OBJECTIVES: We aimed to test the maximum voltage-guided cavotricuspid isthmus (CTI) ablation technique during ongoing atrial flutter. BACKGROUND: Former pathological and electrophysiological studies clarified that the cavotricuspid isthmus is composed of distinct muscular bundles, which are responsible for the conduction of electrical activation. Based on this observation, a maximum voltage-guided ablation technique (MVGT) was developed. This technique was assessed during pacing from the coronary sinus and was reported to be a feasible method to reach bidirectional isthmus block without the need for a complete anatomic ablation line. METHODS: This was a prospective, randomized single center study. Twenty patients underwent CTI ablation during atrial flutter. In group I (10 pts) CTI ablation was performed with complete anatomical ablation line. In group II (10 pts) ablation was guided by the highest amplitude potentials on the CTI sequentially until bidirectional isthmus block was reached. The following parameters were compared: acute success rate, procedure time, fluoroscopy time, number of radiofrequency (RF) applications and total RF duration. RESULTS: In all patients, atrial flutter terminated during ablation. Bidirectional isthmus block could be achieved in all pts. Procedure time was shorter in group II (107 +/- 40 vs 68 +/- 19 min, p < 0.01). Significantly less fluoroscopy was used in group II (22.6 +/- 10.6 vs 12.1 +/- 3.8 min, p < 0.01). There were less RF applications in group II (27.1 +/- 21.5 vs 5.9 +/- 2.4, p < 0.001). CONCLUSIONS: (1) The major finding of this study is that MVGT is a feasible method even during ongoing atrial flutter. (2) Our data confirm that MVGT is an effective technique for CTI ablation with considerable decrease in procedure and fluoroscopy times.
RCT Entities:
OBJECTIVES: We aimed to test the maximum voltage-guided cavotricuspid isthmus (CTI) ablation technique during ongoing atrial flutter. BACKGROUND: Former pathological and electrophysiological studies clarified that the cavotricuspid isthmus is composed of distinct muscular bundles, which are responsible for the conduction of electrical activation. Based on this observation, a maximum voltage-guided ablation technique (MVGT) was developed. This technique was assessed during pacing from the coronary sinus and was reported to be a feasible method to reach bidirectional isthmus block without the need for a complete anatomic ablation line. METHODS: This was a prospective, randomized single center study. Twenty patients underwent CTI ablation during atrial flutter. In group I (10 pts) CTI ablation was performed with complete anatomical ablation line. In group II (10 pts) ablation was guided by the highest amplitude potentials on the CTI sequentially until bidirectional isthmus block was reached. The following parameters were compared: acute success rate, procedure time, fluoroscopy time, number of radiofrequency (RF) applications and total RF duration. RESULTS: In all patients, atrial flutter terminated during ablation. Bidirectional isthmus block could be achieved in all pts. Procedure time was shorter in group II (107 +/- 40 vs 68 +/- 19 min, p < 0.01). Significantly less fluoroscopy was used in group II (22.6 +/- 10.6 vs 12.1 +/- 3.8 min, p < 0.01). There were less RF applications in group II (27.1 +/- 21.5 vs 5.9 +/- 2.4, p < 0.001). CONCLUSIONS: (1) The major finding of this study is that MVGT is a feasible method even during ongoing atrial flutter. (2) Our data confirm that MVGT is an effective technique for CTI ablation with considerable decrease in procedure and fluoroscopy times.
Authors: Mehmet Ozaydin; Hiroshi Tada; Aman Chugh; Christoph Scharf; Steve W K Lai; Frank Pelosi; Bradley P Knight; Fred Morady; Hakan Oral Journal: Pacing Clin Electrophysiol Date: 2003-09 Impact factor: 1.976
Authors: Emoke Posan; Damian P Redfearn; Lorne J Gula; Andrew D Krahn; Raymond Yee; George J Klein; Allan C Skanes Journal: Europace Date: 2007-02-23 Impact factor: 5.214
Authors: Annibale S Montenero; Nicola Bruno; Andrea Antonelli; Daniele Mangiameli; Luca Barbieri; Peter Andrew; Olive Murphy; Stephen O'Connor; Francesco Zumbo Journal: J Am Coll Cardiol Date: 2005-02-15 Impact factor: 24.094
Authors: R E Sperry; K A Ellenbogen; M A Wood; B S Stambler; J P DiMarco; D E Haines Journal: Pacing Clin Electrophysiol Date: 1992-05 Impact factor: 1.976
Authors: G Kirkorian; E Moncada; P Chevalier; G Canu; J P Claudel; C Bellon; L Lyon; P Touboul Journal: Circulation Date: 1994-12 Impact factor: 29.690
Authors: Vincenzo Russo; Anna Rago; Andrea Antonio Papa; Federica Di Meo; Carmine Ciardiello; Giovanni Cimmino; Gerardo Nigro Journal: Acta Myol Date: 2016-10