Erschienen in:
04.03.2023 | Review
Ablation of CTI-dependent flutter using different ablation technologies: acute and long-term outcome from the LEONARDO study
verfasst von:
Giampiero Maglia, Francesco Pentimalli, Roberto Verlato, Francesco Solimene, Maurizio Malacrida, Vittorio Aspromonte, Luca Bacino, Pietro Turrini, Tommaso Infusino, Carmelo La Greca, Giovanni Battista Perego, Andrea Antonio Papa, Ermenegildo De Ruvo, Gianluca Zingarini, Chiara Devecchi, Marco Scaglione, Corrado Tomasi, Salvatore Pirrotta, Giuseppe Stabile
Erschienen in:
Journal of Interventional Cardiac Electrophysiology
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Ausgabe 7/2023
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Abstract
Background
A novel ablation catheter has been released to map and ablate the cavo-tricuspid isthmus (CTI) in patients with atrial flutter (AFL), improving ablation efficiency.
Methods
We evaluated the acute and long-term outcome of CTI ablation aiming at bidirectional conduction block (BDB) in a prospective, multicenter cohort study enrolling 500 patients indicated for typical AFL ablation. Patients were grouped on the basis of the AFL ablation method (linear anatomical approach, Conv group n = 425, or maximum voltage guided, MVG group, n = 75) and ablation catheter (mini-electrodes technology, MiFi group, n = 254, or a standard 8-mm ablation catheter, BLZ group, n = 246).
Results
Complete BDB according to both validation criteria (sequential detailed activation mapping or mapping only the ablation site) was achieved in 443 patients (88.6%). The number of RF applications needed to achieve BDB was lower in the MiFi MVG group vs both the MiFi Conv group and the BLZ Conv group (3.2 ± 2 vs 5.2 ± 4 vs 9.3 ± 5, p < 0.0001 for all comparisons). Fluoroscopy time was similar among groups, whereas we observed a reduction in the procedure duration from the BLZ Conv group (61.9 ± 26min) to the MiFi MVG group (50.6 ± 17min, p = 0.048). During a mean follow-up of 548 ± 304 days, 32 (6.2%) patients suffered an AFL recurrence. No differences were found according to BDB achieved by both validation criteria.
Conclusions
Ablation was highly effective in achieving acute CTI BDB and long-term arrhythmia freedom irrespective of the ablation strategy or the validation criteria for CTI chosen by the operator. The use of an ablation catheter equipped with mini-electrodes technology seems to improve ablation efficiency.
Clinical trial registration
Atrial Flutter Ablation in a Real World Population. (LEONARDO).
ClinicalTrials.gov Identifier: NCT02591875