title: Variable procedural strategies adapted to anatomical characteristics in catheter ablation of the cavotricuspid isthmus using a preoperative multidetector computed tomography analysis.
abstract: OBJECTIVE
  This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies.
  
  
  RESULTS
  This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02).
  
  
  CONCLUSIONS
  Changing the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.
authors.forename: Kenta
authors.initials: K
authors.lastname: Kajihara
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Nakano
authors.forename: Yukoh
authors.initials: Y
authors.lastname: Hirai
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogi
authors.forename: Noboru
authors.initials: N
authors.lastname: Oda
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Suenari
authors.forename: Yuko
authors.initials: Y
authors.lastname: Makita
authors.forename: Akinori
authors.initials: A
authors.lastname: Sairaku
authors.forename: Takehito
authors.initials: T
authors.lastname: Tokuyama
authors.forename: Chikaaki
authors.initials: C
authors.lastname: Motoda
authors.forename: Mai
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Masao
authors.initials: M
authors.lastname: Kiguchi
authors.forename: Yasuki
authors.initials: Y
authors.lastname: Kihara
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007564:Japan; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome