Efficacy of bundle ablation for cavotricuspid isthmus-dependent atrial flutter: Combination of the maximum voltage-guided ablation technique and high-density electro-anatomical mapping

Hirokazu Sato, Tetsuo Yagi, Akio Namekawa, Akihiko Ishida, Yoshihiro Yamashina, Takashi Nakagawa, Manjirou Sakuramoto, Eiji Sato, Tomoyuki Yambe

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Introduction Pathological studies have demonstrated that the cavotricuspid isthmus (CTI) is often composed of discrete muscle bundles, which are thought to be represented electrically as high-amplitude electrograms. Based on this observation, we visualized the bundles using an electro-anatomical mapping system (EAMS) and investigate the efficacy of bundle ablation which is an ablation method for selectively targeting high-voltage sites obtained by high-density electro-anatomical mapping along the CTI. Methods Sixty patients with atrial flutter were randomly assigned to cavotricuspid isthmus ablation using a conventional anatomical approach (Group 1) or bundle ablation approach (Group 2). In Group 2, CTI was mapped in detail with EAMS, and we visualized the bundles that were 1.5 mV or more on a bipolar voltage map. Radiofrequency (RF) ablation was delivered sequentially from the maximum voltage site at the shortest distance of the bundle until bidirectional block was achieved. Results Bidirectional block was achieved in all patients. Mean ablation times (Group 1, 1,392±960 s; Group 2, 638±342 s, p<0.01), the mean number of RF applications (Group 1, 31.7±23.6; Group 2, 13.0±7.0, p<0.01), and fluoroscopy times (Group 1, 50.4±28.3 min; Group 2, 42.3±21.3 min, p< 0.01) were significantly shorter in Group 2 than those in Group 1. Conclusion Bundle ablation at CTI is highly effective for achieving a bidirectional block requiring shorter ablation times, shorter fluoroscopy times, and fewer RF applications.

Original languageEnglish
Pages (from-to)39-44
Number of pages6
JournalJournal of Interventional Cardiac Electrophysiology
Volume28
Issue number1
DOIs
Publication statusPublished - 2010 Jun

Keywords

  • Atrial flutter
  • Catheter ablation
  • Cavotricuspid isthmus
  • Electro-anatomical mapping
  • Voltage-guided ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Efficacy of bundle ablation for cavotricuspid isthmus-dependent atrial flutter: Combination of the maximum voltage-guided ablation technique and high-density electro-anatomical mapping'. Together they form a unique fingerprint.

Cite this