Key result
MDCT-guided ablation cuts RF delivery time ~27% and reduces atrial flutter recurrence vs. conventional ablation.
Why the study?
Does adapting procedural strategies to anatomical characteristics based on preprocedural MDCT improve outcomes and reduce procedure time in patients undergoing CTI ablation?
RCT (n=366)
Open-label
Prospectively randomized
No
Does adapting procedural strategies to anatomical characteristics based on preprocedural MDCT improve outcomes and reduce procedure time in patients undergoing CTI ablation?
Absolute Event Rate: 162.2% vs 222.7%
p-value: p=<0.01
Adapting cavotricuspid isthmus ablation strategies based on preprocedural MDCT anatomical characteristics significantly reduces radiofrequency time, energy delivery, and atrial flutter recurrence.
MDCT-adapted CTI ablation was associated with shorter RF delivery and fewer recurrences; leaves open confirmation in randomized trials before practice change.
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.
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Kajihara et al. (2013) conducted an RCT in Cavotricuspid isthmus (CTI)-dependent atrial flutter or atrial fibrillation (n=366). Variable procedural strategies adapted to MDCT anatomical characteristics (modulation strategy) vs. Conventional ablation strategy (nonmodulation group) was evaluated on Duration of radiofrequency energy delivered (seconds) (p=<0.01). Adapting catheter ablation strategies to anatomical characteristics identified by preprocedural MDCT significantly reduced the duration of radiofrequency energy delivered and lowered the recurrence rate of atrial flutter compared to a conventional strategy.
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