Randomized comparison of two targets in typical atrial flutter ablation
Abstract
Typical atrial flutter ablation has become anatomically guided to 2 separate sites within the isthmus at the inferior right atrium: (1) between the inferior vena cava and the tricuspid annulus (anterior side of the isthmus [A]), (2) between the eustachian crest, the coronary sinus ostium and tricuspid annulus (posterior side of the isthmus [P]). We prospectively compared ablation results at these sites in 72 consecutive patients. Patients were randomized in group P or A according to the initial target site. If ablation failed at 1 site after 15 radiofrequency (RF) pulses, the other side of the isthmus was targeted. Before 15 RF pulses, complete bidirectional isthmus block was achieved in 30 of 36 group A patients and in 25 of 36 group P patients, with similar mean RF pulses number, procedure time, and fluoroscopy time. After shifting to the other target, success was finally obtained at P in 2 of 6 group A patients, and at A in 8 of 11 group P patients before a maximum of 30 RF pulses. Among successful patients, number of RF pulses, procedure time, and fluoroscopy time were significantly lower in group A (7.2 +/- 5.4 vs 11.0 +/- 8.1 pulses, p = 0.03; 131 +/- 44 vs 163 +/- 66 minutes, p = 0.03; 31 +/- 19 vs 46 +/- 24 minutes, p = 0.01, respectively). Impairment of atrioventricular (AV) nodal conduction occurred in 5 patients only during ablation at P. AV block was transient in 4 patients and permanent in 1. Although atrial flutter ablation is equally effective at P and A, success seems easier to obtain when A is first targeted. Ablation at P is associated with a significant risk of AV block.
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Extending ablation inappropriately to the septal right atrium can cause atrioventricular block.
“Inappropriate extension of ablation to the septal RA can result in AV block, 183,184”
From European Heart Rhythm Association (EHRA) consensus document on the management of supraventricular arrhythmias, endorsed by Heart Rhythm Society (HRS), Asia-Pacific Heart Rhythm Society (APHRS), and Sociedad Latinoamericana de Estimulacion Cardiaca y Electrofisiologia (SOLAECE) (2017) · cites this paper as [183]
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BackgroundInfluentialMore on Isthmus Anatomy for Safety and Efficacy
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“In our centers, CTI ablations are performed along the anterior side of the CTI as success seems easier to obtain at this site and is associated with a lower risk of AV block.(9) It is likely that short epicardial connections between the CS musculature and RA are quite”
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“Ablation of common atrial flutter has become anatomically guided to 2 separate sites within the isthmus at the inferior right atrium: between the inferior vena cava and the tricuspid annulus (anterior side of the isthmus), and between the eustachian crest, the CS os and tricuspid annulus (posterior side of the isthmus…”
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“ancient ablation attempt at the so-called posterior isthmus (between the Eustachian crest, the CS ostium, and tricuspid annulus) was less effective (27).”
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- Authors
- Anselme, F., Klug, D., Scanu, P., Poty, H., Lacroix, D., Kacet, S., Cribier, A., & Saoudi, N.
- Affiliations
- Centre Hospitalier Universitaire de Rouen (FR)
- Centre Hospitalier Universitaire de Lille (FR)
- Centre Hospitalier Universitaire de Caen Normandie (FR)
- Corresponding author
- Saoudi, Nadir
- Venue
- The American Journal of Cardiology
- Publisher
- Elsevier BV
- Published
- 2000-06
- Volume
- 85
- Issue
- 11
- Pages
- 1302-1307
- ISSN
- 0002-9149 (ISSN-L)
- OpenAlex
- W2010273816
- Cited by
- 33
- References
- 24
- Citations by year
- 2025: 1 · 2020: 1 · 2018: 1 · 2017: 2 · 2016: 2 · 2015: 1 · 2014: 1
- FWCI
- 0.99
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The American Journal of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- typical atrial flutter, catheter ablation, isthmus ablation, bidirectional block, radiofrequency ablation, atrioventricular block, procedural success
- MeSH terms
- Adult, Aged, Aged, 80 and over, Atrial Flutter, Electrocardiography, Female, Heart Atria, Heart Block, Humans, Male, Middle Aged, Postoperative Complications, Prospective Studies, Recurrence, Reoperation, Treatment Outcome, Catheter Ablation
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