Key result
Recovered cavotricuspid isthmus conduction during repeat ablation for recurrent atrial fibrillation was strongly associated with a pouch-type anatomy and longer CTI length.
Why the study?
Do specific cavotricuspid isthmus (CTI) anatomical and electrophysiological characteristics predict recurrent conduction in patients undergoing repeat ablation for atrial fibrillation?
Observational (n=49)
Do specific cavotricuspid isthmus (CTI) anatomical and electrophysiological characteristics predict recurrent conduction in patients undergoing repeat ablation for atrial fibrillation?
Answers are grounded in this paper and cite their sources.
A pouch-type anatomy and longer cavotricuspid isthmus are significant anatomical predictors of recurrent CTI conduction in patients undergoing repeat ablation for atrial fibrillation.
BACKGROUND: The characteristics of cavotricuspid isthmus (CTI) in patients with atrial fibrillation (AF) and flutter that may predict recurrence of flutter is not known. We aimed to investigate the CTI characteristics in patients who underwent a second ablation procedure for recurrent AF after previous combined pulmonary vein (PV) and CTI ablation. METHODS: Among 196 consecutive patients with drug-refractory symptomatic AF who underwent PV isolation and CTI ablation with bidirectional isthmus block, 49 patients (age 50 +/- 12 years, 43 males) had recurrent AF and received a second procedure 291 +/- 241 days after the first procedure. Right atrial angiography for the evaluation of the CTI morphology, and the biatrial contact bipolar electrograms were obtained before both procedures. RESULTS: In the second procedure, 11 (group 1) of the 49 patients demonstrated recovered CTI conduction. Compared with the patients without CTI conduction (group 2, n = 38), group 1 patients had a higher frequency of a pouch-type anatomy (82% vs 13%, P < 0.001), longer CTI (34.0 +/- 8.6 vs 25.5 +/- 7.5 mm, P = 0.01), longer ablation time, and larger number of radiofrequency applications; furthermore, the preablation bipolar voltage decreased along both the CTI and ablation line in group 2, whereas it remained similar in group 1 in the second procedure. CONCLUSIONS: A high (22%) percentage of CTIs exhibited recurrent conduction in the long-term follow-up. The CTIs with recurrent conduction had a higher incidence of a pouch and longer length compared with those without recurrent conduction.
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Lo et al. (2008) conducted an observational in Atrial fibrillation (n=49). Recovered CTI conduction vs. No CTI conduction was evaluated on Pouch-type anatomy (p=<0.001). Recovered cavotricuspid isthmus conduction during repeat ablation for recurrent atrial fibrillation was strongly associated with a pouch-type anatomy and longer CTI length.
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