Abstract 16484: Utility of Steerable Sheaths and Intracardiac Echocardiography for Typical Atrial Flutter Ablation

Abstract

Introduction: Sheaths (SS) and intracardiac echocardiography (ICE) are being increasingly utilized to improve safety, efficacy, and efficiency of catheter ablation procedures for different arrhythmias. The utility of these tools to guide ablation of typical atrial flutter (AFL) are not well characterized. Hypothesis: The use of SS plus ICE during typical AFL ablation leads to improved procedural and long-term outcomes as well as shorter procedural, fluoroscopy, and total radiofrequency times. Methods: In this retrospective chart review, medical records were abstracted for patients undergoing typical AFL ablation alone between 7/2019-5/2023. Demographics, medical history, and baseline procedural data were collected. Procedural outcomes were achievement of bidirectional block and complications. Long term outcome was recurrence of typical AFL or unblocked cavotricuspid isthmus (CTI) at repeat ablation (for any arrhythmia). Data analyzed with intention-to-treat analysis. Results: 197 patients were identified. The use of SS plus ICE had the shortest procedural time (69.81 ± 34.49 mins, p<0.001), total radiofrequency time (362.91 ± 502.62 secs, p=0.005), and fluoroscopy time (5.28 ± 3.34 mins, p<0.001) (Figure 1). When patients were divided based on SS alone, both procedural and radiofrequency times were shorter with the use of SS vs no SS (81.04 ± 40.37 vs 91.74 ± 37.67 mins, p<0.001; 370.02 ± 460.44 vs 602.27 ± 592.28 secs, p=0.001), however, fluoroscopy time was longer (8.25 ± 7.75 vs 6.60 ± 5.58 mins, p<0.001). There was no difference between acute procedural success rates. Those in SS group were less likely to have recurrent typical AFL or unblocked CTI on redo ablation (0 out of 49 [0%] vs 6 out of 148 [4%]). Conclusion: Typical AFL ablation using SS plus ICE resulted in shorter procedural, total radiofrequency, and fluoroscopy times with similar acute procedural success rates. The use of SS (regardless of ICE) is associated with increased long-term success rate.