Radiofrequency Ablation of Atrial Flutter: A Randomized Controlled Trial of Two Anatomic Approaches
Abstract
Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the "septal" or "posterior" approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 +/- 30.3 versus 70.8 +/- 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice.
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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”
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- Authors
- Passman, R. S., Kadish, A. H., Dibs, S. R., Engelstein, E. D., & Goldberger, J. J.
- Affiliations
- Northwestern University (US)
- Corresponding author
- Passman, Rod S.
- Venue
- Pacing and Clinical Electrophysiology
- Publisher
- Wiley
- Published
- 2004-01
- Volume
- 27
- Issue
- 1
- Pages
- 83-88
- ISSN
- 0147-8389 (ISSN-L)
- 1540-8159
- OpenAlex
- W1524497297
- Cited by
- 24
- References
- 28
- Citations by year
- 2026: 1 · 2024: 1 · 2016: 2 · 2014: 1 · 2013: 1 · 2012: 1
- FWCI
- 1.74
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pacing and Clinical Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5k23hl068814-05)
- National Heart, Lung, and Blood Institute (1 K23 HL68814-01)
- 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
- atrial flutter, radiofrequency catheter ablation, posterior approach, bidirectional block, atrioventricular block, fluoroscopy time, ablation success rate
- MeSH terms
- Atrial Flutter, Female, Humans, Male, Middle Aged, Treatment Outcome, Catheter Ablation
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