Ablation Of Atypical Atrial Flutter Research Articles

Peak frequency mapping of atypical atrial flutter.

Peak frequency (PF) mapping is a novel method that may identify critical portions of myocardial substrate supporting reentry. The aim of this study was to describe and evaluate PFmapping combined with omnipolar voltage mapping in the identification of critical isthmuses of left atrial (LA) atypical flutters. LA omnipolar voltage and PF maps were generated in flutter using the Advisor HD-Grid catheter (Abbott) and EnSite Precision Mapping System (Abbott) in 12 patients. Normal voltage was defined as ≥0.5 mV, low-voltage as 0.1-0.5 mV, and scar as <0.1 mV. PF distributions were compared with ANOVA and post hoc Tukey analyses. The 1 cm radius from arrhythmia termination was compared to global myocardium with unpaired t-testing. The mean age was 65.8 ± 9.7 years and 50% of patients were female. Overall, 34 312 points were analyzed. Atypical flutters most frequently involved the mitral isthmus (58%) or anterior wall (25%). Mean PF varied significantly by myocardial voltage: normal (335.5 ± 115.0 Hz), low (274.6 ± 144.0 Hz), and scar (71.6 ± 140.5 Hz) (p < .0001 for all pairwise comparisons). All termination sites resided in low-voltage regions containing intermediate or high PF. Overall, mean voltage in the 1 cm radius from termination was significantly lower than the remaining myocardium (0.58vs. 0.95 mV, p < .0001) and PF was significantly higher (326.4vs. 245.1 Hz, p < .0001). Low-voltage, high-PF areas may be critical targets during catheter ablation of atypical atrial flutter.

Ablation of atypical atrial flutter in a patient after radiotherapy for adenocarcinoma of the right lung using the Coherent CARTOPRIME™ module of the CARTO system

Ablation of atypical atrial flutter in a patient after radiotherapy for adenocarcinoma of the right lung using the Coherent CARTOPRIME™ module of the CARTO system

CE-454610-1 VENTRICULAR FIBRILLATION REQUIRING EXTRACORPOREAL RESUSCITATION DURING RADIOFREQUENCY ABLATION IN THE CORONARY SINUS

Coronary vasospasm is a rarely reported but potentially catastrophic complication of radiofrequency ablation (RFA). The mechanism is not fully understood but may be related to thermal energy transfer, inflammatory markers released during ablation, and/or alterations in autonomic tone from stimulation of epicardial ganglionated plexi. While most vasospasm occurrences appear subclinical and self-limited, there are exceptions. To highlight an exceptional, life-threatening case of RFA-induced coronary vasospasm. N/A A 62-year-old man with persistent AF and five prior ablations (including one at our institution) presented for ablation of atypical atrial flutter. Termination of the flutter occurred with RFA (7 lesions) at the left atrial roof. There was also a breakthrough of conduction through a prior posterior mitral isthmus line, so coronary sinus (CS) lesions were placed to re-attain mitral block. Two irrigated RF lesions (#1 - 59 seconds, max 26 Watts; #2 - 40 seconds, max 33 Watts) were placed, but 7 seconds into the 3rd lesion (max 27 Watts), ventricular fibrillation (VF) occurred, initially refractory to multiple external shocks. ACLS/CPR commenced. Arterial access was rapidly achieved, and initial coronary angiography simply revealed diffusely slow/no flow related to ongoing VF. Emergent veno-arterial extracorporeal membrane oxygenation (VA ECMO) cannulation was initiated, following which the VF was successfully defibrillated, converting to sinus rhythm. Repeat coronary angiography revealed (known) minimal non-obstructive coronary disease as well as a focal, severe spasm of a dominant left circumflex artery adjacent to the location of CS ablation. Intracoronary nitroglycerin resulted in minimal initial angiographic improvement, so balloon angioplasty and deployment of a drug eluting stent was performed (post: TIMI III flow). The patient made a full recovery and was discharged home on post-procedure day 6 without long-term sequelae. This case underscores a life-threatening complication of RFA within the CS leading to coronary vasospasm and refractory VF. Expedient intervention with extracorporeal resuscitation and support can stabilize patients to allow time to manage arrhythmias and resolve spasm either pharmacologically or procedurally.

Patterns and Characteristics of SKYLINE-Lumipoint Feature in the Catheter Ablation of Atypical Atrial Flutter: Insight from a Novel Lumipoint Module of Rhythmia Mapping System.

Background: Atypical atrial flutter (aAFL) is not uncommon, especially after a prior cardiac surgery or extensive ablation in atrial fibrillation (AF). Aims: To revisit aAFL, we used a novel Lumipoint algorithm in the Rhythmia mapping system to evaluate tachycardia circuit by the patterns of global activation histogram (GAH, SKYLINE) in assisting aAFL ablation. Methods: Fifteen patients presenting with 20 different incessant aAFL, including two naïve, six with a prior AF ablation, and seven with prior cardiac surgery were studied. Results: Reentry aAFL in SKYLINE typically was a multi-deflected peak with 1.5 GAH-valleys. Valleys were sharp and narrow-based. Most reentry aAFL (18/20, 90%) lacked a plateau and displayed a steep GAH-valley with 2 GAH-valleys per tachycardia. Each GAH-valley highlighted 1.9 areas in the map. Successful sites of ablation all matched one of the highlighted areas based on GAH-valleys < 0.4. These sites corresponded with the areas highlighted by GAH-score < 0.4 in reentry aAFL, and by GAH-score < 0.2 in localized-reentry aAFL. Conclusions: The present study showed benefits of the LumipointTM module applied to the RhythmiaTM mapping system. The results were the efficient detection of the slow conduction, better identification of ablation sites, and fast termination of the aAFL with favorable outcomes.

Atypical atrial flutter in patients after cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Atypical atrial flutter (AFL) is often associated with cardiac surgery or extensive catheter ablation (CA) for the treatment of atrial fibrillation (AF) [1-2]. Therefore, the increase in the number of cardiac surgery procedures leads to the development of substrates for atypical AFL onset. Incisions after cardiac surgery are common substrates for macro re-entry tachycardia and one patient can suffer from several macro re-entry tachycardia mechanisms. Atrial flutter in this category of patients lead to heart failure. Objective The aim of our study was to access the effectiveness and safety of catheter ablation of atypical atrial flutter in patients after cardiac surgery. Methods 107 adult patients with AFL after cardiac surgery and catheter ablation were included in a single-center prospective study. The patient’s mean age was 57.8±11.1 years with the prevalence of male (56%). BMI was 27,8±5 kg/m 2. All patients underwent radiofrequency ablation (RFA) of atypical AFL with 3D navigation system Carto3 using the CLOSE protocol. The patients were discharged safely and were monitored for 12 months. Results According to basic characteristics of patients cardiac surgery performed in 19.6% for CABG, in 9.3% for congenital heart disease and in 58.9% for valvular heart diseases. RFA for pulmonary veins isolation (PVI) for AF was performed in 15.9% and cryoballoon isolation of PVI in 19.6%. The onset of atrial events after incision or catheter ablation was 12 (Q1-14; Q3-25) months. In 8.4% of patients, ejection fraction was less than 40%. The mean RFA time was 110,8±10,4 min, mean fluoroscopy time 2.2 min. There were two re-entry mechanisms in 22.4% of patients, three and more re-entry mechanisms in 8.4% of patients. During 12 months monitoring after RFA in 2 (1.9%) patients registered AFL and in 8 (7.5%) of patients noticed non-sustained palpitations. Conclusions RFA of AFL with the use of ablation index and CLOSE protocol lead to the high effect and safety in patients after cardiac surgery. AFL is most frequent in patients after valvular heart surgery and usually occurs 12 months after the surgery.

PO-635-03 HIGH-DENSITY MAPPING GUIDES ABLATION STRATEGIES TO TREAT ATRIAL FLUTTER: RESULTS FROM THE ADVISOR™HD GRID MAPPING CATHETER OBSERVATIONAL STUDY

Patients undergoing RF ablation to treat persistent AF (PersAF) may develop atrial flutter (AFL) during the procedure. Ablation of atypical AFL can be challenging but, recent advancements in high-density (HD) three-dimensional mapping strategies may help rapidly and accurately assess ablation targets to achieve successful outcomes in treating AFL. The Advisor™ HD Grid Mapping Catheter Observational Study (NCT03733392) was designed to quantify and characterize the utility of mapping with a market-released HD mapping catheter in AFL subjects undergoing ablation. This study was sponsored by Abbott Laboratories. Subjects undergoing mapping with the Advisor™ HD Grid Mapping Catheter, Sensor Enabled (HD Grid) for PersAF ablation were enrolled in this multi-center study, some of which were also in AFL. The aim of this study was to gather data regarding safety, mapping and ablation strategies, electrogram (EGM) quality, and outcomes. 15.2% (51/334) of enrolled subjects in this study were in AFL and of these subjects, 96.1% (49/51) were ablated for AFL (65.5yrs, 67.3% male). 81.4% (35/43) of the maps generated were late activation timing (LAT) and 16.3% (7/43) were peak-to-peak voltage maps. Median total mapping points collected and used were 7008 (IQR 3374-16811) and 1654 (IQR 900-2286), respectively, in a median of 11 (IQR 6-17) min per map. HD Grid identified substrates such as, low voltage (82.4%; 42/51) and fibrosis/scar (66.7%; 34/51) and detected signals of interest not identified by the ablation catheter in 90.2% (37/41) of subjects. Ablation strategies included targeting the mitral isthmus (38.8%; 19/49), roof line (36.7%; 18/49), and cavotricuspid isthmus (26.5%; 13/49). The mean procedure time was 171.4 ± 60.3 min with a fluoroscopy time of 13.7 ± 10.6 min and RF time of 36.1 ± 37.3 min. AFL was terminated in 93.9% (46/49) and non-inducible in 94.1% (16/17) of subjects. 84% (21/25) were free from recurrent AF/AT/AFL at 12 months. 2 SAEs, 7 SADEs, and 1 ADE were experienced in 17.6% (9/51) of subjects with none related to HD Grid. The results of this study support the utility of the Advisor™ HD Grid mapping catheter in generating LAT and voltage maps based on high-quality EGMs and for guiding efficient and effective ablation strategies to treat AFL.

Substrate-based ablation of atypical atrial flutter in patients with atrial cardiomyopathy.

BackgroundStandard therapy of atypical atrial flutter (AFL) aims at deploying ablation lines between two non-conducting anatomical structures, thereby creating a line of block within the re-entry circuit. We have developed an ablation strategy, where we incorporate voltage information as a surrogate for atrial fibrosis from the electro-anatomical map (EAM) during AFL ablation procedures to create individualized, substrate-based ablation lines along the area of most pronounced low-voltage within the reentry-circuit.ObjectiveThe aim of this study was to evaluate acute procedural success and long-term outcome of a substrate-based ablation (SBA) strategy in comparison to a standard anatomically based ablation (ABA) strategy for the ablation of atypical AFL.MethodsPatients that underwent ablation for AFL at our institution were included. SBA procedures were compared to ABA procedures. Endpoints were acute termination of AFL and recurrence of the index AFL or any other AFL during follow-up.ResultsWe included 47 patients, 24 individuals (51.1%) in the SBA group and 23 patients (48.9%) in the ABA group. Most patients had signs of atrial cardiomyopathy, namely enlarged left atrial diameter (LAD) and extended amount of left atrial low-voltage areas (LVA). Termination of AFL occurred in 27 of 29 (93.1%) AFL in the SBA group and in 28 of 31 (90.3%) AFL in the ABA group (p = 0.99). Freedom from recurrence of any atypical AFL after 2.5 years was 21.5% in the ABA group compared to 48.8% in the SBA group (p = 0.047).ConclusionSubstrate-based ablation is as effective as an anatomically-based ablation in the acute termination of AFL but yields better rhythm outcome with less recurrence of AFL in patients with atrial cardiomyopathy.

Clinical impact of high density mapping in atypical atrial flutters ablation: outlining critical circuits in complex atrial tachycardias

Abstract Introduction Mapping and ablation of atypical atrial flutter (AFL) continue to be a challenge for clinical electrophysiologists. The advent of high-density (HD) mapping has allowed the generation of electro-anatomic maps with a very high resolution level. Purpose In this single center retrospective analysis, we evaluated the clinical impact of the ultra HD activation sequence mapping compared with the standard low density (LD) ablation catheter mapping technique in the treatment of AFLs. Methods We performed a 7 years-single center retrospective analysis of patients undergoing radiofrequency ablations (RFA) for right and left atypical AFL. We evaluated procedural and clinical outcomes of patients approached with a Low Density (LD) electro-anatomical (EAM) strategy compared with patients mapped with new automatic multipolar HD Mapping (HD Group). Results Seventy-five patients were included. Patients were almost male (60%), relatively old (65±8 years), with a moderate CHA2DS2Vasc score (2.3±1.3), a preserved ejection fraction (58±6) and moderate atrial dilatation (44±7 mm). Baseline clinical characteristics were comparable between groups (p=NS). Among 88 AFLs, 10 (11%) were located in the right and 78 (89%) in the left atrium, including 22 (28%) roof dependent and 37 (47%) mitral dependent (p=NS). Regarding procedural outcomes, Sinus rhythm restoration during ablation was more frequently observed in the HD Group (79% vs 56%, p=0.037), even if no differences in mapping time, procedural time and radiological dose were observed (p=NS). Freedom from AFL/atrial fibrillation (AF) at 1-year was lower in the HD Group (83% vs 45%, p=0.009) with an increased trend for AF recurrences during long term follow-up (17% vs 23% at 1 and 3-years respectively, p=0.059). At the multivariate analysis, HD map (OR 0,17; 95% CI 0,04–0,66) and younger age (OR 1,09; 95% CI 1,01–1,19) were identified as independent predictors of ablation success at 1 year. Conclusions Acute procedural success of ablation of atypical atrial flutter is higher in case of HD mapping strategy. Patient age and HD strategy resulted independent predictors of overall atrial arrhythmias recurrences. During follow-up, AFL recurrences are rare beyond 12 months, differently from AF which continues to show increasing trends. Funding Acknowledgement Type of funding sources: None. Procedural outcomesAtypical atrial flutter HD map

High-density versus low-density mapping in ablation of atypical atrial flutter

Ablation of atypical atrial flutter (AAFL) can be challenging. High-density (HD) mapping of ablation targets may potentially increase procedural success and freedom from recurrent AAFL. The objective of the present study was to explore whether employing HD mapping leads to a more favorable outcome in ablation of AAFL. We compared baseline and procedural characteristics, procedural success, safety and outcome of mapping and ablation of atypical flutter in three groups. (1) HD Grid catheter + the high-density electroanatomical mapping (EAM) system EnSite Precision; (2) standard 10-pole circular mapping catheter (CMC) + EnSite Precision; (3) CMC + the low-density EnSite Velocity EAM. Voltage and propagation maps were constructed. Mapping of 142 AAFL in 82 patients was performed. Acute ablation success was 78%, 68%, and 51% in groups 1, 2, and 3 (p = 0.037 between group 1 and 3, non-significant between groups otherwise). Moreover, 8%, 27%, and 36% of flutters were unmappable in groups 1, 2, and 3, respectively (p < 0.05 between group 1 and both groups 2 and 3). AAFL recurrence at 1-year FU was 26%, 36%, and 62% in groups 1, 2, and 3 (p = 0.007 between groups 1 and 3, p = 0.05 between groups 2 and 3). AAFL-free survival was significantly higher in patients mapped with Precision than with Velocity (p = 0.011). No strokes or mortality occurred within 30 days. Acute procedural success of ablation of atypical atrial flutter is higher and the number of unmappable flutters is lower using the HD Grid mapping catheter in combination with the high-density EnSite Precision system, as compared to a decapolar circular mapping catheter and the low-density EnSite Velocity EAM system. This may lead to increased freedom from recurrent AAFL at 1 year. HD mapping is safe.

Atrial Tachyarrhythmias and Atrial Flutter: the Basics of Diagnostics and Modern Opportunities of Therapy

The article is devoted to the description of all types of atrial tachyarrhythmias, including inappropriate sinus tachycardia, which, as a rule, is not paid enough attention in the domestic literature, sinoatrial node reentrant tachycardia, focal and multifocal atrial tachycardia, atrial flutter, and atrial fibrillation. The electrophysiological mechanisms of development and electrocardiographic criteria for the diagnosis of these cardiac rhythm disturbances are presented. Along with this, the article discusses the modern view of the strategy and tactics of pharmacological cardioversion and preventive therapy in patients with the main types of atrial tachyarrhythmias and atrial flutter. It is noted that the prognosis for inappropriate sinus tachycardia, as a rule, is favorable, and therefore, aim of treatment is to reduce the symptoms, and in their absence medical treatment is not necessary. Much attention is paid to drug and interventional treatment of atrial flutter. It is emphasized that catheter ablation of isthmus-dependent atrial flutter in most cases is preferred over long-term pharmacotherapy. However, in prolonged observation (more than 3 years), nearly 1/3 of patients may develop paroxysmal atrial fibrillation. At the same time, catheter ablation of atypical atrial flutter is, in most cases, substantially less effective. The indications and side effects of catheter ablation of the sinus node are also discussed. The authors provide a critical analysis of traditional approaches to the treatment of atrial tachyarrhythmias and analyze new recommendations for the management of these patients presented in Europe and the USA. Based on these recommendations, clear algorithms for the management of patients with atrial tachyarrhythmias are given. The need to prevent thromboembolic complications in some types of atrial tachyarrhythmias is emphasized.

Ultra–fast, high density 3D mapping system for catheter ablation of atypical atrial flutter.

Ultra–fast, high density 3D mapping system for catheter ablation of atypical atrial flutter.

Успешное устранение атипичного трепетания предсердий у пациента детского возраста после операции Сеннинга

Успешное устранение атипичного трепетания предсердий у пациента детского возраста после операции Сеннинга

Radiofrequency catheter ablation of atypical atrial flutter in dogs

Five dogs were presented to our institution for fatigue caused by an incessant supraventricular tachycardia. In all dogs, an ECG on admission showed a narrow QRS complex tachycardia with a median ventricular cycle length of 220 ms (range 180–360 ms), and a positive atrial depolarization identifiable in the ST segment following the previous QRS complex. There was a 1:1 atrioventricular conduction ratio in all but one dog, which presented with 2:1 atrioventricular block. Electrophysiologic studies identified the underlying arrhythmogenic mechanism as a right atrial macro-reentrant tachycardia with two distinct isthmic areas: right septal (RS) in three dogs and right atrial free wall (RAFW) in two dogs. Linear radiofrequency catheter ablation was performed during tachycardia in all dogs at the identified isthmic area, which acutely blocked the macroreentrant circuit. At 18-month follow-up, 3 dogs (1 with RAFW isthmus and 2 with RS isthmus) showed no recurrence of the arrhythmia on Holter monitoring. One dog with RS isthmus showed recurrence of the supraventricular tachycardia 15 days post-ablation, and 1 dog with RAFW isthmus presented with persistent atrial fibrillation 2 months post-ablation.

PP-279 ABLATION OF THE TYPICAL CAVOTRICUSPID ISTHMUS-DEPENDENT ATRIAL FLUTTER AND ATRIOVENTRICULAR NODAL REENTRY TACHYCARDIA IN A PATIENT WITH OPERATED TETRALOGY OF FALLOT

Introduction: Cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is the most common arrhythmia in operated Tetralogy of Fallot (ToF) patients. Here, we report the successful ablation of a typical counterclockwise AFL and reverse clockwise AFL in a patient with operated ToF. Case report: A 35-year-old male had previously undergone total corrective surgery for ToF 27 years before admitted to our clinic. He suffered from tachyarrhythmias for 3 months, and his symptoms had worsened in the last 1 month with the manifestation of paroxysmal typical AFL. Baseline ECG revealed first degree AV block and right ventricular hypertrophy signs. Upon examination of the 12-lead ECG recorded during palpitation, we observed no visible P waves and inferior axis and thus considered the possibility of AVNRT. Transthoracic and transesophageal echocardiography revealed an incomplete closure of the tricuspid valve with severe tricuspid regurgitation and a dilated right atrium in the apical 4-chamber view. Electrophysiological investigation revealed both clockwise and anticlockwise AFL (Figures 1a,b).

Percutaneous Transhepatic Access for Ablation of Atypical Atrial Flutter in Complex Congenital Heart Disease

Journal of Cardiovascular ElectrophysiologyVolume 24, Issue 5 p. 589-590 EP IMAGE Percutaneous Transhepatic Access for Ablation of Atypical Atrial Flutter in Complex Congenital Heart Disease SÉBASTIEN KNECHT M.D., Ph.D., Corresponding Author SÉBASTIEN KNECHT M.D., Ph.D. CHU Brugmann, Bruxelles, BelgiumAddress for correspondence: Sebastien Knecht, M.D., Ph.D., Service de cardiologie, CHU Brugmann. Place Van Gehuchten, 4 1020 Bruxelles, Brelgium. Fax: +332-477-2632; E-mail: sebastien.knecht@chu-brugmann.beSearch for more papers by this authorMARC LAUREYS M.D., MARC LAUREYS M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorJOSE CASTRO-RODRIGUEZ M.D., JOSE CASTRO-RODRIGUEZ M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorHUGUES DESSY M.D., HUGUES DESSY M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorMATTHEW WRIGHT M.B.B.S., Ph.D., MATTHEW WRIGHT M.B.B.S., Ph.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorTHIERRY VERBEET M.D., THIERRY VERBEET M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this author SÉBASTIEN KNECHT M.D., Ph.D., Corresponding Author SÉBASTIEN KNECHT M.D., Ph.D. CHU Brugmann, Bruxelles, BelgiumAddress for correspondence: Sebastien Knecht, M.D., Ph.D., Service de cardiologie, CHU Brugmann. Place Van Gehuchten, 4 1020 Bruxelles, Brelgium. Fax: +332-477-2632; E-mail: sebastien.knecht@chu-brugmann.beSearch for more papers by this authorMARC LAUREYS M.D., MARC LAUREYS M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorJOSE CASTRO-RODRIGUEZ M.D., JOSE CASTRO-RODRIGUEZ M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorHUGUES DESSY M.D., HUGUES DESSY M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorMATTHEW WRIGHT M.B.B.S., Ph.D., MATTHEW WRIGHT M.B.B.S., Ph.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this authorTHIERRY VERBEET M.D., THIERRY VERBEET M.D. CHU Brugmann, Bruxelles, BelgiumSearch for more papers by this author First published: 03 October 2012 https://doi.org/10.1111/jce.12025Citations: 5 J Cardiovasc Electrophysiol, Vol. 24, pp. 589–590, May 2013 No disclosures. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume24, Issue5May 2013Pages 589-590 RelatedInformation

Roof-dependent atrial flutter after catheter ablation for persistent atrial fibrillation in dextrocardia with situs inversus

A 45-year-old man who had undergone circumferential pulmonary vein isolation for persistent atrial fibrillation 9 months earlier was admitted to our hospital for catheter ablation of atypical atrial flutter (AFL) causing tachycardia-induced cardiomyopathy. The silhouette of the patient's chest and abdominal X-ray film revealed dextrocardia with situs inversus. The dimensions of the anatomic left (right-sided) ventricle and atrium were 52 mm and 50 mm, respectively. Left ventricular ejection fraction was 38% by echocardiography.

221 Complete atrioventricular block during ablation of atrial flutter. Incidence and causes

Radiofrequency (RF) ablation of typical atrial flutter (AFl) is largely used to restore and maintain a sinus rhythm. Little is known on the risk of a third degree atrioventricular block (AVB). The purpose of the study was to evaluate the incidence and the causes of iatrogenic complete AVB during RF ablation of a typical AFl. Population AFl ablation was performed in 763 patients (pts), 606 males, 157 females aged from 18 to 90 years (64±12) with recurrent or bad–tolerated typical AFl; 330 pts had associated significant heart disease (valvular 68, congenital 24, ischemic heart disease 71, dilated cardiomyopathy 43, miscellaneous 78) or chronic pulmonary disease (46). Methods AFl RF catheter ablation was performed by conventional method with setting a HALO catheter in coronary sinus and using an 8-F quadripolar with an 8 mm-tip electrode catheter; a maximum power of 70 w and a maximum target temperature of 70 was used. Obtaining a sinus rhythm and a complete isthmus block was the objective of the procedure. Results Complete AVB (1%) was noted when sinus rhythm was restored, in 8 pts aged from 59 to 89 years (73±9) significantly older than other pts (63.5±12) (p Conclusions Complete AVB was a rare complication of RF ablation of typical atrial flutter (1%) which concern old pts; it is significantly more frequent in pts with ischemic heart disease (3/71, 4%) than in pts without ischemic disease (p

Complete Atrioventricular Block during Ablation of Atrial Flutter

We report the case of a 51-year-old patient who developed a complete atrioventricular (AV) block during the isthmic radiofrequency catheter ablation of a typical atrial flutter. The cause was an acute occlusion of the segment three of the right coronary artery. His recanalization was associated with the immediate restoration of a normal AV conduction. The complication is exceptional (one of 740 consecutive atrial flutter ablations). (PACE 2010; 516-519).

Radiofrequency ablation of atypical atrial flutter after cardiac surgery or atrial fibrillation ablation: A randomized comparison of open-irrigation-tip and 8-mm-tip catheters

The efficacy of radiofrequency ablation of atypical atrial flutter (AAFL) remains relatively low. This is probably related to the complex mechanism of this arrhythmia or may be due to an inability to deliver sufficient energy during ablation. The aim of this study is to assess whether an open-irrigation-tip catheter or an 8-mm-tip catheter is more effective for ablation of AAFL in patients with prior history of cardiac surgery and/or catheter ablation of atrial fibrillation. Seventy patients with AAFL after cardiac surgery/atrial fibrillation ablation were randomized for ablation with either an open-irrigation-tip catheter (Group 1, n=36) or an 8-mm-tip catheter (Group 2, n=34). Acute success was defined as the termination of AAFL by radiofrequency delivery and noninducibility by programmed pacing at the end of procedure. Patients' postoperative courses were followed up by means of intermittent standard electrocardiogram (ECG), transtelephonic ECG monitoring, and telephone interview. All patients underwent 48-hour Holter monitoring at their 3-, 6-, and 9-month follow-up after ablation. Acute success was achieved in 34 patients (94.4%) in Group 1 and 26 patients (76.5%) in Group 2 (P<.05). As compared with the patients in Group 2, more patients in Group 1 remained in sinus rhythm without antiarrhythmic drugs at 90-day follow-up (22 vs 8, P<.05). After 10 months of follow-up, 91.7% of the patients from Group 1 were free of atrial tachyarrhythmias, whereas only 58.9% of the patients from Group 2 remained in sinus rhythm (P <.05). The fluoroscopy and radiofrequency times were significantly shorter when an open-irrigation-tip ablation catheter was used. In patients with a prior history of cardiac surgery or ablation for atrial fibrillation, an open-irrigation-tip catheter is superior to an 8-mm-tip catheter for radiofrequency ablation of scar-related AAFLs. Patients ablated with an open-irrigation-tip catheter seem to have higher acute success rate with less x-ray exposure and radiofrequency delivery, and have a more favorable long-term outcome with more patients maintaining sinus rhythm without antiarrhythmic drugs.

Catheter Ablation of Atypical Atrial Flutter

Catheter Ablation of Atypical Atrial Flutter