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Vol.2 , No. 3, Publication Date: May 6, 2015, Page: 14-19
 of the cavo-tricuspid isthmus (CTI) is one of the most frequently performed procedures in electrophysiology. Cavotricuspidisthmus (CTI) ablation is the treatment of choice in preventing recurrences of typical atrial flutter (AFl). Bidirectional isthmus block is a criterion of successful ablation and is associated with the presence of different activation times on each side of the ablation line. Objective: The aim of this study was to determine a novel parameter clarify to improve a success rate in ablation of the CTI. Population and methods: We studied 35 patients with typical atrial flutter (60% male, mean age 48,5 +/- 10 years) who underwent successful ablation during tachycardia. The heart rhythm was sinus in 11% of patients and atrial flutter in 83% before the procedure. Electrophysiology mapping was used to confirm diagnosis of isthmus-dependent atrial flutter, electroanatomic position guide the ablation line creation and assess its efficacy. Before and after CTI ablation, activation times were measured on the low lateral right atrium under pacing from the proximal coronary sinus ostium (with a 600 ms cycle), on the proximal sinus coronary ostium under pacing from the low lateral right atrium. Results: Mean activation time between proximal sinus coronary ostium and atrial bipolar electrogram (SC-RA ) enregistred from coronary sinus to low-lateral right atrium in sinus rhythm or in atrial flutter before the creation of the CTI block ablation were 103,7 ± 30,6 ms and. After the creation of the CTI block ablation, Mean activation times were 148,15±24,6 ms at low-lateral right atrium (LLRA)underpacing proximal sinus coronary ostium (PSCO) (PSCO -> LLRA) (P<0,001; r=0,54) and 143, 89± 30,36 ms at proximal sinus coronary ostium under pacing low-lateral right atrium to (LLRA -> PSCO ) (P<0,001; r=0,62). The linear regression equation that best described this result was: LLRA -> PSCO = 0,581 * SC-RA + 83,540; PSCO -> LLRA = 0,437 * SC-RA + 102,863. Conclusion: After atrial flutter ablation, the activation time between proximal sinus coronary ostium and atrial bipolar electrogram enregistred at the low-lateral right atrium during atrial flutter or in the sinus rhythm of more than half this time before ablation plus 100 ms was associated with isthmus conduction block. This time criteria is very simplified criteria, make it easy to use in the routine ablation compared to others algorithm. This should however be confirmed before the end of the procedure through demonstration of bidirectional isthmus block.&picture=http://www.aascit.org/aascit/decorators/img/journal/906.jpg)
| [1] | S. Marrakchi, Cardiology department Abderrahman Mami Hospital Ariana Tunis Tunisia, University Manar II, Medical University of Tunis, Tunisia. |
| [2] | S. Mzah, Cardiology department Abderrahman Mami Hospital Ariana Tunis Tunisia, University Manar II, Medical University of Tunis, Tunisia. |
| [3] | B. Zouari, Epidemiology department, University Manar II, Medical University of Tunis, Tunisia. |
| [4] | A. Mrabet, Epidemiology department, University Manar II, Medical University of Tunis, Tunisia. |
| [5] | I. Kammoun, Cardiology department Abderrahman Mami Hospital Ariana Tunis Tunisia, University Manar II, Medical University of Tunis, Tunisia. |
| [6] | S. Kachboura, Cardiology department Abderrahman Mami Hospital Ariana Tunis Tunisia, University Manar II, Medical University of Tunis, Tunisia. |
Background: Radiofrequency ablation (RFA) of the cavo-tricuspid isthmus (CTI) is one of the most frequently performed procedures in electrophysiology. Cavotricuspidisthmus (CTI) ablation is the treatment of choice in preventing recurrences of typical atrial flutter (AFl). Bidirectional isthmus block is a criterion of successful ablation and is associated with the presence of different activation times on each side of the ablation line. Objective: The aim of this study was to determine a novel parameter clarify to improve a success rate in ablation of the CTI. Population and methods: We studied 35 patients with typical atrial flutter (60% male, mean age 48,5 +/- 10 years) who underwent successful ablation during tachycardia. The heart rhythm was sinus in 11% of patients and atrial flutter in 83% before the procedure. Electrophysiology mapping was used to confirm diagnosis of isthmus-dependent atrial flutter, electroanatomic position guide the ablation line creation and assess its efficacy. Before and after CTI ablation, activation times were measured on the low lateral right atrium under pacing from the proximal coronary sinus ostium (with a 600 ms cycle), on the proximal sinus coronary ostium under pacing from the low lateral right atrium. Results: Mean activation time between proximal sinus coronary ostium and atrial bipolar electrogram (SC-RA ) enregistred from coronary sinus to low-lateral right atrium in sinus rhythm or in atrial flutter before the creation of the CTI block ablation were 103,7 ± 30,6 ms and. After the creation of the CTI block ablation, Mean activation times were 148,15±24,6 ms at low-lateral right atrium (LLRA)underpacing proximal sinus coronary ostium (PSCO) (PSCO -> LLRA) (P<0,001; r=0,54) and 143, 89± 30,36 ms at proximal sinus coronary ostium under pacing low-lateral right atrium to (LLRA -> PSCO ) (P<0,001; r=0,62). The linear regression equation that best described this result was: LLRA -> PSCO = 0,581 * SC-RA + 83,540; PSCO -> LLRA = 0,437 * SC-RA + 102,863. Conclusion: After atrial flutter ablation, the activation time between proximal sinus coronary ostium and atrial bipolar electrogram enregistred at the low-lateral right atrium during atrial flutter or in the sinus rhythm of more than half this time before ablation plus 100 ms was associated with isthmus conduction block. This time criteria is very simplified criteria, make it easy to use in the routine ablation compared to others algorithm. This should however be confirmed before the end of the procedure through demonstration of bidirectional isthmus block.
Keywords
Atrial Flutter, Ablation, Isthmic Activation Times
Reference
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