The septal approach to atrial flutter ablation yielded similar fluoroscopy times (58.4 vs 70.8 minutes; P=0.7) and success rates as the posterior approach, but carried a higher risk of AV block.
RCT (n=20)
randomized
Does the septal approach improve acute success rates or fluoroscopy times compared to the posterior approach for radiofrequency ablation of atrial flutter?
The posterior approach is preferred for atrial flutter ablation due to a lower risk of atrioventricular block compared to the septal approach, with similar efficacy.
Absolute Event Rate: 58.4% vs 70.8%
p-value: p=0.7
Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the "septal" or "posterior" approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 +/- 30.3 versus 70.8 +/- 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice.
Passman et al. (Thu,) conducted a rct in Atrial flutter (n=20). Septal approach to radiofrequency ablation vs. Posterior approach to radiofrequency ablation was evaluated on Acute success rates and fluoroscopy times (p=0.7). The septal approach to atrial flutter ablation yielded similar fluoroscopy times (58.4 vs 70.8 minutes; P=0.7) and success rates as the posterior approach, but carried a higher risk of AV block.
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