Characteristics of the cavotricuspid isthmus in predicting recurrent conduction in the long-term follow-up.
BACKGROUND
The characteristics of cavotricuspid isthmus (CTI) in patients with atrial fibrillation (AF) and flutter that may predict recurrence of flutter is not known. We aimed to investigate the CTI characteristics in patients who underwent a second ablation procedure for recurrent AF after previous combined pulmonary vein (PV) and CTI ablation.


METHODS
Among 196 consecutive patients with drug-refractory symptomatic AF who underwent PV isolation and CTI ablation with bidirectional isthmus block, 49 patients (age 50 +/- 12 years, 43 males) had recurrent AF and received a second procedure 291 +/- 241 days after the first procedure. Right atrial angiography for the evaluation of the CTI morphology, and the biatrial contact bipolar electrograms were obtained before both procedures.


RESULTS
In the second procedure, 11 (group 1) of the 49 patients demonstrated recovered CTI conduction. Compared with the patients without CTI conduction (group 2, n = 38), group 1 patients had a higher frequency of a pouch-type anatomy (82% vs 13%, P < 0.001), longer CTI (34.0 +/- 8.6 vs 25.5 +/- 7.5 mm, P = 0.01), longer ablation time, and larger number of radiofrequency applications; furthermore, the preablation bipolar voltage decreased along both the CTI and ablation line in group 2, whereas it remained similar in group 1 in the second procedure.


CONCLUSIONS
A high (22%) percentage of CTIs exhibited recurrent conduction in the long-term follow-up. The CTIs with recurrent conduction had a higher incidence of a pouch and longer length compared with those without recurrent conduction.
Lo
Li-Wei
LW
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Tai
Ching-Tai
CT
Lin
Yenn-Jiang
YJ
Chang
Shih-Lin
SL
Wongcharoen
Wanwarang
W
Tuan
Ta-Chuan
TC
Udyavar
Ameya R
AR
Hu
Yu-Feng
YF
Ueng
Kuo-Chang
KC
Tsai
Wen-Chin
WC
Chang
Chien-Jung
CJ
Tsao
Hsuan-Ming
HM
Higa
Satoshi
S
Chen
Shih-Ann
SA
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000000981:diagnostic imaging* / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012008:Recurrence; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D055815:Young Adult