BACKGROUND: The ablation of cavotricuspid-isthmus (CTI) atrial flutter (AFL) dependent atrial flutter could be difficult in patients with complex anatomy of the CTI.The aim of the study was to assess whether the use of intracardiac echocardiography (ICE) was associated with less fluoroscopy time and faster ablations of cavotricuspid isthmus dependent atrial flutter (CTI-AFL). METHODS: Patients with an indication for an ablation of a CTI-AFL were enrolled. Patients in which ablation of a CTI-AFLas part of an atrial fibrillation ablation were not included. Randomization was done using the envelope method. Standard techniques (i.e., coronary sinus, 20-polar halo catheter, and an ablation catheter), and criteria of success (bidirectional block through the CTI) were used. In patients randomized to the ablation with ICE, a 10F AcuNav ICE probe (Siemens, Germany)was used. RESULTS: Seventy-nine patients were enrolled; 40 were randomized to ablation with ICE and 39 without ICE. The X-ray exposure was shorter (3.29±2.6 vs. 5.94±3.43 min, p<0.001) and total X-ray dose was reduced (3.30±1.98 vs. 6.68±5.25 Gy.cm2, p<0.001) in the ICE group. However, the total RF energy ablation time was not different between groups (ICE group: 604.56±380.46sec vs. 585.82±373.39 sec, p=0.8). The procedure duration was slightly longer in the ICE group (82.0±20.8 vs. 72.1±19.0 min, p=0.03). Procedural success was 100% (40/40) in the ICE group and 95% (37/39) in the control group. Two control patients required crossover to ICE at a prespecified point to achieve bidirectional block. There were two femoral hematomas in the ICE group and one in the control group. CONCLUSION: The use of ICE for atrial flutter ablation is associated with less fluoroscopy time and improved ability to achieve bidirectional block compared to traditional conventional flutter ablation methods. However, it is not asoociated with reduced ablation time or overall procedure duration.

Cardiocenter Department of Cardiology 3rd Faculty of Medicine Charles University and University Hospital KralovskeVinohrady Prague Czech Republic

Zobrazit více v PubMed

Babaev Anvar, Suma Valentin, Tita Cristina, Steinberg Jonathan S. Recurrence rate of atrial flutter after initial presentation in patients on drug treatment. Am. J. Cardiol. 2003 Nov 01;92 (9):1122–4. PubMed

Natale A, Newby K H, Pisanó E, Leonelli F, Fanelli R, Potenza D, Beheiry S, Tomassoni G. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J. Am. Coll. Cardiol. 2000 Jun;35 (7):1898–904. PubMed

Da Costa Antoine, Cucherat Michel, Pichon Nathalie, Messier Marc, Laporte Sylvie, Roméyer-Bouchard Cécile, Mismetti Patrick, Lopez Michel, Isaaz Karl. Comparison of the efficacy of cooled-tip and 8-mm-tip catheters for radiofrequency catheter ablation of the cavotricuspid isthmus: a meta-analysis. Pacing Clin Electrophysiol. 2005 Oct;28 (10):1081–7. PubMed

Kajihara Kenta, Nakano Yukiko, Hirai Yukoh, Ogi Hiroshi, Oda Noboru, Suenari Kazuyoshi, Makita Yuko, Sairaku Akinori, Tokuyama Takehito, Motoda Chikaaki, Fujiwara Mai, Watanabe Yoshikazu, Kiguchi Masao, Kihara Yasuki. Variable procedural strategies adapted to anatomical characteristics in catheter ablation of the cavotricuspid isthmus using a preoperative multidetector computed tomography analysis. J. Cardiovasc. Electrophysiol. 2013 Dec;24 (12):1344–51. PubMed PMC

Schoene Katharina, Rolf Sascha, Schloma Denis, John Silke, Arya Arash, Dinov Borislav, Richter Sergio, Bollmann Andreas, Hindricks Gerhard, Sommer Philipp. Ablation of typical atrial flutter using a non-fluoroscopic catheter tracking system vs. conventional fluoroscopy--results from a prospective randomized study. Europace. 2015 Jul;17 (7):1117–21. PubMed

Matsuo Seiichiro, Yamane Teiichi, Tokuda Michifumi, Date Taro, Hioki Mika, Narui Ryohsuke, Ito Keiichi, Yamashita Seigo, Hama Yoshiyuki, Nakane Tokiko, Inada Keiichi, Shibayama Kenri, Miyanaga Satoru, Yoshida Hiroshi, Miyazaki Hidekazu, Abe Kunihiko, Sugimoto Ken-ichi, Taniguchi Ikuo, Yoshimura Michihiro. Prospective randomized comparison of a steerable versus a non-steerable sheath for typical atrial flutter ablation. Europace. 2010 Mar;12 (3):402–9. PubMed

Chu E, Fitzpatrick A P, Chin M C, Sudhir K, Yock P G, Lesh M D. Radiofrequency catheter ablation guided by intracardiac echocardiography. Circulation. 1994 Mar;89 (3):1301–5. PubMed

Kottkamp H, Hügl B, Krauss B, Wetzel U, Fleck A, Schuler G, Hindricks G. Electromagnetic versus fluoroscopic mapping of the inferior isthmus for ablation of typical atrial flutter: A prospective randomized study. Circulation. 2000 Oct 24;102 (17):2082–6. PubMed

Da Costa Antoine, Romeyer-Bouchard Cécile, Dauphinot Virginie, Lipp Damien, Abdellaoui Loucif, Messier Marc, Thévenin Jérôme, Barthélémy Jean-Claude, Isaaz Karl. Cavotricuspid isthmus angiography predicts atrial flutter ablation efficacy in 281 patients randomized between 8 mm- and externally irrigated-tip catheter. Eur. Heart J. 2006 Aug;27 (15):1833–40. PubMed

Pap Róbert, Klausz Gergely, Gallardo Rodrigo, Sághy László. Intracardiac echocardiography in a case with previous failed cavotricuspid isthmus ablation. J Interv Card Electrophysiol. 2009 Nov;26 (2):119–20. PubMed

Bencsik Gábor, Pap Róbert, Makai Attila, Klausz Gergely, Chadaide Számi, Traykov Vassil, Forster Tamás, Sághy László. Randomized trial of intracardiac echocardiography during cavotricuspid isthmus ablation. J. Cardiovasc. Electrophysiol. 2012 Sep;23 (9):996–1000. PubMed

Venneri Lucia, Rossi Francesco, Botto Nicoletta, Andreassi Maria Grazia, Salcone Nicoletta, Emad Ahmed, Lazzeri Mauro, Gori Cesare, Vano Eliseo, Picano Eugenio. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report. Am. Heart J. 2009 Jan;157 (1):118–24. PubMed