Based on these results, the conventional waiting period is unnecessary in 97.6% patients without dormant conduction after CTI-dependent flutter ablation.Īdenosine atrial flutter catheter ablation cavitricuspid ablation reconnection. All 4 patients underwent further ablation.Ī negative adenosine challenge immediately after CTI ablation with bidirectional block, or after abolition of dormant conduction with further ablation, strongly predicted the absence of subsequent spontaneous reconnection within 30 minutes. Two other patients (1.2%) developed late dormant conduction with adenosine at 30 minutes. In all of these patients, TEE (for exclusion of atrial thrombus) was successfully performed. Two patients (1.2%) had subsequent spontaneous time-dependent reconnection within 30 minutes. This was a single-center, prospective, observational study which included 31 consecutive patients presenting electrocardiographic documented typical atrial flutter undergoing CTI ablation at the Fondazione Cardiocentro Ticino (Lugano, Switzerland). 4 Because LA ablation may alter the normal activation pattern of the LA, 2 it is possible that the 12-lead ECG of CTI-dependent flutter may. 13 However, patients also may experience typical atrial flutter arising from the cavotricuspid isthmus (CTI) after ablation of AF. Nine patients (5.3%) had dormant conduction across the CTI immediately after ablation and BDB, and required further ablation. A typical left atrial (LA) flutter may occur as a proarrhythmic complication of LA ablation of atrial fibrillation (AF). After the achievement of BDB without dormant conduction, spontaneous CTI reconnection during the following 30 minutes and dormant conduction with adenosine at 30 minutes were evaluated.Ī CTI block was achieved in 171 patients. In cases of dormant conduction, the CTI was ablated again until its abolition. Following the completion of CTI ablation and documentation of BDB, adenosine (≥12 mg IV) was administered immediately. Conventional practice involves a waiting period of 20 to 30 minutes after achievement of a bidirectional line of block (BDB) to monitor for recovery of conduction.Īssess whether abolition of dormant conduction with adenosine immediately after CTI ablation and BDB can predict the lack of CTI conduction recovery during the following 30 minutes.Ĭonsecutive patients undergoing catheter ablation for CTI-dependent atrial flutter were studied. of Internal Medicine (내과학교실) > 1.Dormant conduction unmasked by adenosine predicts clinical recurrences of cavotricuspid isthmus (CTI) dependent atrial flutter following catheter ablation. Conclusions: In this large and long-term follow-up study, prophylactic CTI ablation had no benefit in patients with paroxysmal AF without typical AFL. The recurrence rate of typical AFL also was not different (0.5%in PVI vs. The recurrence rate of any AFL was not significantly different in the 2 groups (3.3% in PVI vs. The recurrence rate of AF or AFL was not different in the 2 groups (25.7% in PVI vs. All patients were followed up for at least 18 months, and the median follow-up was 3.4 years. Results: There was no significant difference in procedure time between the two groups because most CTI blocks were performed during the waiting time after the PVI (176.8 +/- 72.6 minutes in PVI vs. We randomly assigned 366 patients to pulmonary vein isolation (PVI) only and prophylactic CTI ablation (PVI vs. Methods: Patients who underwent catheter ablation for paroxysmal AF were enrolled, and patients who had previous or induced atrial flutter (AFL) were excluded. However, the previous study was too small and short-term to clarify the efficacy of this block. Authors Kim, Sung-Hwan Oh, Yong-Seog Choi, Young Hwang, Youmi Kim, Ju-Youn Kim, Tae-Seok Kim, Ji-Hoon Jang, Sung-Won Lee, Man Young Joung, Boyoung Choi, Kee-Joon Citation KOREAN CIRCULATION JOURNAL, Vol.51(1) : 58-64, 2021-01 Journal Title KOREAN CIRCULATION JOURNAL ISSN 1738-5520 Issue Date 2021-01 Keywords Atrial fibrillation Atrial flutter Catheter ablation Abstract Background and Objectives: Cavotricuspid isthmus (CTI) block is easily achieved, and prophylactic ablation can be performed during atrial fibrillation (AF) ablation.
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