Radiofrequency Ablation of Atrial Flutter: A Randomized Controlled Trial of Two Anatomic Approaches

Rod S. Passman, Alan H. Kadish, Samer R. Dibs, Erica D. Engelstein, Jeffrey Goldberger

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the "septal" or "posterior" approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 ± 30.3 versus 70.8 ± 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice.

Original languageEnglish (US)
Pages (from-to)83-88
Number of pages6
JournalPACE - Pacing and Clinical Electrophysiology
Volume27
Issue number1
DOIs
StatePublished - Jan 1 2004
Externally publishedYes

Fingerprint

Atrial Flutter
Randomized Controlled Trials
Fluoroscopy
Tricuspid Valve
Atrioventricular Block
Intention to Treat Analysis
Coronary Sinus
Inferior Vena Cava
Heart Atria
Catheters

Keywords

  • Arrhythmias
  • Atrial flutter
  • Radiofrequency ablation
  • Randomized-controlled study

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Radiofrequency Ablation of Atrial Flutter : A Randomized Controlled Trial of Two Anatomic Approaches. / Passman, Rod S.; Kadish, Alan H.; Dibs, Samer R.; Engelstein, Erica D.; Goldberger, Jeffrey.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 27, No. 1, 01.01.2004, p. 83-88.

Research output: Contribution to journalArticle

Passman, Rod S. ; Kadish, Alan H. ; Dibs, Samer R. ; Engelstein, Erica D. ; Goldberger, Jeffrey. / Radiofrequency Ablation of Atrial Flutter : A Randomized Controlled Trial of Two Anatomic Approaches. In: PACE - Pacing and Clinical Electrophysiology. 2004 ; Vol. 27, No. 1. pp. 83-88.
@article{fb8b3b7bee6d4c99b3f2a9aeaf9ffe80,
title = "Radiofrequency Ablation of Atrial Flutter: A Randomized Controlled Trial of Two Anatomic Approaches",
abstract = "Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the {"}septal{"} or {"}posterior{"} approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 ± 30.3 versus 70.8 ± 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice.",
keywords = "Arrhythmias, Atrial flutter, Radiofrequency ablation, Randomized-controlled study",
author = "Passman, {Rod S.} and Kadish, {Alan H.} and Dibs, {Samer R.} and Engelstein, {Erica D.} and Jeffrey Goldberger",
year = "2004",
month = "1",
day = "1",
doi = "10.1111/j.1540-8159.2004.00390.x",
language = "English (US)",
volume = "27",
pages = "83--88",
journal = "PACE - Pacing and Clinical Electrophysiology",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "1",

}

TY - JOUR

T1 - Radiofrequency Ablation of Atrial Flutter

T2 - A Randomized Controlled Trial of Two Anatomic Approaches

AU - Passman, Rod S.

AU - Kadish, Alan H.

AU - Dibs, Samer R.

AU - Engelstein, Erica D.

AU - Goldberger, Jeffrey

PY - 2004/1/1

Y1 - 2004/1/1

N2 - Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the "septal" or "posterior" approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 ± 30.3 versus 70.8 ± 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice.

AB - Atrial flutter often results from a macroreentrant circuit that uses anatomic structures within the right atrium as its borders. RF ablation at the site of an obligatory isthmus can eliminate the atrial flutter circuit. The aim of this study was to compare two approaches to atrial flutter ablation: the septal (septal aspect of the tricuspid valve annulus to coronary sinus ostium and Eustachian ridge) approach versus the posterior (inferior vena cava to tricuspid valve annulus) approach. Twenty patients were randomized to either the "septal" or "posterior" approach. Entrainment mapping and/or confirmation of bidirectional isthmus conduction at baseline were performed in those patients in atrial flutter and normal sinus rhythm, respectively. RF ablation was performed with standard catheters and techniques. Crossover was permitted after two lines of RF lesions. Endpoints included acute success rates and fluoroscopy times. There was no statistically significant difference in the success rate between the two approaches using intention-to-treat analysis. Fluoroscopy times in the septal versus posterior approaches were 58.4 ± 30.3 versus 70.8 ± 31.1 minutes, respectively (P = 0.7). There was more frequent crossover in patients assigned to the septal approach and the one major complication, atrioventricular block, also occurred using this approach. There was no statistically significant difference in the success rate or fluoroscopy times between the septal and posterior approaches to atrial flutter ablation. However, given the risk of atrioventricular block with the septal approach, the posterior approach should be the preferred initial choice.

KW - Arrhythmias

KW - Atrial flutter

KW - Radiofrequency ablation

KW - Randomized-controlled study

UR - http://www.scopus.com/inward/record.url?scp=1642561524&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1642561524&partnerID=8YFLogxK

U2 - 10.1111/j.1540-8159.2004.00390.x

DO - 10.1111/j.1540-8159.2004.00390.x

M3 - Article

C2 - 14720160

AN - SCOPUS:1642561524

VL - 27

SP - 83

EP - 88

JO - PACE - Pacing and Clinical Electrophysiology

JF - PACE - Pacing and Clinical Electrophysiology

SN - 0147-8389

IS - 1

ER -