title: Voltage-guided ablation technique for cavotricuspid isthmus-dependent atrial flutter: refining the continuous line.
abstract: Ablation of the cavotricuspid isthmus has become first-line therapy for "isthmus-dependent" atrial flutter. The goal of ablation is to produce bidirectional cavotricuspid isthmus block. Traditionally, this has been obtained by creation of a complete ablation line across the isthmus from the ventricular end to the inferior vena cava. This article describes an alternative method used in our laboratory. There is substantial evidence that conduction across the isthmus occurs preferentially over discrete separate bundles of tissue. Consequently, voltage-guided ablation targeting only these bundles with large amplitude atrial electrograms results in a highly efficient alternate method for the interruption of conduction across the cavotricuspid isthmus. Understanding the bundle structure of conduction over the isthmus facilitates more flexible approaches to its ablation and targeting maximum voltages in our hands has resulted in reduction of ablation time and fewer recurrences.
authors.affiliation: Arrhythmia Service, University of Western Ontario, London, Ontario, Canada.
authors.forename: Peter K
authors.initials: PK
authors.lastname: Jacobsen
authors.forename: George J
authors.initials: GJ
authors.lastname: Klein
authors.forename: Lorne J
authors.initials: LJ
authors.lastname: Gula
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Krahn
authors.forename: Raymond
authors.initials: R
authors.lastname: Yee
authors.forename: Peter
authors.initials: P
authors.lastname: Leong-Sit
authors.forename: Alexis
authors.initials: A
authors.lastname: Mechulan
authors.forename: Allan C
authors.initials: AC
authors.lastname: Skanes
mesh_terms: D000200:Action Potentials; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac; D006801:Humans; D011237:Predictive Value of Tests; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014682:Vena Cava, Inferior / Q000503:physiopathology / Q000601:surgery*