Variable procedural strategies adapted to anatomical characteristics in catheter ablation of the cavotricuspid isthmus using a preoperative multidetector computed tomography analysis
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multidetector row-computed tomography
Objectives: This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies.
Methods and Results: This study included 446 consecutive patients (362 males; mean age 60.5±10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. Amultivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTImorphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02).
Conclusion: Changing the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.
Copyright(c) by Author
KENTA KAJIHARA, YUKIKO NAKANO, YUKOH HIRAI, HIROSHI OGI, NOBORU ODA, KAZUYOSHI SUENARI, YUKO MAKITA, AKINORI SAIRAKU, TAKEHITO TOKUYAMA, CHIKAAKI MOTODA, MAI FUJIWARA, YOSHIKAZU WATANABE, MASAO KIGUCHI and YASUKI KIHARA; Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis; Journal of Cardiovascular Electrophysiology, Volume 24, Issue 12, pages 1344-1351, December 2013 (doi: 10.1111/jce.12231)
Philosophy in Medical Science