title: Long term outcome of cavotricuspid isthmus cryoablation for the treatment of common atrial flutter in 180 patients: a single center experience.
abstract: OBJECTIVE
  Recent literature has shown that common type atrial flutter (AFL) can recur late after cavotricuspid isthmus (CTI) catheter ablation using radiofrequency energy (RF). We report the long term outcome of a large group of patients undergoing CTI ablation using cryothermy for AFL in a single center.
  
  
  METHODS
  Patients with AFL referred for CTI ablation were recruited prospectively from July 2001 to July 2006. Cryoablation was performed using a deflectable, 10.5 F, 6.5 mm tip catheter. CTI block was reassessed 30 min after the last application during isoproterenol infusion. Recurrences were evaluated by 12-lead ECG and 24 h Holter recording every clinic visit (1/3/6/9 and 12 months after the procedure and yearly thereafter) or if symptoms developed.
  
  
  RESULTS
  The 180 enrolled patients had the following characteristics: 39 women (22%), mean age 58 years, no structural heart disease in 86 patients (48%), mean left atrium diameter 44+/-7 mm and mean left ventricular ejection fraction 57+/-7%. The average number of applications per patient was 7 (3 to 20) with a mean temperature and duration of -88 degrees C and 3 min, respectively. Acute success was achieved in 95% (171) of the patients. There were no complications. After a mean follow-up of 27+/-17 (from 12 to 60) months, the chronic success rate was 91%. The majority of the recurrences occurred within the first year post ablation. One hundred and twenty three patients had a history of atrial fibrillation (AF) prior to CTI ablation and 85 (69%) of those remained having AF after cryoablation. In 20 of 57 (35%) patients without a history of AF prior to CTI ablation, AF occurred during follow-up.
  
  
  CONCLUSIONS
  This prospective study showed a 91% chronic success rate (range 12 to 60 months) for cryoablation of the CTI in patients with common type AFL and ratified the frequent association of AF with AFL.
authors.affiliation: Department of Cardiology, Academic Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, Maastricht, The Netherlands.
authors.forename: Wendel
authors.initials: W
authors.lastname: Moreira
authors.forename: Carl
authors.initials: C
authors.lastname: Timmermans
authors.forename: Hein J J
authors.initials: HJ
authors.lastname: Wellens
authors.forename: Yuka
authors.initials: Y
authors.lastname: Mizusawa
authors.forename: David
authors.initials: D
authors.lastname: Perez
authors.forename: Suzanne
authors.initials: S
authors.lastname: Philippens
authors.forename: Luz-Maria
authors.initials: LM
authors.lastname: Rodriguez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery; D001282:Atrial Flutter / Q000503:physiopathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D004562:Electrocardiography; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery