title: Incremental pacing maneuver for atrial flutter recurrence reduction after ablation: Vallès: yield of incremental pacing after flutter ablation.
abstract: BACKGROUND
  A < 20 ms increase in the interval between cavo-tricuspid isthmus (CTI) double potentials during incremental pacing (IP) is a highly specific marker differentiating functional from complete CTI block during typical flutter (AFL) ablation. Long-term effects of IP remain unclear. We aimed to assess the impact of IP in reducing AFL recurrences after CTI ablation.
  
  
  METHODS
  One hundred and thirty-four patients (age 67 ± 13 years, 78% males) undergoing successful CTI ablation were included and divided into 2 groups: Group 1 (n = 68), in which ablation was performed before the IP maneuver was incorporated, with CTI block confirmed by at least 1 non-local and 1 local electrogram-based previously established criteria; and Group 2 (n = 66), in which IP maneuver was used to confirm complete CTI block.
  
  
  RESULTS
  No intergroup differences were noted in baseline characteristics, ablation settings and fluoroscopy/radiofrequency times. Long-term AFL recurrences were observed in 14 out of 134 patients (10.4%), and were more common in Group 1 (19%, vs 1.5% among Group 2 patients, p < 0,001). Despite a longer follow-up period among the former group (1603 ± 734 vs. 964 ± 289 days, respectively), the adjusted AFL recurrence rate was still higher among Group 1 patients (4.3%/year vs. 0.6%/year, p < 0,001). Cox-regression analysis confirmed inclusion in Group 1 as the only predictor of AFL recurrences (HR = 8.2, CI 1.04-64.7, p = 0.046).
  
  
  CONCLUSIONS
  The addition of the IP maneuver for the diagnosis of complete CTI block reduces AFL long-term recurrences after ablation.
authors.affiliation: Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain. Electronic address: ermengolvalles@mac.com.
authors.forename: Ermengol
authors.initials: E
authors.lastname: Vallès
authors.affiliation: Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain.
authors.forename: Victor
authors.initials: V
authors.lastname: Bazan
authors.affiliation: Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Cainzos-Achirica
authors.affiliation: Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain.
authors.forename: Miguel Eduardo
authors.initials: ME
authors.lastname: Jáuregui
authors.affiliation: Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Benito
authors.affiliation: Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruguera
authors.affiliation: Electrophysiology Unit, Cardiovascular Division, Department of Medicine, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona 08003, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Martí-Almor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001282:Atrial Flutter / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D058406:Cardiac Resynchronization Therapy / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods* / Q000639:trends; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006327:Heart Block / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence
keywords: Ablation; Cavo-tricuspid isthmus; Complete block; Incremental pacing; Typical flutter