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PubMed2001

Randomized comparison of efficacy of cooled tip catheter ablation of atrial flutter: anatomic versus electrophysiological complete isthmus block.

There is a subset of patients with failed ablation of the cavotricuspid isthmus (CTI) using standard catheters and with 10% of the patients having recurrences. The purpose of this study was to compare the cooled and standard ablation with regard to acute successful electrophysiological achievement of bidirectional isthmus block and the subacute anatomic characteristics of the lesions. This randomized, experimental study compares the effects of ablation on the isthmus using a cooled catheter with those of a standard ablation catheter in 16 pigs. In 12 animals, CTI block was achieved after ablation (8/8 cooled and 4/8 standard). In two animals, it was not possible to achieve complete isthmus block and two had persistent slow conduction (all four using the standard catheter). After 1 week, the animals were slaughtered. The size of the lesion was greater with the irrigated tip catheters. Transmural lesions were found in 14 animals. A complete line of anatomic isthmus block was not documented after thefirst line in six animals, four with the standard and two with the cooled catheter. A conduction block was never present across gaps > or = 5 mm. In conclusion cooled catheters achieved a complete line of electrophysiological and anatomical block in a significantly higher percentage than the standard catheters.

Animals↗
PubMed2004

Typical atrial flutter ablation outcome: correlation with isthmus anatomy using intracardiac echo 3D reconstruction.

AIMS: To verify if sites of conduction gaps on the isthmus correlate with anatomical peculiarities using the intracardiac echo (ICE) and a new 3D device to reconstruct the isthmus in patients undergoing cavotricuspid isthmus ablation. METHODS AND RESULTS: Twenty patients underwent isthmus ablation using an 8 mm tip ablation catheter. Two-dimensional and 3D ICE reconstruction of the isthmus was made before, during and after ablation. At the end of the lesion line isthmus block was validated by electrophysiological criteria. In case of its absence we closed the remaining conduction gaps verifying the position of the sites with ICE. Fourteen patients required a median of 8 RF pulses to obtain complete isthmus block (Group A). In the remaining 6 patients isthmus block was obtained with a median of 25 RF pulses due to conduction gaps 'resistant' to ablation (Group B). Conduction gap positions assessed by ICE were located in the central portion of the isthmus below the coronary sinus os in 71% of cases in Group A and along a prominent Eustachian ridge in Group B patients, respectively. 3D reconstruction showed a smooth isthmus in Group A with a 'peak and valleys' isthmus in Group B. In these latter patients isthmus block was obtained only after the complete ablation of the prominent Eustachian ridge. CONCLUSION: The isthmus presents anatomical variants particularly due to Eustachian ridge peculiarities which may represent a site of conduction gaps "resistant" to ablation.

Aged↗
PubMed2004

Prospective randomised comparison of irrigated-tip and large-tip catheter ablation of cavotricuspid isthmus-dependent atrial flutter.

BACKGROUND: Radiofrequency (RF) ablation of cavotricuspid isthmus (CTI) dependent flutter can be performed using different types of ablation catheters. It has been proposed that irrigated and large-tip catheters are capable of creating larger lesions, resulting in greater efficacy. This prospective, randomised clinical study compared the efficacy of irrigated and large-tip catheters of different designs. METHODS: Eighty patients (69 men, 66+/-11 years) undergoing de novo RF ablation of CTI-dependent flutter were randomised to ablation using one of the following catheters: (i) externally-irrigated 20), (ii) internally-cooled (n=20), (iii) single sensor, 8-mm tip (n=20), or (iv) double sensor, 8-mm tip (n=20). The study endpoint was the demonstration of bidirectional CTI conduction block within 12 min of cumulative RF delivery. Crossover to the externally-irrigated catheter was permitted if this was not achieved. The ablation and procedural parameters, safety and efficacy were compared. RESULTS: The primary endpoint was achieved in 64 patients (80%), including all 20 patients randomised to the externally-irrigated catheter. Crossover was required in 16 patients: 9 initially using the internally-cooled catheter (45%), 3 using single-sensor, 8-mm-tip (15%), and 4 using double-sensor, 8-mm-tip (20%) catheters. The higher initial failure rate with the internally-cooled-tip catheter was significant compared to the externally-irrigated (p = 0.001) and single-sensor, 8-mm-tip (p = 0.04) catheters. The externally-irrigated catheter achieved the study endpoint more frequently with fewer RF applications of shorter duration compared to the internally-cooled-tip catheter and 8-mm-tip catheters, the difference being significant compared with internally cooled ablation. No major complications were observed. CONCLUSION: Among commonly used ablation catheters, the externally-irrigated catheter has a higher efficacy for rapid achievement of CTI block.

Aged↗
PubMed1981

Atrial flutter.

Explore the source record for details and available documents.

Atrial Fibrillation↗
PubMed1996

[Pharmacologic maintenance of sinusal rhythm and/or control of the ventricular response in patients with atrial fibrillation or flutter].

Atrial fibrillation is the most common cardiac arrhythmia and is usually responsible for symptoms requiring some treatment. Antiarrhythmic drugs are the first choice therapy, but their potential risks are significant. This together with their limited efficacy restricts their use. Antiarrhythmic drug use should be tailored; mainly according to the underlying heart disease. When reversion to sinus rhythm is not eligible, the adequate control of ventricular rate and the reduction of embolic risk are the therapeutic goals. Atrial flutter shows different behaviour regarding the very limited efficacy of antiarrhythmic drugs for reversion to and maintenance in sinus rhythm.

Anti-Arrhythmia Agents↗
PubMed2001

Echocardiographic findings in a contemporary Afro-Caribbean population referred for evaluation of atrial fibrillation or flutter.

Atrial fibrillation and/or flutter is the most common and the most significant cardiac arrhythmia in the Caribbean. This study is an attempt to determine the echocardiographic findings in a current, consecutive series of Afro-Caribbean patients referred for evaluation of atrial fibrillation and flutter. Between May 1998 and June 2000, 50 patients (mean age 67 years, 58% male) had echocardiograms done. Measurements included left atrial dimension (LA), left ventricular end-systolic dimension (LVESD), LV end-diastolic dimension (LVEDD), LV posterior wall thickness (LVPWT) and ventricular septal thickness (VST). Left ventricular ejection fraction (EF) was calculated. LA > 4 cm, LVPWT or VST > 13 mm, and LVEF < 50% were considered abnormal. Atrial fibrillation was seen in 92%, atrial flutter in 8%; 60% were chronic, 40% paroxysmal; 56% had congestive heart failure. The most frequent echocardiographic finding was LV hypertrophy (19/50, 38%). Left ventricular systolic dysfunction was present in 12/50, 24% (25% with LV hypertrophy also). Valvular disease (abnormal appearing valve, no Doppler study), was seen in 9/50, 18%. Normal findings ("lone atrial fibrillation") were seen in 10/50, 20%. Increased LA dimension was seen in 39/50, 78%. Patients with lone atrial fibrillation were younger (mean 56 years) than those with valvular disease (mean 64 years), LV systolic dysfunction (mean 69 years) and those with LV hypertrophy (mean 72 years). Thus, LV hypertrophy, probably secondary to hypertension, is the most frequent echocardiographic finding, with LV dysfunction (such as seen in coronary artery disease) seen less often. Valvular disease and lone atrial fibrillation rates are similar to rates in developed countries.

Adolescent↗