Evaluating dragging vs. point-by-point ablation strategies in cavotricuspidal isthmus ablation for atrial flutter: a retrospective single-center trial

Background Cavotricuspid isthmus (CTI) ablation is the preferred treatment for typical atrial flutter, performed using various techniques. This study aimed to compare procedural and follow-up data between point-by-point and continuous “dragging” radiofrequency (RF) catheter ablation methods. Methods This retrospective, single-center study included 121 consecutive patients who underwent first-time RF CTI ablation for typical atrial flutter between January 2023 and August 2024. Patients were assigned to point-by-point ( n = 49) or continuous dragging ( n = 72) groups. All procedures were performed under conscious sedation using irrigated-tip catheters and intracardiac echocardiography. Patients with prior CTI ablation, cardiac surgery, or concomitant ablation were excluded. Procedural and follow-up outcomes were compared between groups. Results The continuous dragging technique significantly shortened the time from the first to last ablation [12 (6; 27) min vs. 18 (11; 32) min; p < 0.05] and the time from the first ablation to the first CTI block [9 (8; 17) min vs. 13 (8; 25) min; p < 0.01]. Additionally, total ablation time [484 (285; 774) s vs. 704 (449; 955) s; p < 0.01] and energy usage [20,613 (11,191.5; 33,257.3) J vs. 25,717 (17,251.8; 36,420) J; p < 0.05] were lower in the dragging group. The dragging technique also increased the first pass block rate (69.4% vs. 46.2%; p < 0.01). There was no significant difference in overall procedure time [55 (46; 66) min vs. 58.5 (45; 72) min; p = 0.46], fluoroscopy duration (41 ± 6 s vs. 55 ± 8 s; p = 0.14), or acute reconnection rate (27.8% vs. 30.8%; p = 0.80). Both groups achieved a 100% acute success rate with no major complications. There was no significant difference in the rate of recurrence between the two groups (2.77% vs. 2.04%, p = 1.0) during the long-term follow-up (13.4 ± 3.8 months). Conclusion The continuous “dragging” RF ablation technique for CTI ablation in typical atrial flutter enhances procedural outcomes compared to the point-by-point method, demonstrating reduced ablation time, lower energy consumption, and a higher first pass block rate, all without compromising efficacy or safety.