© 2001 by European Society of Cardiology
Prospective evaluation of a simplified approach for common atrial flutter radio frequency ablation with only two catheters
Department of Cardiology, University of Lille Lille, France
Intra-atrial conduction block within the inferior vena cava-tricuspid annulus isthmus (IVCT) has been shown to predict successful common atrial flutter ablation. However, its demonstration requires the use of several electrode catheters and mapping of the line of block. The aim of this study was prospectively to test the feasibility of a simplified ablation procedure using only two catheters.
METHODS: Radio frequency (RF) ablation of common atrial flutter was performed in 30 patients with the sole use of a catheter for atrial pacing and a RF catheter. RF ablation lesions were created in the IVCT. Surface ECG criteria were used to monitor the conduction within the IVCT. The end point during low lateral atrial pacing was an increment in the interval between the pacing artefact and the peak of the R wave in surface lead II >50 ms and clockwise rotation of the P wave axis beyond –30° and inferiorly. Then, the line of lesions was mapped during atrial pacing with the RF catheter. Additional RF lesions were applied if mapping disclosed a zone of residual conduction. Otherwise the procedure was stopped if mapping showed parallel double potentials all along the line. Finally, the block was reassessed with a ‘Halo’ catheter.
RESULTS: Surface ECG criteria were met in 26 patients. Mapping the line of lesions showed a complete corridor of parallel double potentials in these 26 cases and in 3 of the 4 patients in whom ECG criteria were not met. Conduction evaluated with the Halo catheter showed bi-directional complete block in these 29 patients. After a follow-up of 16±4 months there was no recurrence of atrial flutter.
CONCLUSION: Surface ECG criteria combined with mapping of the line of block demonstrate evidence of bi-directional IVCT block. This simplified RF ablation of common atrial flutter is feasible with a low recurrence rate.
Key Words: Atrial flutter, radio frequency ablation
Correspondence: Didier Klug, Service de cardiologie A, Hôpital Cardiologique de Lille, Boulevard du Pr Leclercq, CHR-U 59037 Lille (Cedex) France. E-mail: dklug{at}chru-lille.fr
[1] Cosio FG, Lopez-Gil M, Gioclea A, Arribas F, Barroso JL. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993; 71: 705–709.[CrossRef][Web of Science][Medline]
[2] Fischer B, Jais P, Shah D, et al. Radiofrequency catheter ablation of common atrial flutter in 200 patients. J Cardiovasc Electrophysiol 1996; 7: 1225–1233.[Web of Science][Medline]
[3] Anselme F, Saoudi N, Poty H, Douillet R, Cribier A. Radiofrequency catheter ablation of common atrial flutter: significance of palpitations and quality-of-life evaluation in patients with proven isthmus block. Circulation 1999; 99: 534–540.
[4] Poty H, Saoudi N, Abdel Aziz A, Nair M, Letac B. Radiofrequency catheter ablation of type 1 atrial flutter. Prediction of late success by electrophysiological criteria. Circulation 1995; 92: 1389–1392.
[5] Cauchemez B, Haïssaguerre M, Fischer B, Thomas O, Clémenty J, Coumel P. Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Circulation 1996; 93: 284–294.
[6] Schwartzman D, Callans DJ, Gottlieb CD, Dillon SM, Movsowitz C, Marchlinski FE. Conduction block in the inferior vena caval-tricuspid valve isthmus: association with outcome of radiofrequency ablation of type I atrial flutter. J Am Coll Cardiol 1996; 28: 1519–1531.[Abstract]
[7] Poty H, Saoudi N, Nair M, Anselme F, Letac B. Radiofrequency catheter ablation of atrial flutter. Further insights into the various types of isthmus block: application to ablation during sinus rhythm. Circulation 1996; 94: 3204–3213.
[8] Mairesse G, Lacroix D, Klug D, Le Franc P, Kouakam C, Kacet S. Surface 12-lead ECG during atrial pacing to predict intraatrial conduction block after successful ablation of atrial flutter. Eur Heart J 1997; 18: 311 (Abstract).
[9] Shah DC, Haissaguerre M, Jais P, et al. Simplified electrophysiologically directed catheter ablation of recurrent common atrial flutter. Circulation 1997; 96: 2505–2508.
[10] Shah DC, Haissaguerre M, Jais P, et al. High-density mapping of activation through an incomplete isthmus ablation line. Circulation 1999; 99: 211–215.
[11] Allessie MA, Bonke FIM, Schopman FJC. Circus movement in rabbit atrial muscle as a mechanism of tachycardia. Circ Res 1973; 33: 54–62.
[12] Allessie MA, Bonke FIM, Schopman FJC. Circus movement in rabbit atrial muscle as a mechanism of tachycardia. III. The ‘leading circle’ concept: A new model of circus movement in cardiac tissue without the involvement of an anatomical obstacle. Circ Res 1977; 41: 9–18.
[13] Shimizu A, Nozaki A, Rudy Y, Waldo AL. Characterization of double potentials in a functionally determined re-entrant circuit. Multiplexing studies during interruption of atrial flutter in the canine pericarditis model. J Am Coll Cardiol 1993; 22: 2022–2032.[Abstract]
[14] Olshansky B, Okumura K, Henthorn RW, Waldo AL. Characterization of double potentials in human atrial flutter: studies during transient entrainment. J Am Coll Cardiol 1990 Mar 15; 15: 833–841.
[15] Kadish A and Spears J. Identification of conduction block in cardiac muscle: In vitro observations in canine epicardium. Cardiovasc Res 1994; 28: 259–269.
[16] Shah DC, Takahashi A, Jais P, Hocini M, Clementy J, Haissaguerre M. Local electrogram-based criteria of cavotricuspid isthmus block. J Cardiovasc Electrophysiol 1999; 10: 662–669.[Web of Science][Medline]
[17] Albenque JP, Donzeau JP, Goutner C, Dechandol AM, Berthoumieu-Bolinelli H, Charrancon M. A simplified approach to the ablation of atrial flutter with a single catheter: results in 70 cases. Arch Mal Coeur 1999; 92: 387–392.
[18] Hamdam MH, Kalman JM, Barron HV, Lesh MD. P-wave morphology during right atrial pacing before and after atrial flutter ablation — a new marker for success. Am J Cardiol 1997; 79: 1417–1420.[CrossRef][Web of Science][Medline]
[19] Weiss C, Willems S, Hoffmann M, Meinertz T. Impact of the ECG for detection of intraatrial conduction block after atrial flutter ablation. Pacing Clin Electrophysiol 1999; 22: 1457–1465.[CrossRef][Medline]
[20] Shah DC, Takahashi D, Jais P, et al. Tracking dynamic conduction recovery across the cavotricuspid isthmus. J Am Coll Cardiol 2000; 35: 1478–1484.
[21] Tsai CF, Chen SA, Tai CT, et al. Impact of transisthmus linear ablation of typical atrial flutter on coronary sinus activation time. Pacing Clin Electrophysiol 2000; 23: 63–73.[CrossRef][Medline]
[22] Sarter BH, Callans DJ, Man DC, et al. Using intracardiac catheter recordings from the His and proximal coronary sinus to distinguish isthmus conduction block during catheter ablation of type I atrial flutter. Pacing Clin Electrophysiol 2000; 23: 516–521.[CrossRef][Medline]
[23] Klug D, Lacroix D, Le Franc P, et al. Linear isthmus block for atrial flutter radiofrequency ablation modifies AV nodal inputs during low lateral atrial pacing. Pacing Clin Electrophysiol 1998; 21: 833.
[24] Chen J, de Chillou C, Basiouny T, et al. Cavotricuspid isthmus mapping to assess bidirectional block during common atrial flutter radiofrequency ablation. Circulation 1999; 100: 2507–2513.
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