Characteristics of the cavotricuspid isthmus in predicting recurrent conduction in the long-term follow-up

Li Wei Lo, Ching Tai Tai, Yenn Jiang Lin, Shih Lin Chang, Wanwarang Wongcharoen, Ta Chuan Tuan, Ameya R. Udyavar, Yu Feng Hu, Kuo Chang Ueng, Wen Chin Tsai, Chien Jung Chang, Hsuan Ming Tsao, Satoshi Higa, Shih Ann Chen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Scopus citations

Abstract

Cavotricupsid Isthmus Conduction Characteristics. Background: The characteristics of cavotricuspid isthmus (CTI) in patients with atrial fibrillation (AF) and flutter that may predict recurrence of flutter is not known. We aimed to investigate the CTI characteristics in patients who underwent a second ablation procedure for recurrent AF after previous combined pulmonary vein (PV) and CTI ablation. Methods: Among 196 consecutive patients with drug-refractory symptomatic AF who underwent PV isolation and CTI ablation with bidirectional isthmus block, 49 patients (age 50 ± 12 years, 43 males) had recurrent AF and received a second procedure 291 ± 241 days after the first procedure. Right atrial angiography for the evaluation of the CTI morphology, and the biatrial contact bipolar electrograms were obtained before both procedures. Results: In the second procedure, 11 (group 1) of the 49 patients demonstrated recovered CTI conduction. Compared with the patients without CTI conduction (group 2, n = 38), group 1 patients had a higher frequency of a pouch-type anatomy (82% vs 13%, P < 0.001), longer CTI (34.0 ± 8.6 vs 25.5 ± 7.5 mm, P = 0.01), longer ablation time, and larger number of radiofrequency applications; furthermore, the preablation bipolar voltage decreased along both the CTI and ablation line in group 2, whereas it remained similar in group 1 in the second procedure. Conclusions: A high (22%) percentage of CTIs exhibited recurrent conduction in the long-term follow-up. The CTIs with recurrent conduction had a higher incidence of a pouch and longer length compared with those without recurrent conduction.

Original languageEnglish
Pages (from-to)39-43
Number of pages5
JournalJournal of cardiovascular electrophysiology
Volume20
Issue number1
DOIs
StatePublished - Jan 2009

Keywords

  • Ablation
  • Atrial flutter
  • Isthmus
  • Recurrence
  • Right atrium

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