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Jeong JH, Lee HS, Choi YY, Kim YG, Choi JI, Kim YH, Lim HE, Oh IY, Cha MJ, Lee SR, Kim JY, Kwon CH, Lee SH, Park J, Kim KH, Yang PS, Kim JH, Shim J. Association of typical atrial flutter and cavotricuspid isthmus ablation on clinical recurrence after cryoballoon ablation for atrial fibrillation. Front Cardiovasc Med 2023; 10:1303635. [PMID: 38162135 PMCID: PMC10755020 DOI: 10.3389/fcvm.2023.1303635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/30/2023] [Indexed: 01/03/2024] Open
Abstract
Typical atrial flutter commonly occurs in patients with atrial fibrillation (AF). Limited information exists regarding the effects of concurrent atrial flutter on the long-term outcomes of rhythm control. This study investigated the association between concurrent typical atrial flutter and cavotricuspid isthmus (CTI) ablation and the recurrence of atrial arrhythmia. The data were obtained from a multicenter registry of cryoballoon ablation for AF (n = 2,689). Patients who were screened for typical atrial flutter were included in the analysis (n = 1,907). All the patients with typical atrial flutter underwent CTI ablation. The primary endpoint was the late recurrence of atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia. Among the 1,907 patients, typical atrial flutter was detected in 493 patients (25.9%). Patients with concurrent atrial flutter had a lower incidence of persistent AF and a smaller size of the left atrium. Patients with atrial flutter had a significantly lower recurrence rate of atrial arrhythmia (19.7% vs. 29.9%, p < 0.001). In patients with atrial flutter, the recurrence rate of atrial tachycardia or atrial flutter was more frequent (7.3% vs. 4.7%, p = 0.028), but the recurrence rate of AF was significantly lower (17.0% vs. 29.4%, p < 0.001). Atrial flutter has been identified as an independent predictor of the primary endpoint (adjusted hazard ratio, 0.704; 95% confidence interval, 0.548-0.906; p = 0.006). Typical atrial flutter in patients with AF may serve as a positive marker of the recurrence of atrial arrhythmia, and performing CTI ablation in this population is associated with a reduced likelihood of AF recurrence. Performing routine screening and ablation procedures for coexisting atrial flutter may improve the clinical outcomes of AF.
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Affiliation(s)
- Joo Hee Jeong
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hyoung Seok Lee
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yun Young Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
| | - Hong Euy Lim
- Division of Cardiology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea
| | - Il-Young Oh
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Myung-Jin Cha
- Heart Institute, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Youn Kim
- Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Chang Hee Kwon
- Division of Cardiology, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Ho Lee
- Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Junbeom Park
- Department of Cardiology, School of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Ki-Hun Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Pil-Sung Yang
- Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Jun-Hyung Kim
- Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine and Korea University Anam Hospital, Seoul, Republic of Korea
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Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kennebäck G, Ljungström E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation as standard treatment of atrial flutter: a prospective, 2-center study (CASTAF). Acta Cardiol 2021; 76:267-271. [PMID: 32208915 DOI: 10.1080/00015385.2020.1721717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cryoablation (CRYO) of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) has been shown to be non-inferior to radiofrequency ablation (RF) in terms of ablation success and is associated with less pain. However, procedural time has been significantly longer with CRYO compared to RF. A possible explanation for this could be that operators had less experience with CRYO than with RF. The purpose of this study was to test the hypothesis that in the hands of experienced operators, cryoablation of CTI-dependent AFL is effective with procedure-time similar to what is reported for RF. METHODS This prospective 2-center study included 184 patients with CTI-dependent AFL - median age 66 years (range 28-83), 159 men (86%). Cryoablation was performed using a 9 F, 8 mm tip catheter (Freezor MAX, Medtronic, Inc, MN, USA). Ablation endpoint was bidirectional CTI-block. Pain was evaluated with a visual analogue scale (VAS 0-10). All operators had experience of at least 25 previous CTI-ablations with CRYO. RESULTS The acute success rate was 89%. Procedural time including an observation period of 30 min, was 115 ± 36 min which is similar to procedural times for RF in previous studies. Fluoroscopy time was 11 ± 9 min. Cryoablation was perceived as almost pain- free by the patients, VAS (mean) 1.8 ± 1.2. Success rate at 12-month follow-up (FU) was 88% in patients with primary success. No major adverse events occurred. CONCLUSIONS Cryoablation of CTI-dependent AFL is effective, with a low level of procedure-related pain. In experienced hands, the procedure time in this prospective non-randomised trial seems to be in the level of reported procedure times for RF. The long-term relapse rate appears to be higher than for RF.
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Affiliation(s)
- H. Bastani
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T. Bourke
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - F. Braunschweig
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - N. Drca
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K. Gudmundsson
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P. Insulander
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A. Jemtren
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G. Kennebäck
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E. Ljungström
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - B. Sadigh
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - O. Saluveer
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S. Scheel
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - J. Schwieler
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J. Tapanainen
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M. Jensen-Urstad
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
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Atrial fibrillation inducibility during cavo-tricuspid isthmus dependent atrial flutter ablation for the prediction of clinical atrial fibrillation. Int J Cardiol 2017; 240:246-250. [DOI: 10.1016/j.ijcard.2017.01.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 01/27/2017] [Indexed: 11/24/2022]
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Maskoun W, Pino MI, Ayoub K, Llanos OL, Almomani A, Nairooz R, Hakeem A, Miller J. Incidence of Atrial Fibrillation After Atrial Flutter Ablation. JACC Clin Electrophysiol 2016; 2:682-690. [DOI: 10.1016/j.jacep.2016.03.014] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 03/08/2016] [Accepted: 03/31/2016] [Indexed: 01/24/2023]
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Chen YH, Lin H, Xie CL, Zhang XT, Li YG. Efficacy comparison between cryoablation and radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter: a meta-analysis. Sci Rep 2015; 5:10910. [PMID: 26039980 PMCID: PMC4454189 DOI: 10.1038/srep10910] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/06/2015] [Indexed: 11/09/2022] Open
Abstract
We perform this meta-analysis to compare the efficacy and safety of cryoablation versus radiofrequency ablation for patients with cavotricuspid valve isthmus dependent atrial flutter. By searching EMBASE, MEDLINE, PubMed and Cochrane electronic databases from March 1986 to September 2014, 7 randomized clinical trials were included. Acute (risk ratio[RR]: 0.93; P = 0.14) and long-term (RR: 0.94; P = 0.08) success rate were slightly lower in cryoablation group than in radiofrequency ablation group, but the difference was not statistically significant. Additionally, the fluoroscopy time was nonsignificantly reduced (weighted mean difference[WMD]: −2.83; P = 0.29), whereas procedure time was significantly longer (WMD: 25.95; P = 0.01) in cryoablation group compared with radiofrequency ablation group. Furthermore, Pain perception during the catheter ablation was substantially less in cryoabaltion group than in radiofrequency ablation group (standardized mean difference[SMD]: −2.36; P < 0.00001). Thus, our meta-analysis demonstrated that cryoablation and radiofrequency ablation produce comparable acute and long-term success rate for patients with cavotricuspid valve isthmus dependent atrial flutter. Meanwhile, cryoablation ablation tends to reduce the fluoroscopy time and significantly reduce pain perception in cost of significantly prolonged procedure time.
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Affiliation(s)
- Yi-He Chen
- Department of Cardiology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Hui Lin
- Department of Respiratory, the second affiliated hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Cheng-Long Xie
- Department of Neurology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Xiao-Ting Zhang
- Department of Dermatology, the second affiliated hospital of Wenzhou Medical University, Wenzhou 325027, China
| | - Yi-Gang Li
- Department of Cardiology, Xinhua Hospital affiliated to the Medical School of Shanghai Jiaotong University, 1665 Kongjiang Road, Shanghai, 200092, China
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Jones MA, Webster D, Wong KCK, Hayes C, Qureshi N, Rajappan K, Bashir Y, Betts TR. The benefit of tissue contact monitoring with an electrical coupling index during ablation of typical atrial flutter--a prospective randomised control trial. J Interv Card Electrophysiol 2014; 41:237-44. [PMID: 25234603 DOI: 10.1007/s10840-014-9943-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/30/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION We sought to investigate the use of tissue contact monitoring by means of the electrical coupling index (ECI) in a prospective randomised control trial of patients undergoing cavotricuspid isthmus (CTI) ablation for atrial flutter. METHODS Patients with ECG-documented typical flutter undergoing their first CTI ablation were randomised to ECI™-guided or non-ECI™-guided ablation. An irrigated-tip ablation catheter was used in all cases. Consecutive 50-W, 60-s radiofrequency lesions were applied to the CTI, from the tricuspid valve to inferior vena cava, with no catheter movement permitted during radiofrequency (RF) delivery. The ablation endpoint was durable CTI block at 20 min post-ablation. Patients underwent routine clinic follow-up post-operatively. RESULTS A total of 101 patients (79 male), mean age 66 (+/-11), 50 ECI-guided and 51 control cases were enrolled in the study. CTI block was achieved in all. There were no acute complications. All patients were alive at follow-up. CTI block was achieved in a single pass in 36 ECI-guided and 30 control cases (p = 0.16), and at 20 min post-ablation, re-conduction was seen in 5 and 12 cases, respectively (p = 0.07). There was no significant difference in total procedure time (62.7 ± 33 vs. 62.3 ± 33 min, p = 0.92), RF requirement (580 ± 312 vs. 574 ± 287 s, p = 0.11) or fluoroscopy time (718 ± 577 vs. 721 ± 583 s, p = 0.78). After 6 ± 4 months, recurrence of flutter had occurred in 1 (2 %) ECI vs. 8 (16 %) control cases (OR 0.13, 95 % CI 0.01-1.08, p = 0.06). CONCLUSIONS ECI-guided CTI ablation demonstrated a non-statistically significant reduction in late recurrence of atrial flutter, at no cost to procedural time, radiation exposure or RF requirement.
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Affiliation(s)
- Michael A Jones
- Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, United Kingdom,
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Giedrimas E, Goldberger JJ. Catheter ablation for supraventricular tachycardias: contemporary issues. Future Cardiol 2014; 9:581-96. [PMID: 23834697 DOI: 10.2217/fca.13.26] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The treatment of cardiac arrhythmias has evolved significantly over the last 30 years. Understanding of arrhythmia mechanisms has led to pharmacologic therapies, surgical interventions and the widely used percutaneous catheter ablation techniques. The focus of this review is centered on the current catheter ablation therapies available for supraventricular tachycardia. We will discuss current management strategies including challenges when considering catheter ablation therapy for management of supraventricular tachycardias: atrioventricular nodal reentrant tachycardia, atrioventricular reentrant tachycardia utilizing an accessory pathway, atrial tachycardia and atrial flutter. Selected contemporary issues related to supraventricular tachycardia physiology, ablation approaches and ablation outcomes and complications will be discussed. Future goals for electrophysiologists are to continue to improve procedural safety and efficiency, while maintaining the impressive success rates that have been achieved.
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Affiliation(s)
- Evaldas Giedrimas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, 251 East Huron Street, Feinberg 8-503E, Chicago, IL 60611, USA
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Bastani H, Drca N, Insulander P, Schwieler J, Braunschweig F, Kennebäck G, Sadigh B, Tapanainen J, Jensen-Urstad M. Cryothermal vs. radiofrequency ablation as atrial flutter therapy: a randomized comparison. ACTA ACUST UNITED AC 2012; 15:420-8. [DOI: 10.1093/europace/eus261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Andrew P, Hamad Y, Jerat S, Montenero A, O’Connor S. Approaching a decade of cryo catheter ablation for type 1 atrial flutter—a meta-analysis and systematic review. J Interv Card Electrophysiol 2011; 32:17-27. [DOI: 10.1007/s10840-011-9582-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 04/18/2011] [Indexed: 11/27/2022]
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Kuniss M, Vogtmann T, Ventura R, Willems S, Vogt J, Grönefeld G, Hohnloser S, Zrenner B, Erdogan A, Klein G, Lemke B, Neuzner J, Neumann T, Hamm CW, Pitschner HF. Prospective randomized comparison of durability of bidirectional conduction block in the cavotricuspid isthmus in patients after ablation of common atrial flutter using cryothermy and radiofrequency energy: the CRYOTIP study. Heart Rhythm 2009; 6:1699-705. [PMID: 19959115 DOI: 10.1016/j.hrthm.2009.09.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 09/06/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND Recent studies have shown that cryoablation and radiofrequency (RF) ablation are comparable with regard to success rates and safety in the treatment of common atrial flutter (AFL). Long-term success requires persistence of bidirectional conduction block (BCB) in the inferior cavotricuspid isthmus (CTI). OBJECTIVE The purpose of this study was to determine the persistence of BCB in a prospective randomized multicenter trial of the two ablation techniques. METHODS A total of 191 patients were randomized to RF ablation or cryoablation of the CTI using an 8-mm-tip catheter. In all patients, BCB was defined as the ablation end-point. Primary end-point of the study was nonpersistence of achieved BCB and/or ECG-documented relapse of common AFL within 3-month follow-up. RESULTS Acute success rates were 91% (83/91) in the RF group and 89% (80/90) in the cryoablation group (P = NS). Invasive follow-up after 3 months with repeated electrophysiologic study was available for 60 patients in the RF group and 64 patients in the cryoablation group. Persistent BCB could be confirmed in 85% of the RF group versus 65.6% of the cryoablation group. The primary end-point was achieved in 15% of the RF group and 34.4% of the cryoablation group (P = .014). As a secondary end-point, pain perception during ablation was significant lower in the cryoablation group (P <.001). CONCLUSION Persistence of BCB in patients treated with cryoablation reinvestigated after 3 months is inferior to that patients treated with RF ablation, as evidenced by the higher recurrence rate of common AFL seen in this study.
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Affiliation(s)
- Malte Kuniss
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany.
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