Predictors of acute inefficacy and the radiofrequency energy time required for cavotricuspid isthmus-dependent atrial flutter ablation

Pérez-Rodón, Jordi; Rodríguez-García, Julián; Sarrias, Axel; Rivas-Gándara, Núria; Roca‐Luque, Ivo; Francisco‐Pascual, Jaume; Santos‐Ortega, Alba; Martin-Sanchez, Gabriel; Ferreira‐González, Ignacio; Rodríguez-Palomares, José F.; Evangelista-Masip, Artur; Garcı́a-Dorado, David; Moya-Mitjans, Àngel

doi:10.1007/s10840-017-0232-z

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Sometimes, prophylactic cavotricuspid isthmus ablation is needed to combine with PV isolation, which may be considered for patients with COPD. However, the recurrence of arrhythmia after first ablation is higher in this type of patients and most of them needed to be performed a second ablation [ 13 , 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

The progression in atrial fibrillation patients with COPD: a systematic review and meta-analysis

2017

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AimChronic Obstructive Pulmonary Disease (COPD) and atrial fibrillation (AF) share pathophysiological links, as supported by the high prevalence of AF within COPD patients. AF progression and recurrence can increase the risks of mortality, morbidity and adverse cardiovascular events. The present systematic review and meta-analysis aims to assess the risk for AF progression and recurrence for COPD patients, to further demonstrate the risk of COPD in AF patients.Methods and ResultsA systematic review was conducted in MEDLINE / PubMed and Cochrane Library and Embase, Web of science. Prospective studies including AF patients with COPD were screened and included if matching inclusion and exclusion criteria. 7 studies were included, adding up to 10761 AF patients (1556 with AF and COPD, 9205 without COPD). Mean age from each study ranged from 51 to 81 years, and 57.2% were male. Hypertension accounted for 75.5% of the population, and 20.7% had the comorbidity of diabetes mellitus. The pool analysis showed that COPD could promote AF progression (OR = 1.90; 95% CI, 1.34–2.68, I2 = 77%, p = 0.0003). For subgroup analysis, we found that COPD could increase the risk of AF recurrence (OR = 2.35; 95% CI, 1.86–2.97, I2 = 0%, p = 0.39). Besides, in the younger group, at the median age of 64, COPD was still a risk factor for AF progression (OR = 2.22; 95% CI, 1.80–2.74, I2 = 0%, p = 0.69).ConclusionsCOPD is an independent risk for AF progression and recurrence, COPD patients with AF carry a worse prognosis than those in sinus rhythm (SR).

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Section: Discussionmentioning

confidence: 99%

The progression in atrial fibrillation patients with COPD: a systematic review and meta-analysis

2017

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Section: Discussionmentioning

confidence: 99%

“…Several studies have revealed marked heterogeneity in CTI architecture, and morphological variations such as trabeculae or recesses and structural anomalies can affect procedural and long-term outcomes. [25][26][27] Data from contact-force sensing catheters suggest that site-specific inconsistencies in isthmus tissue contact may be responsible for procedural failure. 28 Our study is the first to make use of precise LI characteristics and derived/associated LI lesion parameters to describe the heterogeneity encountered when ablating the CTI.…”

Section: Characteristics Of Ablation Lesions Along the Ctimentioning

confidence: 99%

Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter

Ducceschi

Zingarini

Nigro

et al. 2022

Pacing Clinical Electrophis

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Background Although radiofrequency (RF) catheter ablation of cavo‐tricuspid isthmus (CTI) is an established treatment for typical right atrial flutter (RAFL), it remains to be established whether local tissue impedance (LI) is able to predict effective CTI ablation and what LI drop values during ablation should be used to judge a lesion as effective. We aimed to investigate the ability of LI to predict ablation efficacy in patients with RAFL. Methods RF delivery was guided by the DirectSense™ algorithm. Successful single RF application was defined according to a defragmentation of atrial potentials (DAP), reduction of voltage (RedV) by at least 80% or changes on unipolar electrogram (UPC). The ablation endpoint was the creation of bidirectional conduction block (BDB) across the isthmus. Results 392 point‐by‐point RF applications were analyzed in 48 consecutive RAFL patients. The mean baseline LI was 105.4 ± 12Ω prior to ablation and 92.0 ± 11Ω after ablation (p < 0.0001). According to validation criteria, absolute drops in impedance were larger at successful ablation sites than at ineffective ablation sites (DAP: 17.8 ± 6Ω vs. 8.7 ± 4Ω; RedV: 17.2 ± 6Ω vs. 7.8 ± 5Ω; UPC: 19.6 ± 6Ω vs. 10.1 ± 5Ω, all p < 0.0001). LI drop values significantly increased according to the number of criteria satisfied (ranging from 7.5Ω to 19.9). BDB was obtained in all cases. No procedure‐related adverse events were reported. Conclusions A LI‐guided approach to CTI ablation was safe and effective in treating RAFL. The magnitude of LI drop was associated with effective lesion formation and BDB and could be used as a marker of ablation efficacy. Clinical trial registration Catheter Ablation of Arrhythmias with a High‐Density Mapping System in Real‐World Practice (CHARISMA). URL: http://clinicaltrials.gov/ Identifier: NCT03793998.

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“…The main objective of ablation is the termination and non-reinduction of clinical arrhythmia ( 2 , 45 , 66 , 70 – 71 ). However, it is not uncommon for the patient to present in sinus rhythm, or for more than one arrhythmia to be induced.…”

Section: Specific Arrhythmia Typesmentioning

confidence: 99%

Tachyarrhythmias in congenital heart disease

Francisco-Pascual,

Mallofré Vila,

Santos-Ortega

et al. 2024

Front. Cardiovasc. Med.

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The prevalence of congenital heart disease (CHD) in adult patients has risen with advances in diagnostic and surgical techniques. Surgical modifications and hemodynamic changes increase the susceptibility to arrhythmias, impacting morbidity and mortality rates, with arrhythmias being the leading cause of hospitalizations and sudden deaths. Patients with CHD commonly experience both supraventricular and ventricular arrhythmias, with each CHD type associated with different arrhythmia patterns. Macroreentrant atrial tachycardias, particularly cavotricuspid isthmus-dependent flutter, are frequently reported. Ventricular arrhythmias, including monomorphic ventricular tachycardia, are prevalent, especially in patients with surgical scars. Pharmacological therapy involves antiarrhythmic and anticoagulant drugs, though data are limited with potential adverse effects. Catheter ablation is preferred, demanding meticulous procedural planning due to anatomical complexity and vascular access challenges. Combining imaging techniques with electroanatomic navigation enhances outcomes. However, risk stratification for sudden death remains challenging due to anatomical variability. This article practically reviews the most common tachyarrhythmias, treatment options, and clinical management strategies for these patients.

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Predictors of acute inefficacy and the radiofrequency energy time required for cavotricuspid isthmus-dependent atrial flutter ablation

Abstract: Tricuspid regurgitation is associated with less acute efficacy in CTI-AFL ablation. Prior CTI ablation, COPD, use of an irrigated catheter, and advanced age are independent predictors for needing less RF energy time to achieve a complete bidirectional CTI block.

Cited by 5 publications

References 28 publications

The progression in atrial fibrillation patients with COPD: a systematic review and meta-analysis

The progression in atrial fibrillation patients with COPD: a systematic review and meta-analysis

Optimized radiofrequency lesions through local impedance guidance for effective CTI ablation in right atrial flutter

Tachyarrhythmias in congenital heart disease

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