Anatomic characterization of cavotricuspid isthmus by 3D transesophageal echocardiography in patients undergoing radiofrequency ablation of typical atrial flutter.
- Regoli F Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Faletra F Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Marcon S Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Leo LA Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Dequarti MC Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Caputo ML Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Conte G Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Moccetti T Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- Auricchio A Division of Cardiology, Fondazione Cardiocentro Ticino, Via Tesserete 48, CH-6900 Lugano, Switzerland.
- 2017-02-10
Published in:
- European heart journal cardiovascular Imaging. - 2018
3D-TEE and RF ablation
Three-dimensional transesophageal imaging
cavo-tricuspid isthmus ablation
typical atrial flutter
Aged
Atrial Flutter
Cohort Studies
Echocardiography, Three-Dimensional
Echocardiography, Transesophageal
Female
Humans
Male
Middle Aged
Prognosis
Prospective Studies
Radiofrequency Ablation
Severity of Illness Index
Switzerland
Treatment Outcome
Tricuspid Valve
English
Aims
Radiofrequency ablation (RFA) is the treatment of choice of cavotricuspid isthmus (CTI)-dependent atrial flutter. Procedural time is highly variable due to anatomical structures. This study aimed to characterize CTI anatomy by transesophageal 3D echocardiography imaging (3D-TEE) to identify anatomic structures related to longer ablation time.
Methods and results
Thirty-one consecutive patients (mean age 67.3 ± 11.5 years, 22 males) underwent CTI-ablation procedure. Before ablation, TEE was performed and 3D-TEE images were acquired to evaluate CTI anatomy qualitatively as well as perform measures of CTI morphological features. The electrophysiologist performing RFA was blinded to 3D-TEE data. Bidirectional block of CTI was achieved in all patients without procedural complications after a median ablation time of 11 (IQR 7-14) min. Patients with RFA time ≥11 min (Group 2) presented lower left ventricular ejection fraction (51.1 ± 17.0 vs. 59.5 ± 6.6%, P < 0.010), a larger left atrium (46.2 ± 8.4 vs. 39.9 ± 9.4 mm, P < 0.058), and, more frequently, a right atrial pouch (12/16 patients vs. 4/15, P = 0.012) compared with patients with RFA time < 11 min (Group 1); CTI pouch was significantly deeper in Group 2 compared with Group 1: telediastolic (TD) pouch depth was 10.4 ± 4.5 vs. 6.3 ± 1.5 mm (P = 0.003) and telesystolic (TS) depth 12.8 ± 4.4 vs. 7.0 ± 1.4 mm (P < 0.001), respectively. TD isthmus length, prominent pectinate muscle, and presence of an Eustachian ridge (ER) did not differ between the two groups.
Conclusion
Routine pre-procedural 3D-TEE imaging is extremely helpful in qualitative and quantitative evaluation of CTI anatomy in patients undergoing RFA for symptomatic typical atrial flutter. Detection of a deep right atrial pouch was found to be associated with significantly prolonged CTI ablation time to achieve bidirectional block.
Radiofrequency ablation (RFA) is the treatment of choice of cavotricuspid isthmus (CTI)-dependent atrial flutter. Procedural time is highly variable due to anatomical structures. This study aimed to characterize CTI anatomy by transesophageal 3D echocardiography imaging (3D-TEE) to identify anatomic structures related to longer ablation time.
Methods and results
Thirty-one consecutive patients (mean age 67.3 ± 11.5 years, 22 males) underwent CTI-ablation procedure. Before ablation, TEE was performed and 3D-TEE images were acquired to evaluate CTI anatomy qualitatively as well as perform measures of CTI morphological features. The electrophysiologist performing RFA was blinded to 3D-TEE data. Bidirectional block of CTI was achieved in all patients without procedural complications after a median ablation time of 11 (IQR 7-14) min. Patients with RFA time ≥11 min (Group 2) presented lower left ventricular ejection fraction (51.1 ± 17.0 vs. 59.5 ± 6.6%, P < 0.010), a larger left atrium (46.2 ± 8.4 vs. 39.9 ± 9.4 mm, P < 0.058), and, more frequently, a right atrial pouch (12/16 patients vs. 4/15, P = 0.012) compared with patients with RFA time < 11 min (Group 1); CTI pouch was significantly deeper in Group 2 compared with Group 1: telediastolic (TD) pouch depth was 10.4 ± 4.5 vs. 6.3 ± 1.5 mm (P = 0.003) and telesystolic (TS) depth 12.8 ± 4.4 vs. 7.0 ± 1.4 mm (P < 0.001), respectively. TD isthmus length, prominent pectinate muscle, and presence of an Eustachian ridge (ER) did not differ between the two groups.
Conclusion
Routine pre-procedural 3D-TEE imaging is extremely helpful in qualitative and quantitative evaluation of CTI anatomy in patients undergoing RFA for symptomatic typical atrial flutter. Detection of a deep right atrial pouch was found to be associated with significantly prolonged CTI ablation time to achieve bidirectional block.
- Language
-
- English
- Open access status
- hybrid
- Identifiers
-
- DOI 10.1093/ehjci/jew336
- PMID 28180237
- Persistent URL
- https://sonar.ch/global/documents/58735
Statistics
Document views: 12
File downloads:
- fulltext.pdf: 0