Safety and durability of cavo-tricuspid isthmus linear ablation in the current era: Single-center 9 year experience from 1078 procedures.

Abstract

BACKGROUND\nCavo-tricuspid isthmus (CTI) linear ablation is performed not only for atrial flutter (AFL) but empirically during atrial fibrillation (AF) ablation in real-world practice.\n\n\nPURPOSE\nWe sought to evaluate the safety and durability of the CTI ablation.\n\n\nMETHODS\nThis retrospective study included 1078 consecutive patients who underwent a CTI ablation. AFL was documented before or during the procedure in 249(23.1%) patients, and an empirical CTI and atrial fibrillation ablation were performed in 829(76.9%) patients.\n\n\nRESULTS\nCTI block was successfully created in 1051(97.5%) patients with a 10.3±6.6 minute total radiofrequency time. Repeat procedures were performed for recurrent arrhythmias in 187(17.3%) patients at a median of 11.0(5.0-30.0) months post-procedure, and conduction resumption was identified in 68/174(39.1%). Among those undergoing a CTI ablation with an AF ablation, the durability was significantly higher in those with than without documented AFL (78.1% vs. 58.2%, p=0.031). The total radiofrequency time was significantly shorter (9.0±5.3 vs. 10.0±6.4 [mins], p=0.024) and durability significantly higher (78.1 vs. 58.7[%], p=0.043) in the large-tip than irrigated-tip catheter group. Iatrogenic AFL was observed after the empiric CTI ablation in 11(1.3%) patients. Procedure-related complications occurred in 15(1.4%) patients. Eight patients experienced coronary artery spasms, including 1 with ventricular fibrillation following ST elevation on the ward. The other 6 patients experienced transient atrioventricular block and one experienced cardiac tamponade requiring drainage.\n\n\nCONCLUSIONS\nDespite a high acute CTI ablation success, the conduction block durability was relatively low after the empiric ablation. An empiric CTI ablation at the time of the AF ablation is not recommended. This article is protected by copyright. All rights reserved.