© 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.
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