© 2002 by European Society of Cardiology
REGULAR ARTICLES
Acute resumption of conduction in the cavotricuspid isthmus after catheter ablation in patients with common atrial flutter
Real-time evaluation and long-term follow-up
1Department of Heart Disease, Haukeland University Hospital Bergen, Norway; 2Department of Cardiology, University Hospital Nancy, France
AIMS: Cavotricuspid isthmus conduction (CIC) is closely associated with the maintenance and recurrence of common atrial flutter (AFL). This study systematically sought to assess the prevalence and characteristics of acute CIC recovery during AFL ablation and to define its predictors and its relationship with the results of long-term follow-up.
METHODS AND RESULTS: A total of 124 consecutive patients (105 men, 19 women, mean age 58±11 years) who underwent successful AFL ablation were included. The procedure endpoint was defined as complete bi-directional CIC block. During an observation period of 30 min, the incidence of CIC restoration was 34·7% in patients and 39·8% in applications. It increased with increasing block time and decreased over time during the observation period. Block time in successful burns followed by persistent block was shorter than in those followed by CIC resumption (12±6 vs 33±12 s, P< 0·0001). A negative correlation between block time and resumption time was found (r=–0·57, P< 0·001). Patients with permanent pacemakers had a higher incidence of acute CIC resumption than those without pacemakers (5/7 vs 29/117, P=0·007). The AFL recurrence rate was 4·8% during a mean follow-up period of 21±8 months. Our results suggest that acute CIC resumption may be a potential risk for clinical AFL recurrence during long-term follow-up.
CONCLUSIONS: Acute CIC resumption in common AFL ablation varies in terms of incidence and time course. Block time has a predictive value for acute CIC recovery. Observation time can be shortened if block time is short. With longer block time, it is essential to observe for a longer period in order to minimize CIC resumption. Copyright 2002 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.
Key Words: Atrial flutter, radiofrequency, ablation, mapping
Correspondence: Jian Chen, MD, Department of Heart Disease, Haukeland University Hospital, N-5021 Bergen, Norway. Tel: +47 55 972220; Fax: +47 55 975150; E-mail: jian.chen{at}med.uib.no This manuscript has been partly presented at the XXII Congress of the European Society of Cardiology, Amsterdam, August 2000.
[1] Feld GK, Fleck RP, Chen PS, et al. Radiofrequency catheter ablation for the treatment of human type I atrial flutter. Identification of the critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992; 86: 1233–1240.
[2] Cosio FG, Lopez-Gil M, Goicolea 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][ISI][Medline]
[3] Lesh MD, Van Hare GF, Epstein LM, et al. Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation 1994; 89: 1074–1089.
[4] Calkins H, Leon AR, Deam AG, Kalbfleisch SJ, Langberg JJ, Morady F. Catheter ablation of atrial flutter using radiofrequency energy. Am J Cardiol 1994; 73: 353–356.[CrossRef][ISI][Medline]
[5] Kirkorian G, Moncada E, Chevalier P, et al. Radiofrequency ablation of atrial flutter: efficacy of an anatomically guided approach. Circulation 1994; 90: 2804–2814.
[6] Fischer B, Haïssaguerre M, Garrigues S, et al. Radiofrequency catheter ablation of common atrial flutter in 80 patients. J Am Coll Cardiol 1995; 25: 1365–1372.[Abstract]
[7] Natale A, Newby KH, Pisonó E, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol 2000; 35: 1898–1904.
[8] 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.
[9] 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.
[10] 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]
[11] Schumacher B, Pfeiffer D, Tebbenjohanns J, Lewalter T, Jung W, Lüderitz B. Acute and long-term effects of consecutive radiofrequency applications on conduction properties of the subeustachian isthmus in type I atrial flutter. J Cardiovasc Electrophysiol 1998; 9: 152–163.[ISI][Medline]
[12] Tai CT, Chen SA, Chiang CE, et al. Long-term outcome of radiofrequency catheter ablation for typical atrial flutter: risk prediction of recurrent arrhythmias. J Cardiovasc Electrophysiol 1998; 9: 115–121.[ISI][Medline]
[13] Shah DC, Haïssaguerre M, Jaïs P, Takahashi A, Hocini M, Clémenty J. High-density mapping of activation through an incomplete isthmus ablation line. Circulation 1999; 99: 211–215.
[14] Nakagawa H, Lazzara R, Khastgir T, et al. Role of the tricuspid annulus and Eustachian valve/ridge on atrial flutter. Relevance to catheter ablation for the septal isthmus and a new technique for rapid identification of ablation success. Circulation 1996; 94: 407–424.
[15] Olgin JE, Kalman JM, Fitzpatrick AP, Lesh MD. Role of right atrial endocardial structures as barriers to conduction during human type I atrial flutter: activation and entrainment mapping guided by echocardiography. Circulation 1995; 92: 1839–1848.
[16] Kalman JM, Olgin JE, Saxon LA, Fisher WG, Lee RJ, Lesh MD. Activation and entrainment mapping defines the tricuspid annulus as the anterior barrier in typical atrial flutter. Circulation 1996; 94: 398–406.
[17] Shah DC, Takahashi A, Jaïs P, Hocini M, Clémenty J, Haïssaguerre M. Local electrogram-based criteria of cavotricuspid isthmus block. J Cardiovasc Electrophysiol 1999; 10: 662–669.[ISI][Medline]
[18] 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.
[19] Shah DC, Haïssaguerre M, Jaïs P, et al. Simplified electrophysiologically directed catheter ablation of recurrent common atrial flutter. Circulation 1997; 96: 2505–2508.
[20] Nabar A, Rodriguez LM, Timmermans C, Smeets JLRM, Wellens HJJ. Isoproterenol to evaluate resumption of conduction after right atrial isthmus ablation in type I atrial flutter. Circulation 1999; 99: 3286–3291.
[21] Tabuchi T, Okumura K, Matsunaga T, Tsunoda R, Jougasaki M, Yasue H. Linear ablation of the isthmus between the inferior vena cava and tricuspid annulus for the treatment of atrial flutter: a study in the canine atrial flutter model. Circulation 1995; 92: 1312–1319.
[22] Jaïs P, Haïssaguerre M, Shah DC, et al. Successful irrigated-tip catheter ablation of atrial flutter resistant to conventional radiofrequency ablation. Circulation 1998; 98: 835–838.
[23] Otomo K, Yamanashi WS, Tondo C, et al. Why a large tip electrode makes a deeper radiofrequency lesion: effects of increase in electrode cooling and electrode-tissue interface area. J Cardiovasc Electrophysiol 1998; 9: 47–54.[ISI][Medline]
[24] Cabrera JA, Sanchez-Quintana D, Ho SY, Medina A, Anderson RH. The architecture of the atrial musculature between the orifice of the inferior caval vein and tricuspid valve: anatomy of the isthmus. J Cardiovasc Electrophysiol 1998; 9: 1186–1195.[ISI][Medline]
[25] Kamalvand K, Tan K, Kotsakis A, Bucknall C, Sulke N. Is mode switching benificial? A randomized study in patients with paroxysmal atrial tachyarrhythmias. J Am Coll Cardiol 1997; 30: 496–504.[Abstract]
[26] Ellenbogen KA, Wood MA, Stambler BS. Acute effects of radiofrequency ablation of atrial arrhythmias on implanted permanent pacing systems. Pacing Clin Electrophysiol 1996; 19: 1287–1295.[CrossRef][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||