time of 30 min ( 18 ), first-pass conduction block was established ( 5 ), and all RF applications were considered successful. If BDB was not present after the first ablation line or we detected and early recovery in conduction across the CTI during the waiting time, an activation map along the CTI line was performed from the TA to the IVC to localize the gap.…”

Section: Methodsmentioning

confidence: 99%

Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach

Melero-Polo,

Cabrera-Ramos,

Alfonso-Almazán

et al. 2024

Front. Cardiovasc. Med.

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IntroductionA new technology capable of monitoring local impedance (LI) and contact force (CF) has recently been developed. At the same time, there is growing concern regarding catheter ablation performed under fluoroscopy guidance, due to its harmful effects for both patients and practitioners. The aim of this study was to assess the safety and effectiveness of zero-fluoroscopy cavotricuspid isthmus (CTI) ablation monitoring LI drop and CF as well as to elucidate if these parameters can predict successful radiofrequency (RF) applications in CTI ablation.MethodsWe conducted a prospective observational study recruiting 50 consecutive patients who underwent CTI ablation. A zero-fluoroscopy approach guided by the combination of LI drop and CF was performed. In each RF application, CF and LI drop were monitored. A 6-month follow-up visit was scheduled to assess recurrences.ResultsA total of 767 first-pass RF applications were evaluated in 50 patients. First-pass effective RF applications were associated with greater LI drops: absolute LI drops (30.05 ± 6.23 Ω vs. 25.01 ± 5.95 Ω), p = 0.004) and relative LI drops (−23.3 ± 4.9% vs. −18.3 ± 5.6%, p = 0.0005). RF applications with a CF between 5 and 15 grams achieved a higher LI drop compared to those with a CF below 5 grams (29.4 ± 8.76 Ω vs. 24.8 ± 8.18 Ω, p < 0.0003). However, there were no significant differences in LI drop between RF applications with a CF between 5 and 15 grams and those with a CF beyond 15 grams (29.4 ± 8.76 Ω vs. 31.2 ± 9.81 Ω, p = 0.19). CF by itself, without considering LI drop, did not predict effective RF applications (12.3 ± 7.54 g vs. 11.18 ± 5.18 g, p = 0.545). Successful CTI ablation guided by a zero-fluoroscopy approach was achieved in all patients. Only one patient experienced a recurrence during the 6-month follow-up.ConclusionsLI drop (absolute and relative values) appears to be a good predictor of successful RF applications to achieve CTI conduction block. The optimal CF to achieve a good LI drop is between 5 and 15 g. A zero-fluoroscopy approach guided by LI and CF was feasible, effective, and safe.

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Comparative Efficacy of Cavotricuspid Isthmus Ablation in Sinus Rhythm Versus Typical Atrial Flutter

Katov,

Teumer,

Schlarb

et al. 2024

Hearts

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Background: Cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is the most common atrial macro-reentrant tachycardia, characterized by a typical ECG pattern (type I ECG). Often, tachycardia terminates before it can be confirmed by an electrophysiological study (EPS), necessitating CTI ablation in sinus rhythm (SR). This study aims to compare the success rate of CTI ablation in patients with type I ECG during SR versus ongoing CTI-dependent AFL, focusing on arrhythmia recurrence. Methods: We screened patients at Ulm University Heart Center from January 2010 to November 2020 with type I ECG who underwent CTI ablation. Patients were divided into two groups: those whose tachycardia terminated before EPS and underwent ablation in SR, and those with ongoing CTI-dependent AFL during EPS. CTI ablation was deemed complete when a bidirectional conductance block was achieved, confirmed after 30 min. Results: A total of 230 patients were included, all showing typical AFL in ECG recordings. Of these, 67 patients underwent ablation in SR, while 163 were ablated during ongoing AFL. The median follow-up time was 2.7 years. Recurrence of CTI-dependent AFL occurred in 8.3% of patients: 4.5% in the SR ablation group and 9.8% in the ongoing AFL group. Kaplan–Meier estimation showed similar efficacy for both methods regarding arrhythmia recurrence (log-rank p = 0.07). Conclusions: Our decade-long study indicates that CTI ablation during SR is as effective as ablation during ongoing CTI-dependent AFL in achieving long-term freedom from arrhythmia. This research supports the efficacy of both techniques in clinical settings, validating a widely practiced approach.

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

Abstract: Waiting 30 minutes after CTI ablation to check for early resumption and early reablation allows for decreasing significantly the rate of recurrent atrial flutter.

Cited by 3 publications

References 21 publications

Cavotricuspid isthmus ablation guided by force‐time integral – A randomized study

Cavotricuspid isthmus ablation guided by force‐time integral – A randomized study

Local impedance and contact force guidance to predict successful cavotricuspid isthmus ablation with a zero-fluoroscopy approach

Comparative Efficacy of Cavotricuspid Isthmus Ablation in Sinus Rhythm Versus Typical Atrial Flutter

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