Safety and durability of cavo‐tricuspid isthmus linear ablation in the current era: Single‐center 9‐year experience from 1078 procedures

Abstract

Background: Cavo-tricuspid isthmus (CTI) linear ablation is performed not only for atrial flutter (AFL) but empirically during atrial fibrillation (AF) ablation in real-world practice.Purpose: We sought to evaluate the safety and durability of the CTI ablation.Methods: This retrospective study included 1078 consecutive patients who underwent a CTI ablation. AFL was documented before or during the procedure in 249 (23.1%) patients, and an empirical CTI and AF ablation were performed in 829 (76.9%) patients.Results: CTI block was successfully created in 1051 (97.5%) patients with a 10.3 ± 6.6 min total radiofrequency time. Repeat procedures were performed for recurrent arrhythmias in 187 (17.3%) patients at a median of 11.0 (5.0-30.0) months postprocedure, and conduction resumption was identified in 68/174 (39.1%).Among those undergoing a CTI ablation with an AF ablation, the durability was significantly higher in those with than without documented AFL (78.1% vs. 58.2%, p = .031). The total radiofrequency time was significantly shorter (9.0 ± 5.3 vs. 10.0 ± 6.4 [mins], p = .024) and durability significantly higher (78.1 vs. 58.7[%], p = .043) in the large-tip than irrigated-tip catheter group. Iatrogenic AFL was observed after the empiric CTI ablation in 11 (1.3%) patients. Procedure-related complications occurred in 15 (1.4%) patients. Eight patients experienced coronary artery spasms, including one with ventricular fibrillation following ST elevation on the ward. The other six patients experienced transient atrioventricular block and one experienced cardiac tamponade requiring drainage.Conclusions: Despite a high acute CTI ablation success, the conduction block durability was relatively low after the empiric ablation. An empiric CTI ablation at the time of the AF ablation is not recommended.

Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter

“…Technical development, modern ablation catheters, and increasing experience in electrophysiology have led to shorter ablation procedures or EPS duration in patients with CTI-dependent AFL. In most recent studies, the ablation time in patients who underwent RF CTI ablation with common open irrigated RF catheters ranged from 10 to 15 min [ 16 – 18 ]. In a large representative series of 1,051 patients, Kakehashi et al reported a total radiofrequency time of 10.3 ± 6.6 min to achieve bidirectional CTI block [ 16 ].…”

“…In most recent studies, the ablation time in patients who underwent RF CTI ablation with common open irrigated RF catheters ranged from 10 to 15 min [ 16 – 18 ]. In a large representative series of 1,051 patients, Kakehashi et al reported a total radiofrequency time of 10.3 ± 6.6 min to achieve bidirectional CTI block [ 16 ]. Katritsis and Bacillieri report similar RF delivery time across the CTI in smaller series of patients with CTI-dependent AFL (12.2 and 10.7 min respectively) [ 17 , 18 ].…”

Cavotricuspid isthmus ablation: Is more the enemy of good enough?

“…In this issue of the Journal of Cardiovascular Electrophysiology, Kakehashi et al 2 report their single-center, retrospective observations of patients undergoing CTI ablation. The investigators studied 1078 patients who had a CTI ablation, the vast majority (76.9%) of whom had an empiric CTI ablation as part of ablation for AF.…”