Ablation of typical right atrial flutter with a single catheter
approach: a pilot study
Abstract
Introduction: The success rate of cavo-tricuspid isthmus (CTI) ablation
to treat right common flutter is high, up to 95%, but needs
bidirectional block confirmation, requiring 2 or 3 catheters. We
describe a new pacing technic using a single catheter to ablate and
confirm CTI block with differential PR interval measurements. Methods:
We included 61 patients from 5 centers that were referred for CTI
ablation. All patients had CTI ablation and the CTI block was confirmed
by differential pacing using 2 or 3 catheters. The new method consisted
in measuring PR interval on the surface ECG using pacing from the tip of
ablation catheter on the lateral side (lateral delay) and septal side
(coronary sinus ostium) of the CTI line (difference =delta PR interval)
before and after CTI ablation. We analyzed the value of delta PR
interval to predict bidirectional CTI block as confirmed by standard
methods. Results: Among our patient’s population (63±12 years-old), 39
patients were ablated during sinus rhythm while 22 during common
flutter. CTI block was achieved in all patients but one. Then, Lateral
delay and delta PR interval increased significantly after validation of
CTI block (257±42ms vs 318±50ms and 32±23 vs 96±22ms,
p<0.0001, respectively). A cut-off ≥70ms of delta PR interval
had a 100% of sensitivity and specificity to predict bidirectional CTI
block. Conclusion: A single catheter ablation approach to perform CTI
line based on surface ECG PR interval measurement is feasible. After
ablation, CTI block