Empirical cavo-tricuspid isthmus ablation during AF ablation had lower conduction block durability compared to ablation with documented atrial flutter (58.2% vs 78.1%, P=0.031).
Observational (n=1,078)
No
Does empiric cavo-tricuspid isthmus (CTI) linear ablation during AF ablation provide durable conduction block and safety?
Empiric CTI ablation during AF ablation is associated with relatively low conduction block durability and potential complications, suggesting it should not be routinely recommended.
Absolute Event Rate: 58.2% vs 78.1%
p-value: p=0.031
BACKGROUND: Cavo-tricuspid isthmus (CTI) linear ablation is performed not only for atrial flutter (AFL) but empirically during atrial fibrillation (AF) ablation in real-world practice. PURPOSE: We sought to evaluate the safety and durability of the CTI ablation. METHODS: This retrospective study included 1078 consecutive patients who underwent a CTI ablation. AFL was documented before or during the procedure in 249 (23.1%) patients, and an empirical CTI and AF ablation were performed in 829 (76.9%) patients. RESULTS: CTI block was successfully created in 1051 (97.5%) patients with a 10.3 ± 6.6 min total radiofrequency time. Repeat procedures were performed for recurrent arrhythmias in 187 (17.3%) patients at a median of 11.0 (5.0-30.0) months postprocedure, and conduction resumption was identified in 68/174 (39.1%). Among those undergoing a CTI ablation with an AF ablation, the durability was significantly higher in those with than without documented AFL (78.1% vs. 58.2%, p = .031). The total radiofrequency time was significantly shorter (9.0 ± 5.3 vs. 10.0 ± 6.4 mins, p = .024) and durability significantly higher (78.1 vs. 58.7%, p = .043) in the large-tip than irrigated-tip catheter group. Iatrogenic AFL was observed after the empiric CTI ablation in 11 (1.3%) patients. Procedure-related complications occurred in 15 (1.4%) patients. Eight patients experienced coronary artery spasms, including one with ventricular fibrillation following ST elevation on the ward. The other six patients experienced transient atrioventricular block and one experienced cardiac tamponade requiring drainage. CONCLUSIONS: Despite a high acute CTI ablation success, the conduction block durability was relatively low after the empiric ablation. An empiric CTI ablation at the time of the AF ablation is not recommended.
Kakehashi et al. (Fri,) conducted a observational in Atrial flutter and atrial fibrillation (n=1,078). Empirical cavo-tricuspid isthmus (CTI) ablation vs. CTI ablation with documented atrial flutter was evaluated on Conduction block durability (p=0.031). Empirical cavo-tricuspid isthmus ablation during AF ablation had lower conduction block durability compared to ablation with documented atrial flutter (58.2% vs 78.1%, P=0.031).