PO-03-004 VISITAG SURPOINT GUIDED HIGH-POWER SHORT-DURATION ABLATION FOR CAVOTRICUSPID ISTHMUS DEPENDENT ATRIAL FLUTTER

Abstract

VISITAG SURPOINT (VS) guided high-power short-duration (HPSD) ablation has been shown to be safe and effective for the treatment of paroxysmal atrial fibrillation. However, there is limited data on its utility in guiding ablation of cavotricuspid isthmus (CTI) dependent atrial flutter and the effect of CTI anatomy on HPSD procedural success. The purpose of this study was to assess the safety and efficacy of VS guided HPSD ablation for CTI dependent atrial flutter compared to standard ablation strategies and determine the impact of CTI anatomy on reconnection rates. Sixty-four consecutive patients underwent HPSD ablation for atrial flutter at 50W, with a target VS index of 400 and an inter-lesion distance < 6mm. Retrospective data from 35 patients receiving standard CTI ablation at 40W without VS were analyzed as controls. CTI anatomy was assessed using intracardiac echocardiography and categorized as either flat/concave, discrete diverticulum or having an underlying vascular structure. CTI morphology, radiofrequency (RF) time, first-pass bidirectional block (BDB), reconnection rates and ablation complications were compared. CTI morphology, mean CTI length and post-CTI waiting period were not significantly different between HPSD and standard 40W groups. Four patients (7%) in the HPSD group had CTI reconnection. Of these, 3 had evidence of a diverticulum and 1 had an underlying vascular structure. None of the HPSD patients with flat/concave CTI morphology had reconnection. In the standard 40W ablation group, 7 patients (20%) had reconnection (p < 0.05). Of these, 3 were flat/concave, 3 had a diverticulum and 1 had an underlying vascular structure. First pass BDB was achieved in 88% of HPSD patients and 77% of standard 40W patients (p = 0.18). Total RF delivery was significantly shorter in the HPSD group (p < 0.001) with a mean time of 3.65 ± 1.27 minutes, corresponding to 21 ± 10 ablation lesions. Durable bidirectional block was achieved in all HPSD and standard ablation patients, including those with reconnection. There were no complications in either group. HPSD with a target VS index of 400 is safe and effective for typical flutter ablation, with a lower rate of CTI reconnection and shorter RF time compared to standard ablation. The presence of diverticula or underlying vascular structures decreases procedural success. The absence of these anatomical variants may preclude the need for a standard waiting period when using VS guided HPSD technique.Tabled 150W (n = 64)40W (n = 35)p-valueAge (years)66 ± 1065 ± 100.81Gender (male)37 (58%)19 (54%)0.74Flat/Concave39 (61%)22 (63%)0.85Diverticulum22 (34%)11 (31%)0.77Underlying Vessel3 (5%)2 (6%)0.82CTI Length (cm)3.16 ± 0.623.21 ± 0.780.67RF Time (min)3.65 ± 1.278.73 ± 2.77< 0.001First Pass Block56 (88%)27 (77%)0.18Reconnection Rate4 (7%)7 (20%)< 0.05 Open table in a new tab