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Maglia G, Pentimalli F, Verlato R, Solimene F, Malacrida M, Aspromonte V, Bacino L, Turrini P, Infusino T, La Greca C, Perego GB, Papa AA, De Ruvo E, Zingarini G, Devecchi C, Scaglione M, Tomasi C, Pirrotta S, Stabile G. Ablation of CTI-dependent flutter using different ablation technologies: acute and long-term outcome from the LEONARDO study. J Interv Card Electrophysiol 2023; 66:1749-1757. [PMID: 36869990 DOI: 10.1007/s10840-023-01519-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND A novel ablation catheter has been released to map and ablate the cavo-tricuspid isthmus (CTI) in patients with atrial flutter (AFL), improving ablation efficiency. METHODS We evaluated the acute and long-term outcome of CTI ablation aiming at bidirectional conduction block (BDB) in a prospective, multicenter cohort study enrolling 500 patients indicated for typical AFL ablation. Patients were grouped on the basis of the AFL ablation method (linear anatomical approach, Conv group n = 425, or maximum voltage guided, MVG group, n = 75) and ablation catheter (mini-electrodes technology, MiFi group, n = 254, or a standard 8-mm ablation catheter, BLZ group, n = 246). RESULTS Complete BDB according to both validation criteria (sequential detailed activation mapping or mapping only the ablation site) was achieved in 443 patients (88.6%). The number of RF applications needed to achieve BDB was lower in the MiFi MVG group vs both the MiFi Conv group and the BLZ Conv group (3.2 ± 2 vs 5.2 ± 4 vs 9.3 ± 5, p < 0.0001 for all comparisons). Fluoroscopy time was similar among groups, whereas we observed a reduction in the procedure duration from the BLZ Conv group (61.9 ± 26min) to the MiFi MVG group (50.6 ± 17min, p = 0.048). During a mean follow-up of 548 ± 304 days, 32 (6.2%) patients suffered an AFL recurrence. No differences were found according to BDB achieved by both validation criteria. CONCLUSIONS Ablation was highly effective in achieving acute CTI BDB and long-term arrhythmia freedom irrespective of the ablation strategy or the validation criteria for CTI chosen by the operator. The use of an ablation catheter equipped with mini-electrodes technology seems to improve ablation efficiency. CLINICAL TRIAL REGISTRATION Atrial Flutter Ablation in a Real World Population. (LEONARDO). CLINICALTRIALS gov Identifier: NCT02591875.
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Affiliation(s)
- Giampiero Maglia
- Cardiology - Coronary Care Unit, Electrophysiology and Cardiac Pacing, Pugliese - Ciaccio Hospital, Via Pio X, 88100, Catanzaro, Italy.
| | - Francesco Pentimalli
- S.S. di Elettrofisiologia Cardiaca, S.C. di Cardiologia, Ospedale S. Paolo, Savona, Italy
| | - Roberto Verlato
- ULSS 6 Euganea, Ospedale di Camposampiero-Cittadella, Cittadella, Padova, Italy
- Cardiology Unit, Civil Hospital, Camposampiero, Padova, Italy
| | | | | | - Vittorio Aspromonte
- Cardiology - Coronary Care Unit, Electrophysiology and Cardiac Pacing, Pugliese - Ciaccio Hospital, Via Pio X, 88100, Catanzaro, Italy
| | - Luca Bacino
- S.S. di Elettrofisiologia Cardiaca, S.C. di Cardiologia, Ospedale S. Paolo, Savona, Italy
| | - Pietro Turrini
- Cardiology Unit, Civil Hospital, Camposampiero, Padova, Italy
| | | | | | | | - Andrea Antonio Papa
- Cardiology Unit, Department of Cardiology, Monaldi - Hospital, Naples, Italy
| | | | | | - Chiara Devecchi
- Division of Cardiology, Sant'Andrea Hospital, Vercelli, Italy
| | | | - Corrado Tomasi
- U.O.C. Cardiologia di Ravenna, Faenza e Lugo, Ospedale "S. Maria delle Croci", Ravenna, Italy
| | - Salvatore Pirrotta
- Cardiology - Coronary Care Unit, Electrophysiology and Cardiac Pacing, Pugliese - Ciaccio Hospital, Via Pio X, 88100, Catanzaro, Italy
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Luani B, Basho M, Ismail A, Rauwolf T, Kaese S, Tobli N, Samol A, Pankraz K, Schmeisser A, Wiemer M, Braun-Dullaeus RC, Genz C. Catheter navigation by intracardiac echocardiography enables zero-fluoroscopy linear lesion formation and bidirectional cavotricuspid isthmus block in patients with typical atrial flutter. Cardiovasc Ultrasound 2023; 21:13. [PMID: 37537565 PMCID: PMC10398930 DOI: 10.1186/s12947-023-00312-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
INTRODUCTION One of the most helpful aspects of intracardiac echocardiography (ICE) implementation in electrophysiological studies (EPS) is the real-time visualisation of catheters and cardiac structures. In this prospective study, we investigated ICE-guided zero-fluoroscopy catheter navigation during radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) in patients with typical atrial flutter (AFL). METHODS AND RESULTS Thirty consecutive patients (mean age 72.9 ± 11.4 years, 23 male) with ongoing (n = 23) or recent CTI-dependent AFL underwent an EPS, solely utilizing ICE for catheter navigation. Zero-fluoroscopy EPS could be successfully accomplished in all patients. Mean EPS duration was 41.4 ± 19.9 min, and mean ablation procedure duration was 20.8 ± 17.1 min. RF ablation was applied for 6.0 ± 3.1 min (50W, irrigated RF ablation). Echocardiographic parameters, such as CTI length, prominence of the Eustachian ridge (ER), and depth of the CTI pouch on the ablation plane, were assessed to analyse their correlation with EPS- or ablation procedure duration. The CTI pouch was shallower in patients with an ablation procedure duration above the median (4.8 ± 1.1 mm vs. 6.4 ± 0.9 mm, p = 0.04), suggesting a more lateral ablation plane in these patients, where the CTI musculature is stronger. CTI length or ER prominence above the respective median did not correlate with longer EPS duration. CONCLUSIONS Zero-fluoroscopy CTI ablation guided solely by intracardiac echocardiography in patients with CTI-dependent AFL is feasible and safe. ICE visualisation may help to localise the optimal ablation plane, detect and correct poor tissue contact of the catheter tip, and recognise early potential complications during the ablation procedure.
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Affiliation(s)
- Blerim Luani
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University Bochum, Hans-Nolte-Str. 1, Minden, 32429, Germany.
| | - Maksim Basho
- Department of Radiology, University Hospital Center Mother Teresa, Tirana, Albania
| | - Ammar Ismail
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University Bochum, Hans-Nolte-Str. 1, Minden, 32429, Germany
| | - Thomas Rauwolf
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Sven Kaese
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University Bochum, Hans-Nolte-Str. 1, Minden, 32429, Germany
| | - Ndricim Tobli
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University Bochum, Hans-Nolte-Str. 1, Minden, 32429, Germany
| | - Alexander Samol
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University Bochum, Hans-Nolte-Str. 1, Minden, 32429, Germany
| | - Katharina Pankraz
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University Bochum, Hans-Nolte-Str. 1, Minden, 32429, Germany
| | - Alexander Schmeisser
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Marcus Wiemer
- Department of Cardiology and Intensive Care Medicine, Johannes Wesling University Hospital Minden Ruhr-University Bochum, Hans-Nolte-Str. 1, Minden, 32429, Germany
| | - Rüdiger C Braun-Dullaeus
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
| | - Conrad Genz
- Department of Internal Medicine, Division of Cardiology and Angiology, Magdeburg University, Magdeburg, Germany
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Pelosi F. Cavotricuspid isthmus ablation: Is more the enemy of good enough? J Cardiovasc Electrophysiol 2021; 33:46-47. [PMID: 34676945 DOI: 10.1111/jce.15280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 10/09/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Frank Pelosi
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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