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Temporal Pattern of Conduction Recurrence During Radiofrequency Ablation for Typical Atrial Flutter
Author(s) -
STOVICEK PETR,
FIKAR MIROSLAV,
WICHTERLE DAN
Publication year - 2006
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2006.00457.x
Subject(s) - medicine , atrial flutter , ablation , cardiology , catheter ablation , predictive value , radiofrequency ablation , thermal conduction , surgery , materials science , composite material
Conduction recurrence during radiofrequency (RF) ablation of cavotricuspid isthmus for typical atrial flutter is common. Understanding the temporal pattern of recurrences could help to predict a durable bidirectional block (BDB) and optimize the procedure. Methods and Results: We analyzed atrial flutter ablations in 108 consecutive patients (85 males, age 63 ± 11 years). RF energy was delivered through 8‐mm tip or 4‐mm cooled‐tip catheter. On average, 18 ± 11 pulses were necessary to achieve BDB. The time to recurrence of conduction after RF cessation was recorded. Early and late conduction recurrences were defined as ≤10 minutes and >10 minutes, respectively. Patients were observed for ≥30 minutes after bidirectional cavotricuspid isthmus (CTI) block was achieved. Conduction did not recur in 46 patients. In 8 cases, no block was achieved. A total of 167 conduction recurrences were recorded in the remaining 54 cases (1–10 per case). Of these, in 53 patients, recurrences were classified as early (98%) and 14 patients had late recurrences (8%). Thirteen patients had both early and late recurrences (24%). All but one late recurrence were preceded by at least one early recurrence. Absence of early recurrence had negative predictive value of 98%, while any early recurrence had positive predictive value of 26% for subsequent late conduction recovery. Conclusion: Incidence of isthmus conduction recurrence rapidly decayed during the waiting period. Absence of conduction recurrence within 10 minutes after first successful RF delivery was highly predictive of persistent BDB.