Key result
A deep cavotricuspid isthmus (≥ 4.1 mm) was associated with a significantly lower first-pass success rate for typical atrial flutter ablation compared to a shallow isthmus (34% vs 81%, p<0.01).
Why the study?
Although ablation index has emerged as a novel marker for estimating ablation lesions, the relationship between cavotricuspid isthmus depth and ablation parameters on typical atrial flutter ablation outcomes was unclear.
Does a deep cavotricuspid isthmus (≥ 4.1 mm) reduce the first-pass success rate of typical atrial flutter ablation compared to a shallow isthmus?
Observational (n=107)
No
Does a deep cavotricuspid isthmus (≥ 4.1 mm) reduce the first-pass success rate of typical atrial flutter ablation compared to a shallow isthmus?
Absolute Event Rate: 34% vs 81%
p-value: p=<0.01
A deep cavotricuspid isthmus (≥ 4.1 mm) is associated with a lower first-pass success rate and longer ablation time during typical atrial flutter ablation, despite similar ablation index values.
Deeper CTI was associated with lower first-pass success despite similar AI; leaves open whether adjusted targets or techniques improve outcomes.
Cavotricuspid isthmus (CTI) linear ablation has been established as the treatment for typical atrial flutter. Recently, ablation index (AI) has emerged as a novel marker for estimating ablation lesions. We investigated the relationship between CTI depth and ablation parameters on the procedural results of typical atrial flutter ablation. A total of 107 patients who underwent CTI ablation were retrospectively enrolled in this study. All patients underwent computed tomography before catheter ablation. From the receiver-operating curve, the best cut-off value of CTI depth was < 4.1 mm to predict first-pass success. Although the average AI was not different between deep CTI (DC; CTI depth ≥ 4.1) and shallow CTI (SC; CTI depth < 4.1), DC required a longer ablation time and showed a lower first-pass success rate (p < 0.01). In addition, the catheter inversion technique was more frequently required in the DC (p < 0.01). The lowest AI sites of the first-pass CTI line were determined in both the ventricular (2/3 segment of CTI) and inferior vena cava (IVC, 1/3 segment of CTI) sides. The best cut-off values of the weakest AIs at the ventricular and IVC sides for predicting first-pass success were > 420 and > 386, respectively. Among patients with these cut-off values, the first-pass success rate was 89% in the SC and 50% in the DC (p < 0.01). Although ablation parameters were not significantly different, the first-pass success rate was lower in the DC than in the SC. Further investigation might be required for better outcomes in deep CTIs.
No takes yet. Share an insight, caveat, or question.
Kashiwagi et al. (2021) conducted an observational in Typical atrial flutter (n=107). Deep cavotricuspid isthmus (≥ 4.1 mm) vs. Shallow cavotricuspid isthmus (< 4.1 mm) was evaluated on First-pass success of CTI ablation (p=<0.01). A deep cavotricuspid isthmus (≥ 4.1 mm) was associated with a significantly lower first-pass success rate for typical atrial flutter ablation compared to a shallow isthmus (34% vs 81%, p<0.01).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: