title: Evaluation of an individualized strategy of cavotricuspid isthmus ablation as an adjunct to atrial fibrillation ablation.
abstract: OBJECTIVE
  To evaluate supplementary cavotricuspid isthmus (CTI) ablation as an adjunct to atrial fibrillation (AF) ablation in selected patients.
  
  
  BACKGROUND
  It is unclear whether routine CTI ablation is beneficial in all patients undergoing AF ablation.
  
  
  RESULTS
  In patients undergoing AF ablation, additional CTI block was created only for those with typical atrial flutter (Afl) before or during the ablation. Out of 188 consecutive patients (108 male, 56 +/- 9 years), 75 underwent CTI ablation (Group CTI+) and left atrial (LA) ablation (circular mapping-guided extensive pulmonary vein isolation in all and linear LA ablation when required), while 113 underwent LA ablation alone (Group CTI-). Group CTI+ patients had smaller LA and less frequently persistent/permanent AF and linear LA ablation. Over a follow-up of 30 +/- 10 months, complications (4% vs 5%, P = NS), typical Afl occurrence (1.3% and 2.6%, P = NS) and AF recurrence (25% and 28%, P = NS) were similar. Atypical Afl was more common in Group CTI- (4 vs 14%, P = 0.026). Eighty-two percent and 79% of patients in Groups CTI+ and CTI-, respectively, remained arrhythmia free in stable sinus rhythm without antiarrhythmic drug treatment (P = NS).
  
  
  CONCLUSIONS
  Avoiding supplementary CTI ablation in AF ablation patients without evidence of typical flutter does not result in a higher incidence of typical Afl. Despite more persistent/permanent AF and larger LA in patients without evidence of typical flutter, a strategy of selective supplementary ablation resulted in similar and low AF recurrence rates in the group without CTI ablation compared with the group with CTI ablation.
authors.affiliation: Service de Cardiologie, Hopital Cantonal de Geneve, Geneva, Switzerland. dipen.shah@hcuge.ch
authors.forename: Dipen C
authors.initials: DC
authors.lastname: Shah
authors.forename: Henri
authors.initials: H
authors.lastname: Sunthorn
authors.forename: Haran
authors.initials: H
authors.lastname: Burri
authors.forename: Pascale
authors.initials: P
authors.lastname: Gentil-Baron
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D055502:Secondary Prevention; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*