title: Catheter inversion: a technique to complete isthmus ablation and cure atrial flutter.
abstract: Cure of typical atrial flutter (AFL) by catheter ablation to produce bidirectional block across the tricuspid annulus-inferior vena cava isthmus (IS) is highly effective, but failures may occur. We describe a technique that may allow creation of bidirectional block where a conventional strategy has failed. AFL ablation was performed using the conventional approach with a mapping/ablation (ablation) catheter introduced via the right femoral vein (RFV) to create a line of bidirectional block across the IS. If this was not achieved after five passes of the ablation catheter from the tricuspid annulus to the inferior vena cava (IVC) a catheter inversion technique was used. This allowed stable positioning of the ablation catheter at the IVC end of the isthmus. In 11 patients, a mean of 17 (range 3 to 45) radiofrequency (RF) applications was given before the catheter inversion technique was applied. Following catheter inversion a mean of 4 (1 to 14) further RF applications achieved bidirectional isthmus block in every patient. No complications occurred. Catheter inversion provides a simple, safe, and effective means of achieving bidirectional isthmus conduction block in cases where a conventional ablation strategy might have failed.
authors.affiliation: Department of Cardiology, Bart's and The London NHS Trust, London, UK.
authors.forename: Simon C
authors.initials: SC
authors.lastname: Sporton
authors.forename: D Wyn
authors.initials: DW
authors.lastname: Davies
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Earley
authors.forename: Vias
authors.initials: V
authors.lastname: Markides
authors.forename: Anthony W
authors.initials: AW
authors.lastname: Nathan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Schilling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D017211:Treatment Failure; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014682:Vena Cava, Inferior / Q000601:surgery