Isthmus Cavo-Tricuspid

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Editorial

Short Editorial: Risk of Atrial Fibrillation after Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter: Is Combined Ablation of Atrial Fibrillation Worthwhile?

Cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) is a common cardiac arrhythmia that can cause significant symptoms and is associated with an increased risk of stroke and the development or worsening of heart failure. The anatomic/electrophysiological substrate underlying AFL is a combination of slow conduction in the isthmus of atrial tissue between the tricuspid annulus and the inferior vena cava and conduction block along the crista terminalis and Eustachian ridge, enabling the emergence and perpetuation of a macro-reentrant circuit in the right atrium.^,

Because of the well-defined anatomic/electrophysiological substrate and the unsatisfactory results of antiarrhythmic drug therapy in treating AFL, radiofrequency catheter ablation, by means of creating a linear lesion from the tricuspid annulus to the inferior vena cava (cavotricuspid isthmus) under fluoroscopic and electrocardiographic guidance, is an established interventional procedure, with a low risk of complications (1% or less) and success rates over 90%.^,

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Original Article

Risk of Atrial Fibrillation after Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter: Is Combined Ablation of Atrial Fibrillation Worthwhile?

Isabella Bianco et al. Gabriel Odozynski da Silva Alexander Romeno Janner Dal Forno Helcio Garcia Nascimento … Andrei Lewandowski Elayne Pereira André d’Avila

Abstract

Background

Simultaneous ablation of atrial fibrillation (AF) and cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed when both arrythmias had been recorded before the procedure. However, the best approach has not been defined in case of patients referred for ablation with CTI-dependent atrial flutter, without history of AF.

Objectives

To assess the prevalence and to identify predictors of the first episode of AF after ablation of CTI-dependent atrial flutter in patients without history of AF.

Methods

Retrospective cohort of patients with CTI-dependent atrial flutter without history of AF undergoing catheter ablation. Clinical characteristics were compared between patients who developed AF and those who did not have AF after the procedure. Significance level was set at 5%. In the analysis of predicting factors, the primary outcome was occurrence of AF after CTI-dependent atrial flutter ablation.

Results

Of a total of 227 patients undergoing ablation of CTI-dependent atrial flutter (110 with history of AF and 33 without adequate follow-up), 84 were included, and 45 (53.6%) developed post-ablation AF. The HATCH and CHA2DS2-VASC scores were not different between the groups. Recurrence rate of CTI-dependent atrial flutter and complication rate were 11.5% and 1.2%, respectively, after ablation.

Conclusions

Although ablation of CTI-dependent atrial flutter is a safe and effective procedure, 50% of the patients developed AF after the procedure. However, the role of combined ablation (CTI-dependent atrial flutter plus AF) aiming at preventing AF is still uncertain. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0)