title: Predictors of acute inefficacy and the radiofrequency energy time required for cavotricuspid isthmus-dependent atrial flutter ablation.
abstract: OBJECTIVE
  Although cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) ablation is a highly efficacious treatment, a bidirectional CTI block cannot be achieved in some patients. In this study, we sought to determine the predictors of acute inefficacy of CTI-AFL ablation and the predictors of the radiofrequency (RF) energy time required to achieve a complete bidirectional CTI block.
  
  
  METHODS
  All consecutive patients who underwent stand-alone CTI-AFL ablation in our institution, except patients with congenital heart disease, were included in this retrospective study. Clinical, echocardiographic, and ablation data were collected from the Arrhythmia Unit and Imaging Unit databases and medical charts.
  
  
  RESULTS
  Three hundred and fifty-five patients, with a mean age 63 ± 12 years, were included. The ablation was acutely inefficacious in 30 patients (9%). Tricuspid regurgitation was the only independent predictor of acute inefficacy of CTI-AFL ablation (OR 3.161, 95% CI 1.084-9.220, p = 0.035) and was associated with a longer RF time required to achieve CTI bidirectional block (p = 0.031). Age was inversely correlated with the RF time required to achieve a bidirectional CTI block (r = -0.133, p = 0.025). A previous CTI RF ablation, chronic obstructive pulmonary disease (COPD), the use of an irrigated catheter, and advanced age were the independent predictors for requiring less RF energy time to achieve a bidirectional CTI block.
  
  
  CONCLUSIONS
  Tricuspid regurgitation is associated with less acute efficacy in CTI-AFL ablation. Prior CTI ablation, COPD, use of an irrigated catheter, and advanced age are independent predictors for needing less RF energy time to achieve a complete bidirectional CTI block.
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain. jordiperez@vhebron.net.
authors.forename: Jordi
authors.identifier: http://orcid.org/0000-0003-2234-5248
authors.initials: J
authors.lastname: Pérez-Rodon
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Julian
authors.initials: J
authors.lastname: Rodriguez-García
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Axel
authors.initials: A
authors.lastname: Sarrias-Merce
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Nuria
authors.initials: N
authors.lastname: Rivas-Gandara
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Ivo
authors.initials: I
authors.lastname: Roca-Luque
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Francisco-Pascual
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Santos-Ortega
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Martín-Sánchez
authors.affiliation: Department of Cardiology, CIBER de Epidemiología y Salud Pública, CIBERESP, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: Rodríguez-Palomares
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Artur
authors.initials: A
authors.lastname: Evangelista-Masip
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: David
authors.initials: D
authors.lastname: García-Dorado
authors.affiliation: Department of Cardiology, Hospital Universitari Vall d'Hebrón. Universitat Autònoma de Barcelona, Edifici Annexos, planta 9, Passeig Vall d'Hebrón, 119-129, 08035, Barcelona, Spain.
authors.forename: Àngel
authors.initials: À
authors.lastname: Moya-Mitjans
mesh_terms: D017677:Age Distribution; D001282:Atrial Flutter / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D017115:Catheter Ablation / Q000706:statistics & numerical data*; D015897:Comorbidity; D004735:Energy Transfer; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D013030:Spain / Q000453:epidemiology; D017211:Treatment Failure; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000175:diagnosis / Q000453:epidemiology*
keywords: Ablation; Cavotricuspid isthmus-dependent atrial flutter; Efficacy; Predictors; Radiofrequency time