Rate Dependent Conduction Block of the Crista Terminalis in Patients With Typical Atrial Flutter

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. FUNDunding Acknowledgement Type of funding sources: None.

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A Case Report of Radiofrequency Ablation of Typical Atrial Flutter Combined with Atrial Tachycardia

Cardiovascular Innovations and Applications ◽

10.15212/cvia.2021.0022 ◽

2021 ◽

Author(s):

Chen Chun-hui

Keyword(s):

Radiofrequency Ablation ◽

Atrial Flutter ◽

Cycle Length ◽

Atrial Tachycardia ◽

Tricuspid Annulus ◽

Crista Terminalis ◽

Typical Atrial Flutter ◽

History Of ◽

Focal Atrial Tachycardia ◽

Endocardial Mapping

A 63-year-old female patient with a history of pulmonary heart disease underwent radiofrequency ablation because ofa persistent atrial flutter. Endocardial mapping with the carto3 system confirmed atrial flutter counterclockwise reentryaround the tricuspid annulus. Routine ablation of the cavo-tricuspid isthmus line to bi-directional block was performed.However, tachycardia with the same cycle length was induced again. After remapping, the tachycardia was confirmedto be focal atrial tachycardia located in the crista terminalis. After ablation, the tachycardia was terminated and couldnot be induced again.

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Vector Mapping in Localizing the Transverse Conduction Site of the Crista Terminalis in Patients with Typical Atrial Flutter

Pacing and Clinical Electrophysiology ◽

10.1111/j.1540-8159.2005.00142.x ◽

2005 ◽

Vol 28 (7) ◽

pp. 685-691 ◽

Cited By ~ 3

Author(s):

HIROSHIGE YAMABE ◽

YASUAKI TANAKA ◽

MEGUMI YAMAMURO ◽

HISAO OGAWA ◽

YOSHIHIRO KIMURA ◽

...

Keyword(s):

Atrial Flutter ◽

Crista Terminalis ◽

Typical Atrial Flutter ◽

Vector Mapping

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High-Resolution Mapping Around the Crista Terminalis During Typical Atrial Flutter:. New Insights into Mechanisms

Journal of Cardiovascular Electrophysiology ◽

10.1046/j.1540-8167.2004.03535.x ◽

2004 ◽

Vol 15 (4) ◽

pp. 406-414 ◽

Cited By ~ 41

Author(s):

CHING-TAI TAI ◽

JIN-LONG HUANG ◽

PI-CHANG LEE ◽

YU-AN DING ◽

MAU-SONG CHANG ◽

...

Keyword(s):

High Resolution ◽

Atrial Flutter ◽

Crista Terminalis ◽

High Resolution Mapping ◽

Typical Atrial Flutter ◽

Resolution Mapping

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Conduction Properties of the Crista Terminalis and Its Influence on the Right Atrial Activation Sequence in Patients with Typical Atrial Flutter

Pacing and Clinical Electrophysiology ◽

10.1046/j.1460-9592.2002.00132.x ◽

2002 ◽

Vol 25 (2) ◽

pp. 132-141 ◽

Cited By ~ 19

Author(s):

HIROSHIGE YAMABE ◽

IKUO MISUMI ◽

HIRONOBU FUKUSHIMA ◽

KAZUHIRO UENO ◽

YOSHIHIRO KIMURA ◽

...

Keyword(s):

Atrial Flutter ◽

Right Atrial ◽

Crista Terminalis ◽

Typical Atrial Flutter ◽

Atrial Activation ◽

The Right ◽

Conduction Properties ◽

Activation Sequence

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The use of half normal saline during catheter ablation of typical atrial flutter has no impact on the time to achieve bidirectional block

European Heart Journal ◽

10.1093/ehjci/ehaa946.0694 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

N.J.H Alhammad ◽

D.R Redfearn ◽

A.E Enriquez ◽

S.C Chacko ◽

K.H Hong ◽

...

Keyword(s):

Catheter Ablation ◽

Atrial Flutter ◽

Normal Saline ◽

Conduction Block ◽

Ionic Concentration ◽

Typical Atrial Flutter ◽

Population Reduction ◽

Significant Difference ◽

Power Setting ◽

The Mean

Abstract Background Achieving bidirectional block (BB) is generally considered to be the endpoint in the ablation of typical atrial flutter (AFL), however acute reconnection is common. Recent data suggest that deeper ablation lesions may be created by decreasing the irrigant ionic concentration using half normal saline (HNS) delivered through an open irrigated ablation catheter compared with normal saline (NS). We sought to assess whether the use of HNS was associated with a more rapid achievement of BB and less reconnections compared with NS. Methods Patients were randomly allocated to catheter ablation with either NS or HNS using a 4-mm irrigated catheter at a power setting of 30 W. Ablation approach employing either a maximum voltage guided (MVG) or empiric cavo-tricuspid isthmus (CTI) line was performed aiming for BB that was confirmed by double potentials separated by an isoelectric line measuring ≥110 ms and evidence of conduction block using differential pacing. Study was powered to an endpoint of acute reconnection within 30 mins. Results A total of 60 patients underwent catheter ablation for typical AFL with either HNS (n=30) or NS (n=30). There were no significant differences between the two groups in terms of patient age (68±7 yrs HNS vs. 68±10 yrs NS) and BMI (31±7 HNS vs 31±5 NS). BB was achieved in all patients. The MVG approach was employed in 28/60 patients. Acute reconnection was observed in 11 patients (18%); 4 in HNS vs 7 in NS group (ns). The mean RF time to achieve BB was 386±262 seconds in HNS vs 456±270 seconds in NS (p=0.21). The approach to CTI ablation showed a significant difference in time to BB: Time to block in MVG cases was 264±143 seconds vs 567±273 in empiric CTI line cases. Figure 1 demonstrates the time to block in both approaches with the choice of irrigant not appearing to impact the time to BB. There were 4 steam pops in the HNS arm and 0 steam pops observed in the NS arm. There were no significant complications in either arm. Conclusion Irrigation with HNS resulted in no statistically significant reduction in duration of RF time or improvement in acute outcomes over NS in the atrial flutter population. Reduction in duration of RF time was driven by MVG approach. However, acute reconnections were higher in NS group, all 4 steam pops occurred in HNS arm. Figure 1 Funding Acknowledgement Type of funding source: None

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