Comparison of Intra Cardiac Echo (ICE) Guided Verses Non- Intra Cardiac Echo Radiofrequency Catheter Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

The isthmus-dependent atrial flutter can be effectively treated with Radiofrequency (RF) catheter ablation. Objectives: To compare the ICE guided versus non-ICE radiofrequency catheter ablation of Cavo tricuspid isthmus dependent atrial flutter. Methods: A cross-sectional study was carried out on 40 patient’s atrial flutter data in the Cardiac Electrophysiology Department, Hayatabad medical Complex Peshawar, Pakistan from August 2017 to August 2022. Patients were categorized into two groups: Group-I (ICE-guided RF catheter ablation) and Group-II (non-ICE RF catheter ablation). The standard protocol of ablation was followed using 40-50 watts power at temperature 60oC. In the case of an irrigated cooled tip catheter, the flow was limited to 30 mL/hour and the power was limited to 30 watts. Results: The overall mean ablation and flouro time was 9.44 ± 6.93 minutes and 20.64 ± 9.77 minutes respectively. The frequency of patients in Group-I and Group-II was 29 (72.5%) and 11 (27.5%) respectively. Out of the total patients, about 8 (20%) patients had shown failed status in terms of procedure success, out of which 5 (62.5%) were from Group-II. Compared to non-ICE guided procedure, the ICE guided procedure had lesser flouro and ablation time with higher rate of success and lower complications and recurrence. Conclusions: The present study observed that intracardiac echocardiography (ICE) can effectively disclose the Cavo tricuspid isthmus and guide ablation anatomy. Additionally, ICE guided radiofrequency catheter ablation had higher success rate, less flouro and ablation time, and lower complications than non-ICE guided radiofrequency catheter ablation.