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Mitral Isthmus Ablation Using Steerable Sheath and High Ablation Power: A Single Center Experience
Author(s) -
WONG KELVIN C. K.,
QURESHI NORMAN,
JONES MICHAEL,
RAJAPPAN KIM,
BASHIR YAVER,
BETTS TIMOTHY R.
Publication year - 2012
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.1540-8167.2012.02380.x
Subject(s) - medicine , ablation , cardiology , atrial fibrillation , atrial tachycardia , catheter ablation , coronary sinus , atrial flutter , sinus rhythm , ablation of atrial fibrillation
Case Series of Mitral Isthmus Ablation. Background: Mitral isthmus ablation is challenging. The use of steerable sheath and high ablation power may improve success rate. Methods: This single‐center, prospective study enrolled 200 patients who underwent ablation for atrial fibrillation (AF), including mitral isthmus ablation. Mitral isthmus ablation was performed using an irrigated ablation catheter via a steerable sheath (endocardium: maximum power: 40/50 W limited to annular end, maximum temperature: 48 °C; coronary sinus [CS]: maximum power: 25/30 W, maximum temperature: 48 °C). Endpoint was bidirectional mitral isthmus block. Results: Mitral isthmus block was acutely achieved in 182/200 patients (91%). Sixty‐nine percent of patients required CS ablation. Mean total ablation time was 13 ± 6 minutes. There was 1 case of acute circumflex artery occlusion. Mean left atrium (LA) diameter was significantly bigger in patients with unsuccessful mitral isthmus ablation (49 ± 4 mm vs. 43 ± 6 mm; P = 0.0007). In redo procedures, the incidence of reconduction at the mitral isthmus, roof and cavotricuspid isthmus was 44%, 37%, and 29%, respectively. Overall incidence of perimitral flutter was 9%. Prior complex fractionated atrial electrogram ablation was a predictor for microreentrant atrial tachycardia (AT) whereas gaps in linear lesions predicted macroreentrant flutters. After a mean follow‐up of 20 ± 9 months, 73% of patients remained free from AF or AT. Conclusion: We reported on a series of mitral isthmus ablation using steerable sheath and high ablation power (50 W). Larger LA diameter was a predictor of failure to achieve mitral isthmus block. The mitral isthmus had a moderately high incidence of re‐conduction but was only associated with a relatively low incidence of perimitral flutter. (J Cardiovasc Electrophysiol, Vol. 23, pp. 1193–1200, November 2012)