scholarly journals Local impedance and ultra-high density 3-dimensional mapping results in improved ablation metrics for cavotricuspid isthmus dependent atrial flutter compared with conventional ablation and contact force-guided ablation with 3-dimensional mapping

2021 ◽  
Author(s):  
Karan Saraf ◽  
Nicholas Black ◽  
Clifford Garratt ◽  
Sahrkaw Muhyaldeen ◽  
Gwilym Morris
Keyword(s):  
Real Time ◽  
Atrial Flutter ◽  
Contact Force ◽  
High Density ◽  
Complication Rates ◽  
3 Dimensional ◽  
Cavotricuspid Isthmus ◽  
Procedural Success ◽  
Dimensional Mapping

Introduction Multiple contact-based ablation technologies have been developed to allow real-time judgement of lesion effectiveness; local impedance (LI) guided ablation and the role of ultra-high density (UHD) mapping have not yet been evaluated for cavotricuspid isthmus dependent atrial flutter (CTI-AFL). Methods This non-randomised observational study evaluated patients undergoing CTI-AFL ablation using conventional, contact force (CF) and LI guided strategies. Ablation metrics were collected, and in the LI cohort, the use of UHD mapping for breakthrough was evaluated. Results 30 patients were included, 10 in each group. Mean total ablation time was significantly shorter with LI (3.2±1.3min) vs conventional (5.6±2.7min) and CF (5.7±2.0min, p=0.0042). Time from start of ablation to CTI block was numerically shorter with LI (14.2±8.0min) vs conventional and CF (19.7±14.1 and 22.5±19.1min, p=0.4408). There were no differences in the number of lesions required to achieve block, procedural success, complication rates or recurrence. 15/30 patients did not achieve block following first-pass ablation. UHD mapping rapidly identified breakthrough in the 5 LI patients, including epicardial-endocardial breakthrough (EEB) away from the line. Conclusion The use of LI for real-time assessment of lesion formation resulted in significantly less ablation requirement. UHD mapping rapidly identified breakthrough, including EEB, which would likely have been difficult to identify otherwise and possibly require extensive ablation, contributing towards shortening of time to CTI block with LI.

231Local impedance-guided ablation and ultra-high density mapping provide improved ablation metrics vs conventional or contact force-guided ablation for cavotricuspid isthmus dependent atrial flutter

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
K Saraf ◽  
G M Morris
Keyword(s):  
Atrial Flutter ◽  
Contact Force ◽  
Cost Savings ◽  
High Density ◽  
Patient Specific ◽  
Procedure Time ◽  
Potential Cost ◽  
Cavotricuspid Isthmus ◽  
Density Mapping

Abstract INTRODUCTION. Radiofrequency ablation (RFA) of cavotricuspid isthmus dependent atrial flutter (CTI-AFL) can be performed with fluoroscopy (Fluo) or 3-dimensional (3D) electroanatomic mapping and contact force (CF) catheters. Local impedance (LI) is an alternative but no comparisons have yet been made. METHODS. An observational study comparing Fluo, CF- and LI-guided RFA for CTI-AFL. In the LI group, if CTI block was not obtained after initial ablation, ultra-high density mapping (UHDm) was used to identify breakthrough sites. Contact was determined using patient specific LI; RF delivered until 20 ohm LI drop seen, or LI drop plateaued >2 secs. In the CF group 10-40g force was used. Power was limited to 40-50W in all groups. Total RFA time, time from RFA start to CTI block, no. of lesions required to achieve block, acute success, complications and re-ablation during follow-up were analysed using ANOVA. RESULTS. Data presented for 24 patients (7 Fluo, 7 CF, 10 LI). Mean RFA time: 6.6, 5.9, 3.2 min respectively (p = 0.0478). Statistically significant differences also seen with LI vs Fluo (p = 0.0451) and LI vs CF (p = 0.0313). Time from first RFA to block: 25.5, 19.8, 14.2 min (p = 0.5688); number of lesions to achieve block: 8.5, 10.3, 8 (p = 0.3909). 100% success and no complications in all groups. 0% need for re-ablation (16.3 ± 7, 12.6 ± 8, 6.5 ± 4.4 months follow-up). DISCUSSION. This data illustrates that UHDm and LI-guidance significantly reduces the amount of CTI RFA, by 52% and 47% vs Fluo and CF respectively (p = sig, fig. 1). A reduction from first RFA to block is also seen (43% and 37%; p = ns, fig. 2). Given no difference in the no. of lesions, LI-guided RFA during lesion formation shortens the duration of each lesion. Many patients require further RFA (+/- mapping) if they do not achieve block following the initial ablation line, resulting in longer procedures. Several patients without block in the LI group underwent repeat UHDm, which quickly identified CTI or epicardial-endocardial breakthrough (fig. 3 & 4), allowing rapid targeting for re-ablation. In the fluo group, these procedures would often be significantly prolonged, meaning extensive RFA and radiation exposure. Fig. 1 shows smaller error bars with LI compared to the others, resulting in more predictable total ablation times; this could potentially benefit procedure scheduling (more procedures per unit time). We could not directly compare overall procedure time as many in the CF group had CTI RFA combined with left atrial RFA. Multiple LI cases were performed fluo-free with only magnetic tracking. This may allow case scheduling without a radiographer, with potential cost savings. CONCLUSION. LI-guided CTI-AFL RFA is safe and effective and has shown favourable ablation metrics compared to Fluo or CF-RFA. LI-RFA with UHDm more quickly and accurately identifies breakthrough and with fluoro-free technique could possibly reduce procedure time and cost. A larger study is planned to provide more insight. Abstract Figures

The role of quantitation of real-time 3-dimensional contrast-enhanced ultrasound in detecting microvascular invasion: an in vivo study

2016 ◽  
Vol 41 (10) ◽  
pp. 1973-1979 ◽  
Author(s):  
Zhu Wang ◽  
Wei Wang ◽  
Guang-Jian Liu ◽  
Zheng Yang ◽  
Li-Da Chen ◽  
...  
Keyword(s):  
Real Time ◽  
Microvascular Invasion ◽  
In Vivo Study ◽  
Contrast Enhanced Ultrasound ◽  
3 Dimensional ◽  
Contrast Enhanced

scholarly journals 216-13: Does higher contact force impair lesion formation at the cavotricuspid isthmus? Insights from MR-guided ablation of atrial flutter

EP Europace ◽  
2016 ◽  
Vol 18 (suppl_1) ◽  
pp. i144-i144
Author(s):  
Henry Chubb ◽  
Rashed Karim ◽  
Steven Williams ◽  
James Harrison ◽  
John Whitaker ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Contact Force ◽  
Lesion Formation ◽  
Cavotricuspid Isthmus

Characteristics of Cavotricuspid Isthmus Ablation for Atrial Flutter Guided by Novel Parameters Using a Contact Force Catheter

2016 ◽  
Vol 27 (12) ◽  
pp. 1429-1436 ◽  
Author(s):  
PAUL A. GOULD ◽  
CAMERON BOOTH ◽  
KIERAN DAUBER ◽  
KEVIN NG ◽  
ANDREW CLAUGHTON ◽  
...  
Keyword(s):  
Atrial Flutter ◽  
Contact Force ◽  
Cavotricuspid Isthmus

scholarly journals Mathematical model for forecasting postablative atrial fibrillation in patients with typical atrial flutter

2021 ◽  
Vol 98 (9-10) ◽  
pp. 685-690
Author(s):  
M. V. Emelyanenko ◽  
Yu. V. Ovchinnikov ◽  
V. I. Steklov ◽  
V. M. Emelyanenko
Keyword(s):  
Atrial Fibrillation ◽  
Mathematical Model ◽  
Radiofrequency Ablation ◽  
Atrial Flutter ◽  
Cavotricuspid Isthmus ◽  
Typical Atrial Flutter ◽  
Electrophysiological Test

The article represents clinical, instrumental and electrophysiological predictors of postablative atrial fi brillation (AF) occurrence after radiofrequency ablation of cavotricuspid isthmus in 209 patients with typical atrial fl utter. The results of our own experience in the treatment of these patients are analyzed. The technique of the modifi ed intraoperative electrophysiological test of AF induction in patients with typical atrial fl utter is described. The role of this technique in the occurrence of postablative AF is evaluated. A mathematical model for predicting postablative AF at the intraoperative stage of treatment of patients with typical atrial fl utter has been developed.

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