Radiofrequency Catheter Ablation Of Atrial Flutter Research Articles

Dual linear lesions for right atrial flutter after mitral valve surgery via the superior transseptal approach.

The superior transseptal approach (STA) for mitral valve surgery is associated with a higher risk of developing macroreentrant incisional atrial flutter (AFL) than the left atrial approach. This study aimed to describe the linear lesions for the complex AFL circuit after the STA and to propose an option for the linear ablation target site. Of the 26 patients who underwent radiofrequency catheter ablation for AFL after mitral valve surgery, data from seven patients with STA incisions were retrospectively analyzed. All patients who had undergone the STA had incisional AFL rotated in a long loop within the right atrium (RA) and cavo-tricuspid isthmus (CTI)-dependent AFL. The linear lesions were created in the CTI, the superior RA vestibule, and between the RA-free wall incision or the septal incision and the inferior vena cava. Procedural success was achieved with dual linear lesions in the CTI and superior RA vestibule. Two of seven patients had AFL recurrence during a mean observation period of 22.5 ± 16.7months. The circuits of recurrent AFL were CTI-dependent AFL and perimitral AFL, respectively. No AFL recurrence was noted with reconduction of the superior RA vestibular lesion. Dual linear lesions in the CTI and superior RA vestibule are an effective treatment option for RA macroreentrant AFL after the STA.

Feasibility and efficacy using the KODEX-EPD imaging system in right atrial flutter ablation: a single center experience

Abstract Background Isthmus-dependent right atrial flutter is the most frequently encountered atrial flutter in clinical practice (80–90% of atrial flutters). Purpose The aim of our study was to assess as first experience the feasibility and safety of radiofrequency catheter ablation (RFCA) of cavo-tricuspid isthmus (CTI) guided by KODEX-EPD imaging system in patients presenting with typical atrial flutter (AFL). Methods 16 consecutive patients (mean age 68,46±7,8 years, 80% males) with diagnosis of AFL underwent RFCA guided by KODEX-EPD imaging system. In 15 patients the analysis performed during tachycardia showed a counter-clockwise activation. In 1 patient no tachycardia could be induced and the ablation was performed in sinus rhythm with fixed pacing from the coronary sinus. The KODEX-EPD imaging system was also used to guide ablation and to confirm persistent bidirectional block after ablation. Results Mean procedural time was 37,6±8,2 min, mean radiofrequency ablation time was 7,8±3,4 min, and mean fluoroscopy time was 2,1±1,2 min. All procedures were acutely successful with interruption of AFL during RFCA along the inferior CTI in 15 patients and achievement of the bidirectional conduction block in 16 patients proven by atrial pacing medial and lateral to the ablation line. There were no major procedural and 30-day complications. Over a mean follow-up of 18 months, we observed no recurrence of arrhythmia and no complications. Conclusions Our study shows that RFCA for AFL using the KODEX-EPD imaging system is feasible, safe, and effective. Funding Acknowledgement Type of funding sources: None.

Electrophysiological Characteristics and Outcomes of Radiofrequency Catheter Ablation of Atrial Flutter in Children with or Without Congenital Heart Disease.

There are scarce studies on radiofrequency catheter ablation (RFCA) of atrial flutter (AFL) in the pediatric population. This study therefore aimed to investigate the clinical features and RFCA of AFL in children with or without congenital heart disease. Data from 72 consecutive children (44 males; mean age, 6.1 ± 3.8 [0.9-15.0] years; and mean weight, 23.6 ± 13.9 [8.1-72.0] kg) undergoing RFCA for AFL from 2009 to 2019 were retrospectively reviewed. Thirty-three patients had normal cardiac structure and 39 had congenital heart disease (CHD) of whom 29 had undergone surgical repair and developed AFL at a mean of 3.1 ± 2.5years later. Fifty-nine patients (84%) presented with persistent AFL. Five patients (7%) had cardiac dysfunction with LVEF of 30-48%, which normalized after ablation. Overall, acute success rate of ablation was 99% and recurrence rate was 18% at 0.5-10years of follow-up. No procedure-related complications were identified. All 33 patients with normal cardiac structure had cavotricuspid isthmus (CTI)-dependent AFL. Among patients who had undergone corrective surgery for CHD, 15 (52%) had CTI-dependent AFL, 4 (14%) had surgical incisional scar reentrant AFL and the remaining 10 (34%) had both CTI-dependent and scar reentrant AFL. Success rate (100% vs. 97%, P = 1.0000) and recurrence rate (21% vs. 16%, P = 0.7008) were similar between patients with and without CHD. Overall, sick sinus syndrome (SSS) was found in 42% (30/72) of patients with AFL, with an incidence of 39% (13/33) among patients with normal cardiac structure and 59% (17/29) among those who underwent surgery for congenital defects. Permanent pacemakers (PM) were implanted in 53% (16/30) of patients with SSS after ablation. RFCA therefore appeared efficacious and safe for treatment of pediatric AFL. The mechanisms underlying AFL after corrective surgery for CHD are complex, including CTI-dependent macro-reentrant, scar reentrant, or a combination of both. SSS is not rare among pediatric AFL cases, with approximately half of patients needing PM implantation.

New oral anticoagulants in patients undergoing atrial flutter radiofrequency catheter ablation: an observational study.

Atrial flutter (AFL) ablation requires optimal periprocedural anticoagulation in order to minimize thromboembolic events/bleeding risk. This study describes the characteristics of patients receiving new oral anticoagulants before AFL ablation and assesses complications. This multicenter, retrospective study reports ischemic and hemorrhagic predischarge, postprocedural complications. We evaluated 60 patients (62.3% male; mean age: 69.2 ± 9.7 years; CHA2DS2-VASc score: 2.44 ± 1.46, HAS-BLED score: 1.14 ± 0.7). Twenty-one (35.0%) and 23 patients (38.3%) received twice-daily dabigatran 110 or 150 mg; 16 patients (26.6%) received once-daily rivaroxaban (15 mg [n = 5] or 20 mg [n = 11]). Four cases of postprocedural minor bleeding were reported. This is the first study assessing new oral anticoagulants for periprocedural anticoagulation, specifically in patients undergoing AFL ablation. No major bleeding was reported. Further prospective investigation is warranted.

257 Feasibility, safety and cost effectiveness of same-day discharge after common atrial flutter radiofrequency catheter ablation

257 Feasibility, safety and cost effectiveness of same-day discharge after common atrial flutter radiofrequency catheter ablation

Cardiac Arrest Caused by Torsades de Pointes Tachycardia after Successful Atrial Flutter Radiofrequency Catheter Ablation

Cardiac Arrest Caused by Torsades de Pointes Tachycardia after Successful Atrial Flutter Radiofrequency Catheter Ablation

Cardiac Arrest Caused by Torsades de Pointes Tachycardia after Successful Atrial Flutter Radiofrequency Catheter Ablation

A 66-year-old woman underwent successful radiofrequency catheter ablation for long-lasting, drug refractory fast atrial flutter. Two days later she had a cardiac arrest due to torsades de pointes (TdP) tachycardia attributed to relative sinus bradycardia and QT interval prolongation. After successful resuscitation further episodes of TdP occurred, which were treated with temporary pacing. Because of concomitant systolic dysfunction due to ischemic and valvular heart disease she was finally treated with an implantable defibrillator. In conclusion we strongly advise prolonged monitoring for 2 or more days for patients with structural heart disease following successful catheter ablation for long lasting tachyarrhythmias.

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

153 Quality of life in typical atrial flutter patients before and after radiofrequency catheter ablation using irrigational and conventional techniques

Purpose: to evaluate quality of life (QoL) before and after radiofrequency catheter ablation (RFA) of isthmus-depended atrial flutter (AF) patients. Material and Methods: the study included 69 consecutive pts (8 female), 55,64-12.3 years of age, referred for electrophysiological study (EPS) and radiofrequency ablation (RFA) due to paroxysmal typical AE The tachyarhythmia history was 7.24-6.0 years. Incidences of AF were 10.84-4.9 per month regardless of antiarrhythmic drug (AAD) therapy pursued. Conventional catheters were used in 49 pts (group one). Irrigated tip catheters with slow infusion rate (10 cc/min) were used in 20 pts (group the second). Bi-directional cavatricuspid isthmus block was verified using local criteria. QoL was evaluated by SF-36 questionnaire and symptom checklist-frequency and Severity Scale specific for cardiac arrhythmias during follow up period by the month the 2nd, 6th and the 12 after RFA. Results: the recurrences of the arrhythmia were observed in 7 cases (14.3%) of group one and in 2 cases (10%) of group two during first two-month of follow-up period. Repeated RFA were successful in all these cases. Improvement of QoL parameters, symptom-frequency score and symptom-severity score was observed by the 2nd months after RFA in both groups (p<0.05). Follow-up questioning (6, 12 mo. after RFA) showed comparable gradual increasing of QoL parameters in both groups. Conclusion: successful RFA of AF by means of either irrigational or conventional technique significantly improves QoL parameters by the month the 2nd after the procedure with subsequent improvement of the parameters of interest during 12 months of follow up period.

6.8 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

6.8 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

6.8 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

6.8 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

6.8 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

6.8 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

2681 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

2681 Long-term recurrence of atrial fibrillation after isthmus-dependent atrial flutter radiofrequency catheter ablation

Early versus late atrial fibrillation after atrial flutter ablation.

Radiofrequency catheter ablation of atrial flutter (AFl) has high initial success with a 10-15% recurrence. Atrial fibrillation (AFib) after radiofrequency catheter ablation of AFl can occur but may be transient (lasting no more than four weeks). Of one hundred seventeen consecutive patients studied, one hundred and four consecutive patients with sustained, symptomatic AFl, as the predominant rhythm disturbance (some of whom had transient pre-ablation AFib), referred for radiofrequency catheter ablation, had clinical follow-up. All had evidence for successful AFl ablation. Patients were followed prospectively. Over a mean follow-up of 28 months, 28 patients developed AFib after ablation of AFl [12 early AFib (<2 months) and 16 late AFib (>2 months)]. Seven of 12 (58%) patients in the early onset group reverted to normal sinus rhythm; none required long-term antiarrhythmic therapy. Only one (8%) developed permanent AFib. No patient in the late onset group remained in sinus rhythm without an antiarrhythmic drug. Three (19%) developed permanent AFib despite therapy among those with late onset AFib. Two (17%) patients with early onset AFib reverted to normal sinus rhythm with treatment versus 5 (31%) in the late onset group. Finally, only 2 patients (17%) with paroxysmal/persistent episodes of Afib from the early onset group stayed in normal sinus rhythm despite therapy, while 8 patients (50%) with paroxysmal/persistent AFib episodes from the late onset group required therapy to maintain normal sinus rhythm. Early onset AFib after ablation of AFl is likely to be transient and self-limited. Late onset AFib after ablation of AFl can persist and require chronic therapy.

Alternation in the flutter wave morphology during radiofrequency catheter ablation for common atrial flutter.

A linear lesion created at the right atrial isthmus by radiofrequency current application can successfully eliminate common atrial flutter (AF). The mechanism of unsuccessful cases has not yet been well delineated. This study sought to investigate the cause of unsuccessful cases of radiofrequency catheter ablation of AF. Sixty-six patients with refractory common AF were referred for radiofrequency catheter ablation. Radiofrequency current was applied to the right atrial isthmus between the inferior vena cava and tricuspid annulus or between the coronary sinus orifice and tricuspid annulus. In 5 (8%) of the 66 patients, a morphological change of the flutter wave was observed in the 12-lead ECG concomitant with the change of the atrial excitation sequence during the delivery of radiofrequency energy without the termination of atrial flutter. In 8 (12%) patients, the morphology of the new AF wave, which was provoked electrically after the termination of the original AF, was different, and the average flutter cycle length also differed in 3 cases (2%). The results of radiofrequency application could be misinterpreted as unsuccessful when the occurrence of another, different type of AF has been overlooked following the elimination of the original AF during the radiofrequency catheter ablation procedure. It is possible that the flutter circuit can take an alternative pathway despite the complete conduction block at the right atrial isthmus.