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Evaluation of an Individualized Strategy of Cavotricuspid Isthmus Ablation as an Adjunct to Atrial Fibrillation Ablation
Author(s) -
SHAH DIPEN C.,
SUNTHORN HENRI,
BURRI HARAN,
GENTILBARON PASCALE
Publication year - 2007
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.1540-8167.2007.00896.x
Subject(s) - ablation , medicine , atrial flutter , atrial fibrillation , cardiology , pulmonary vein , catheter ablation , radiofrequency ablation , sinus rhythm , surgery
Objectives: To evaluate supplementary cavotricuspid isthmus (CTI) ablation as an adjunct to atrial fibrillation (AF) ablation in selected patients. Background: It is unclear whether routine CTI ablation is beneficial in all patients undergoing AF ablation. Methods and Results: In patients undergoing AF ablation, additional CTI block was created only for those with typical atrial flutter (Afl) before or during the ablation. Out of 188 consecutive patients (108 male, 56 ± 9 years), 75 underwent CTI ablation (Group CTI+) and left atrial (LA) ablation (circular mapping‐guided extensive pulmonary vein isolation in all and linear LA ablation when required), while 113 underwent LA ablation alone (Group CTI−). Group CTI+ patients had smaller LA and less frequently persistent/permanent AF and linear LA ablation. Over a follow‐up of 30 ± 10 months, complications (4% vs 5%, P = NS), typical Afl occurrence (1.3% and 2.6%, P = NS) and AF recurrence (25% and 28%, P = NS) were similar. Atypical Afl was more common in Group CTI− (4 vs 14%, P = 0.026). Eighty‐two percent and 79% of patients in Groups CTI+ and CTI−, respectively, remained arrhythmia free in stable sinus rhythm without antiarrhythmic drug treatment (P = NS). Conclusions: Avoiding supplementary CTI ablation in AF ablation patients without evidence of typical flutter does not result in a higher incidence of typical Afl. Despite more persistent/permanent AF and larger LA in patients without evidence of typical flutter, a strategy of selective supplementary ablation resulted in similar and low AF recurrence rates in the group without CTI ablation compared with the group with CTI ablation.