“Largest Amplitude Ablation” is the Optimal Approach for Typical Atrial Flutter Ablation: A Subanalysis from the AURUM 8 Study

Lewalter, Thorsten; Lickfett, Lars; Weiß, Christian; Mewis, Christian; Spencker, Sebastian; Jung, Werner; Haverkamp, Wilhelm; Schwacke, Harald; Deneke, Thomas; Proff, Jochen; Dorwarth, Uwe; Bauer, Wolfgang R.

doi:10.1111/j.1540-8167.2011.02252.x

Cited by 17 publications

(15 citation statements)

References 21 publications

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“…9,17, 18 In addition, the difference in catheter stability, especially with respiration, might affect successful ablation line position. Quantitative evaluation of catheter stability using a…”

Section: Study Limitationsmentioning

confidence: 99%

Counterclockwise Heart Rotation Affects Variation in Successful Ablation Line Position in Common Atrial Flutter

Machino

Tada

Sekiguchi

et al. 2014

Circ J

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SubjectsThis study included 94 consecutive patients (80 men; mean age, 58±11 years; range, 24-83 years) without any structural heart disease who underwent AFL ablation at Tsukuba University Hospital. Prophylactic AFL ablation was performed during ablation of atrial fibrillation in 84 patients without any clinical AFL, 7 and curative AFL ablation was performed in the remaining 10 patients with clinical AFL. Ethics approval was obtained from the institutional review committee, and all patients gave their informed, written consent before participation. AFL Ablation ProcedureThe AFL ablation was performed with an 8-mm-tip, quadripolar, deflectable, 2-5-2 inter-electrode-spaced and temperaturecontrolled ablation catheter (Ablaze, single directional E curve, Japan Life Line) supported by a long guiding introducer (SL0, St. Jude Medical). To create linear lesions, radiofrequency (RF) atheter ablation has become well established as a curative treatment for typical atrial flutter (AFL). 1-3 A successful AFL ablation is achieved by creating a linear lesion with bidirectional conduction block in the cavotricuspid isthmus (CTI). The central part of the CTI (central CTI) is a reasonable site for creating the linear lesion, because it has a shorter length and thinner myocardium. 3,4 Therefore, AFL ablation targets the central CTI, which is speculated to be at a 6 o'clock position on left anterior oblique (LAO) view. The linear lesion for successful AFL ablation, however, varies from a 5 to 7 o'clock position on LAO view. Although previous studies have reported several predictors of successful AFL ablation, they have not sufficiently investigated the variation in successful AFL ablation line position. 5, 6 The aim of this study was to clarify the factors affecting variation in successful AFL ablation line position.

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Section: Study Limitationsmentioning

confidence: 99%

Counterclockwise Heart Rotation Affects Variation in Successful Ablation Line Position in Common Atrial Flutter

Machino

Tada

Sekiguchi

et al. 2014

Circ J

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“…Therefore, we used an 8 mm tip catheter throughout the study. The usefulness of a voltage‐guided technique to target the high‐voltage electrograms along the CTI to ablate the functionally important anatomical muscle bundles was reported recently . The results of this study may be useful for overcoming difficult cases with this approach.…”

Section: Discussionmentioning

confidence: 63%

Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis

Kajihara¹,

Nakano²,

Hirai³

et al. 2013

Cardiovasc electrophysiol

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Variable Strategies for CTI AblationObjectivesThis study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies.Methods and ResultsThis study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02).ConclusionChanging the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.

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“…Thus, long-term successful follow should be achieved similar to Lewalter et al in which the gold tip catheter subgroup was 98%. [5,21] …”

Section: Discussionmentioning

confidence: 99%

Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach

Deutsch¹,

Śledź²,

Mazij³

et al. 2017

Medicine

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Radiofrequency catheter ablation (RFCA) is an established effective method for the treatment of typical cavo-tricuspid isthmus (CTI)-dependent atrial flutter (AFL). The introduction of 3-dimensional electro-anatomic systems enables RFCA without fluoroscopy (No-X-Ray [NXR]). The aim of this study was to evaluate the feasibility and effectiveness of CTI RFCA during implementation of the NXR approach and the maximum voltage-guided (MVG) technique for ablation of AFL.Data were obtained from prospective standardized multicenter ablation registry. Consecutive patients with the first RFCA for CTI-dependent AFL were recruited. Two navigation approaches (NXR and fluoroscopy based as low as reasonable achievable [ALARA]) and 2 mapping and ablation techniques (MVG and pull-back technique [PBT]) were assessed. NXR + MVG (n = 164; age: 63.7 ± 9.5; 30% women), NXR + PBT (n = 55; age: 63.9 ± 10.7; 39% women); ALARA + MVG (n = 36; age: 64.2 ± 9.6; 39% women); and ALARA + PBT (n = 205; age: 64.7 ± 9.1; 30% women) were compared, respectively. All groups were simplified with a 2-catheter femoral approach using 8-mm gold tip catheters (Osypka AG, Germany or Biotronik, Germany) with 15 min of observation. The MVG technique was performed using step-by-step application by mapping the largest atrial signals within the CTI.Bidirectional block in CTI was achieved in 99% of all patients (P = NS, between groups). In NXR + MVG and NXR + PBT groups, the procedure time decreased (45.4 ± 17.6 and 47.2 ± 15.7 min vs. 52.6 ± 23.7 and 59.8 ± 24.0 min, P < .01) as compared to ALARA + MVG and ALARA + PBT subgroups. In NXR + MVG and NXR + PBT groups, 91% and 98% of the procedures were performed with complete elimination of fluoroscopy. The NXR approach was associated with a significant reduction in fluoroscopy exposure (from 0.2 ± 1.1 [NXR + PBT] and 0.3 ± 1.6 [NXR + MVG] to 7.7 ± 6.0 min [ALARA + MVG] and 9.1 ± 7.2 min [ALARA + PBT], P < .001). The total application time significantly decreased in the MVG technique subgroup both in NXR and ALARA (P < .01). No major complications were observed in either groups.Complete elimination of fluoroscopy is feasible, safe, and effective during RFCA of CTI in almost all AFL patients without cardiac implanted electronic devices. The most optimal method for RFCA of CTI-dependent AFL seems to be MVG; however, it required validation of optimal RFCA's parameters with clinical follow-up.

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“Largest Amplitude Ablation” is the Optimal Approach for Typical Atrial Flutter Ablation: A Subanalysis from the AURUM 8 Study

Abstract: Major procedural parameters are remarkably improved with MVG technique. Gold-tip catheters are substantially less susceptible to charring and may therefore be preferred over Pt-Ir-tip catheters for MVG ablation technique.

Cited by 17 publications

References 21 publications

Counterclockwise Heart Rotation Affects Variation in Successful Ablation Line Position in Common Atrial Flutter

Counterclockwise Heart Rotation Affects Variation in Successful Ablation Line Position in Common Atrial Flutter

Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis

Maximum voltage gradient technique for optimization of ablation for typical atrial flutter with zero-fluoroscopy approach

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