[Simplified approach to ablation in atrial flutter using a single catheter electrode. Based on 70 cases]

Abstract

The object of this study was to assess the feasibility, efficacy and risks of ablation of common atrial flutter using a single catheter electrode. Recent studies have shown that radiofrequency ablation is effective for interrupting atrial flutter but with a variable rate of recurrence. Therefore, the search for a conduction block in the isthmic region has become the reference method for reducing the incidence of recurrence but this requires the use of costly material. The necessity of single usage has incited research to find a less costly method without compromising efficacy. The authors reviewed the results in 70 consecutive patients with common atrial flutter resistant to anti-arrhythmic medication. The site of ablation was located using anatomical landmarks and electrophysiological criteria. The anatomic site was situated either on a lateral isthmus or, to a variable degree, a septal isthmus; the electrophysiological criterion was an endocavitary auriculogramme, the amplitude of which had to decrease by more than 2/3 after application of the radiofrequency. The technique was interrupted not after the interruption of the flutter but after obtaining a microvoltage atrial activity along the isthmus. Radiofrequency energy of 10 to 50 W was delivered at each site for 90 seconds. Atrial flutter was interrupted in all 70 patients (100%). The average number of applications to interrupt the flutter was 12.67 and to create a microvoltage barrier 14.58. The average duration of the radiofrequency procedure was 50.43 minutes. After an average of six months' follow-up, the recurrence rate was 13%: 9 patients, 5 of whom underwent a second session of radiofrequency ablation. There were no immediate complications after this method of ablation.