What is the clinical evidence from this study?

Study design: Observational. Population: Atrial flutter (n=181). Intervention: Ablation index-guided cavotricuspid isthmus ablation with CARTO UNIVU vs. Conventional non-AI-guided cavotricuspid isthmus ablation. Primary outcome: Fluoroscopy time (minutes) (p=<0.001).

March 16, 2022Open Access

Ablation index-guided cavotricuspid isthmus ablation with contiguous lesions using fluoroscopy integrated 3D mapping in atrial flutter

Q: What are the key findings of this study?

Ablation index-guided cavotricuspid isthmus ablation with fluoroscopy integrated 3D mapping significantly reduced fluoroscopy time to 0.2 minutes compared to 1.7 minutes with conventional ablation.

SSSusumu SakamaTokai University AYAtsuhiko YagishitaElectrophysiology TST. SakaiTokyo Women's Medical University

Key Result

Ablation index-guided cavotricuspid isthmus ablation with fluoroscopy integrated 3D mapping significantly reduced fluoroscopy time to 0.2 minutes compared to 1.7 minutes with conventional ablation.

Study Design

Type

Observational (n=181)

Blinding

None

Randomization

None

Multicenter

Structured PICO

Does AI-guided CTI ablation with contiguous lesions under fluoroscopy integrated 3D mapping improve procedural outcomes compared to conventional ablation in patients with atrial flutter?

Population

181 patients with typical atrial flutter (median age 70, 27% female) undergoing cavotricuspid isthmus (CTI) ablation.

Intervention

Ablation index (AI)-guided CTI ablation with contiguous lesions (target AI value of 450, interlesion distance ≤ 4 mm) under fluoroscopy integrated 3D mapping (CARTO UNIVU) guidance.

Comparator

Conventional non-AI-guided CTI ablation using a contact-force-sensing irrigated catheter with a power setting of 35 W and 30 s at each point with a contact force of 5-30 g.

Outcome

Procedural outcomes including the rate of first-pass conduction block across the CTI, duration of fluoroscopic use, number of RF applications, delivered energy, and complications.surrogate

AI-guided CTI ablation with contiguous lesions and fluoroscopy-integrated 3D mapping is feasible and significantly reduces fluoroscopy and radiofrequency times compared to conventional ablation in patients with atrial flutter.

Main Result

Absolute Event Rate: 0.2% vs 1.7%

p-value: p=<0.001

Limitations

Small, single-center, observational cohort study
Difference in the number of patients between the two groups
Absence of continuous monitoring devices to detect asymptomatic atrial flutter recurrences
Cost effectiveness of the use of intracardiac echocardiography was not validated
Efficacy was not compared with other strategies such as maximum voltage-guided ablation
Lack of systematic invasive procedures to assess reconnections and relatively short follow-up duration of 6 months

Abstract

PURPOSE: The feasibility and safety of cavotricuspid isthmus (CTI) ablation with contiguous lesions using ablation index (AI) under the guidance of fluoroscopy integrated 3D mapping (CARTO UNIVU/CU) in typical atrial flutter (AFL) remains uncertain. This study aimed to determine the efficacy of AI-guided CTI ablation with contiguous lesions in patients with AFL. METHODS: In this single-center, prospective, non-randomized, single-arm, observational study, procedural outcomes were determined in 151 patients undergoing AI-guided CTI ablation (AI group) with a target AI value of 450 and an interlesion distance of ≤ 4 mm under CU guidance. These outcomes were compared with those of 30 patients undergoing non-AI-guided ablation (non-AI group). RESULTS: Among 151 patients, first-pass conduction block was achieved in 120 (80%) patients in the AI group (67% in the non-AI group, P = 0.152) with a shorter fluoroscopy time of 0.2 ± 0.4 min (1.7 ± 2.0 min in the non-AI group, P < 0.001). Conduction gaps were located at the atrial aspects near the inferior vena cava in 24 of 31 (78%) patients without first-pass conduction block. The AI group received 11 ± 5 (12 ± 4 in the non-AI group, P = 0.098) radiofrequency (RF) applications, and the RF time was 4.2 ± 2.4 (5.1 ± 2.5 min in the non-AI group, P = 0.011). Despite the occurrence of steam pop in 3 (2%) patients, none of them developed cardiac tamponade. No patients had recurrence within 6 months of follow-up. CONCLUSIONS: AI-guided CTI ablation in combination with CU was feasible and effective in reducing radiation exposure in patients with AFL.

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