A NOVEL RADIOFREQUENCY CATHETER ABLATION TECHNIQUE FOR CREATION OF CAVOTRICUSPID ISTHMt BLOCK IN ISTHMUS-DEPENDENT ATRIAL FLUTTER

摘要

We devised a novel technique for cavotricuspid isthmus (CI) ablation for atrial flutter. Methods: Fifteen patients with CI dependent atrial flutter were studied. We mapped the CI using an octapolar catheter positioned parallel to the ablation line during lower atrial pacing or persistent atrial flutter. The isthmus mapping catheter (IS) was located downstream of the activation wavefront from the ablation line, and we performed point-by-point RF ablation targeting the breakthrough points on the CI. Results: In 7 initial patients, we used the IS in combination with Halo, His and coronary sinus catheters, to confirm the bidirectional conduction block of the CI (BIB). A shift in the breakthrough point with a conduction delay was observed with each effective RF application. Simultaneous activation pattern along the ablation line with delayed local activation corresponded to creation of BIB. In the 8 remaining patients, we concealed all recordings other than IS recordings to assess the BIB. All 8 patients were correctly judged to have BIB from the IS recording only. The number of RF applications, total procedure time, and total fluoroscopic time were 6.9+-2.8 times, 60.3+-24.0 min, and 18.1+-6.4 min, respectively. Conclusions: This novel technique is simple, precise and cost-effective for atrial flutter ablation.