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Cavotricuspid isthmus ablation using ablation index in typical right atrial flutter
Author(s) -
Zhang Tao,
Wang Yunlong,
Han Zhihong,
Zhao Hua,
Liang Zhuo,
Wang Ye,
Wu Yongquan,
Ren Xuejun
Publication year - 2019
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/jce.14156
Subject(s) - medicine , ablation , atrial flutter , radiofrequency ablation , cardiology , catheter ablation , surgery , nuclear medicine
Abstract Background Ablation index (AI) has been evaluated as guidance quality marker for pulmonary vein isolation, but not for linear ablation of the cavotricuspid isthmus (CTI) for typical right atrial flutter (AFL). We thus studied the feasibility and effectiveness of AI‐guided CTI for AFL. Methods Procedural and 6‐month outcomes of ablation for AFL were retrospectively compared between consecutive patients undergoing either AI‐guided ablation of CTI (n = 43; AI target of 500 for anterior 2/3 segments and 400 for posterior 1/3 segments) or contact force (CF)‐guided ablation (n = 42) at a single center. Each Visitag dataset from all patients in each group was analyzed. Results AI guidance vs CF guidance was associated with: higher first‐pass conduction block of CTI (93.0% vs 76.2%, P = .03) with similar ablation time; similar acute spontaneous CTI reconnection 2.3% vs 9.5%, P = .343); fewer radiofrequency (RF) applications (10.1 ± 2.8 vs 11.5 ± 3.0, P = .031) needed to achieve CTI directional block; significantly higher mean ablation time, impedance drop, force time integral and AI and similar mean CF and power of each VisiTag point. One inguinal hematoma and one pseudoaneurysm developed in the AI and CF groups, respectively. Recurrent AFL was recorded in two (4.7%) AI‐group patients and four (9.5%) CF‐group patients ( P = .650). Conclusion AI‐guided ablation of CTI line for AFL appears feasible and effective with similar ablation time, fewer RF applications, a higher rate of first‐pass conduction block, and no additional complications.