Comparative characteristics of different methods of radiofrequency catheter ablation in atrial flutter
Keywords:atrial flutter, atrial fibrillation, paroxysmal tachycardia, reciprocating tachycardias
Catheter ablation occupies the first place in the treatment of atrial macro reentry arrhythmias. The main controllable parameters in ablations are energy, duration of exposure and use of catheter tip cooling. With traditional ablation techniques, there is a high risk of insufficient tissue damage due to electrode instability. Regarding the issue of stability, a new technique was proposed – reducing the application time with increasing the energy.
The aim of this work was to compare the results of radiofrequency catheter ablation (RFA) using an 8 mm uncooled electrode to a 4 mm cooled electrode and a 4 mm cooled electrode with increased energy.
Materials and methods. The work is based on a retrospective analysis of the results of catheter ablations in patients with atrial flutter. Patients were divided into 3 groups depending on the parameters of the used radio frequency energy and the type of ablation electrode.
Results. It was found that in the group with increased energy, there were the shortest time from the start of RFA to the achievement of success criteria and the lowest radiation exposure. The obtained differences were statistically significant in comparison with two groups of patients who underwent traditional methods. Such differences were associated both with a reduction in the time of the application itself due to the use of high energy as well as the need to apply a smaller number of applications owing to a lower probability of the electrode displacement from the target area.
Conclusions. The use of a high-energy protocol allows to success criteria for cavo-tricuspid isthmus ablation more quickly compared to traditional techniques (by 30 % and 22 %, respectively) with less radiation exposure (by 27 % and 24 %, respectively). The use of the high-energy protocol does not lead to an increase in the frequency of complications and can be considered safe for clinical use.
DeLago, A. J., Essa, M., Ghajar, A., Hammond-Haley, M., Parvez, A., Nawaz, I., Shalhoub, J., Marshall, D. C., Nazarian, S., Calkins, H., Salciccioli, J. D., & Philips, B. (2021). Incidence and Mortality Trends of Atrial Fibrillation/Atrial Flutter in the United States 1990 to 2017. The American journal of cardiology, 148, 78-83. https://doi.org/10.1016/j.amjcard.2021.02.014
Kacprzyk, M., Kuniewicz, M., & Lelakowski, J. (2020). Trzepotanie przedsionków w praktyce kardiologa [Atrial flutter in cardiology practice]. Polski merkuriusz lekarski, 48(285), 204-208.
Diamant, M. J., Andrade, J. G., Virani, S. A., Jhund, P. S., Petrie, M. C., & Hawkins, N. M. (2021). Heart failure and atrial flutter: a systematic review of current knowledge and practices. ESC heart failure, 8(6), 4484-4496. https://doi.org/10.1002/ehf2.13526
Steinbeck, G., Sinner, M. F., Lutz, M., Müller-Nurasyid, M., Kääb, S., & Reinecke, H. (2018). Incidence of complications related to catheter ablation of atrial fibrillation and atrial flutter: a nationwide in-hospital analysis of administrative data for Germany in 2014. European heart journal, 39(45), 4020-4029. https://doi.org/10.1093/eurheartj/ehy452
Li, J H., Xie, H. Y., Chen, Y. Q., Cao, Z. J., Tang, Q. H., Guo, X. G., Sun, Q., & Ma, J. (2021). Risk of New-Onset Atrial Fibrillation Post-cavotricuspid Isthmus Ablation in Typical Atrial Flutter Without History of Atrial Fibrillation. Frontiers in physiology, 12, 763478. https://doi.org/10.3389/fphys.2021.763478
Zahid, S., Whyte, K. N., Schwarz, E. L., Blake, R. C., 3rd, Boyle, P. M., Chrispin, J., Prakosa, A., Ipek, E. G., Pashakhanloo, F., Halperin, H. R., Calkins, H., Berger, R. D., Nazarian, S., & Trayanova, N. A. (2016). Feasibility of using patient-specific models and the "minimum cut" algorithm to predict optimal ablation targets for left atrial flutter. Heart rhythm, 13(8), 1687-1698. https://doi.org/10.1016/j.hrthm.2016.04.009
Cosío, F. G. (2017). Atrial Flutter, Typical and Atypical: A Review. Arrhythmia & electrophysiology review, 6(2), 55-62. https://doi.org/10.15420/aer.2017.5.2
Golian, M., Ramirez, F. D., Alqarawi, W., Hansom, S. P., Nery, P. B., Redpath, C. J., Nair, G. M., Shaw, G. C., Davis, D. R., Birnie, D. H., & Sadek, M. M. (2020). High-power short-duration radiofrequency ablation of typical atrial flutter. Heart rhythm O2, 1(5), 317-323. https://doi.org/10.1016/j.hroo.2020.09.002
Calkins, H., Hindricks, G., Cappato, R., Kim, Y. H., Saad, E. B., Aguinaga, L., Akar, J. G., Badhwar, V., Brugada, J., Camm, J., Chen, P. S., Chen, S. A., Chung, M. K., Nielsen, J. C., Curtis, A. B., Davies, D. W., Day, J. D., d'Avila, A., de Groot, N., Di Biase, L., … Yamane, T. (2017). 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart rhythm, 14(10), e275-e444. https://doi.org/10.1016/j.hrthm.2017.05.012
Chen, Y. L., Lin, Y. S., Wang, H. T., Liu, W. H., Chen, H. C., & Chen, M. C. (2019). Clinical outcomes of solitary atrial flutter patients using anticoagulation therapy: a national cohort study. Europace : European pacing, arrhythmias, and cardiac electrophysiology, 21(2), 313-321. https://doi.org/10.1093/europace/euy181
Lang, R. M., Bierig, M., Devereux, R. B., Flachskampf, F. A., Foster, E., Pellikka, P. A., Picard, M. H., Roman, M. J., Seward, J., Shanewise, J., Solomon, S., Spencer, K. T., St John Sutton, M., Stewart, W., American Society of Echocardiography's Nomenclature and Standards Committee, Task Force on Chamber Quantification, American College of Cardiology Echocardiography Committee, American Heart Association, & European Association of Echocardiography, European Society of Cardiology (2006). Recommendations for chamber quantification. European journal of echocardiography, 7(2), 79-108. https://doi.org/10.1016/j.euje.2005.12.014
Ellis, K., Wazni, O., Marrouche, N., Martin, D., Gillinov, M., McCarthy, P., Saad, E. B., Bhargava, M., Schweikert, R., Saliba, W., Bash, D., Rossillo, A., Erciyes, D., Tchou, P., & Natale, A. (2007). Incidence of atrial fibrillation post-cavotricuspid isthmus ablation in patients with typical atrial flutter: left-atrial size as an independent predictor of atrial fibrillation recurrence. Journal of cardiovascular electrophysiology, 18(8), 799-802. https://doi.org/10.1111/j.1540-8167.2007.00885.x
Tscholl, V., Kamieniarz, P., Nagel, P., Landmesser, U., Attanasio, P., & Huemer, M. (2020). The use of a high-power (50 W), ablation index-guided protocol for ablation of the cavotricuspid isthmus. Journal of arrhythmia, 36(6), 1045-1050. https://doi.org/10.1002/joa3.12443
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