Adapting procedural strategies to MDCT-evaluated anatomical characteristics reduced the recurrence rate of type 1 atrial flutter compared to a conventional strategy (1.7% vs 6.3%, P=0.02).
Observational (n=446)
Does a modulation strategy adapted to anatomical characteristics using preoperative MDCT improve procedural efficiency and reduce recurrence in patients undergoing CTI ablation?
Adapting CTI ablation procedural strategies based on preoperative MDCT anatomical characteristics significantly reduces radiofrequency energy delivery and atrial flutter recurrence.
Absolute Event Rate: 1.7% vs 6.3%
p-value: p=0.02
OBJECTIVES: This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies. METHODS AND RESULTS: This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02). CONCLUSION: Changing the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.
Kajihara et al. (Mon,) conducted a observational in Type 1 atrial flutter undergoing cavotricuspid isthmus ablation (n=446). Modulation strategy adapted to MDCT anatomical characteristics vs. Nonmodulation (conventional) strategy was evaluated on Recurrence rate of type 1 atrial flutter after CTI ablation (p=0.02). Adapting procedural strategies to MDCT-evaluated anatomical characteristics reduced the recurrence rate of type 1 atrial flutter compared to a conventional strategy (1.7% vs 6.3%, P=0.02).