Open AccessThe deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography
Author(s) -
Shimizu Yukiko,
Yoshitani Kazuyasu,
Murotani Kenta,
Kujira Kazuto,
Kurozumi Yuma,
Fukuhara Rei,
Taniguchi Ryoji,
Toma Masanao,
Miyamoto Tadashi,
Kita Yoshio,
Takatsu Yoshiki,
Sato Yukihito
Publication year - 2018
Publication title -
journal of arrhythmia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.463
H-Index - 21
eISSN - 1883-2148
pISSN - 1880-4276
DOI - 10.1002/joa3.12075
Subject(s) - pouch , medicine , ablation , catheter ablation , radiofrequency ablation , atrial fibrillation , cardiology , surgery
Background The aim of this study was to explore whether the pouch depth influenced the radiofrequency ( RF ) duration and total delivered RF energy for cavotricuspid isthmus ( CTI ) ablation and define the cutoff value for a deep pouch‐specified ablation strategy. Methods This study included 94 atrial fibrillation ( AF ) patients (56 males, age 68 ± 8.0 years). With intracardiac echocardiography, the isthmus length and pouch depth were precisely measured. After a standard AF ablation, all patients underwent the CTI ablation along the lateral isthmus. If bidirectional block could not be achieved, the ablation catheter was deflected more than 90 degrees to ablate inside the pouch (knuckle‐curve ablation). Results Seventy‐two patients (76.6%) had a sub‐Eustachian pouch. Bidirectional block could be achieved in all patients. By a univariate logistic regression analysis, only the pouch depth was significantly correlated with the RF duration ( P = .005) and RF energy ( P = .006). A multivariate logistic regression analysis also revealed the pouch depth was the sole factor that influenced the RF duration ( P = .001) and RF energy ( P = .001). Among the 72 patients, 21 patients needed a knuckle‐curve ablation. Using a receiver operating characteristic curve, the optimal cutoff value of the pouch depth for a knuckle‐curve ablation was 3.7 mm with a sensitivity of 90% and specificity of 69%. Conclusions The sub‐Eustachian pouch depth was the sole factor that influenced the RF duration and energy in the CTI ablation. If the pouch was deeper than 3.7 mm, a deep pouch‐specified ablation strategy would be needed.