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Randomized Controlled Trial
. 2022 May;45(5):503-508.
doi: 10.1002/clc.23805. Epub 2022 Mar 17.

Cavotricuspid isthmus ablation guided by force-time integral - A randomized study

Affiliations
Randomized Controlled Trial

Cavotricuspid isthmus ablation guided by force-time integral - A randomized study

Dimitrios Asvestas et al. Clin Cardiol. 2022 May.

Abstract

Background: Force-time integral (FTI) is an ablation marker of lesion quality and transmurality. A target FTI of 400 gram-seconds (gs) has been shown to improve durability of pulmonary vein isolation, following atrial fibrillation ablation. However, relevant targets for cavotricuspid isthmus (CTI) ablation are lacking.

Hypothesis: We sought to investigate whether CTI ablation with 600 gs FTI lesions is associated with reduced rate of transisthmus conduction recovery compared to 400 gs lesions.

Methods: Fifty patients with CTI-dependent flutter were randomized to ablation using 400 gs (FTI400 group, n = 26) or 600 gs FTI lesions (FTI600 group, n = 24). The study endpoint was spontaneous or adenosine-mediated recovery of transisthmus conduction, after a 20-min waiting period.

Results: The study endpoint occurred in five patients (19.2%) in group FTI400 and in four patients (16.7%) in group FTI600, p = .81. First-pass CTI block was similar in both groups (50% in FTI400 vs. 54.2% in FTI600, p = .77). There were no differences in the total number of lesions, total ablation time, procedure time and fluoroscopy duration between the two groups. There were no major complications in any group. In the total population, patients not achieving first-pass CTI block had significantly higher rate of acute CTI conduction recovery, compared to those with first-pass block (29.2% vs. 7.7% respectively, p = .048).

Conclusions: CTI ablation using 600 gs FTI lesions is not associated with reduced spontaneous or adenosine-mediated recurrence of transisthmus conduction, compared to 400 gs lesions.

Keywords: ablation; atrial flutter; cavotricuspid isthmus; force-time integral.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Ablation line along the cavotricuspid isthmus in a patient with typical atrial flutter in right anterior oblique (A) and left anterior oblique (B) views. Red dots represent ablation lesions with a force‐time integral of 600 gs
Figure 2
Figure 2
Transisthmus conduction recovery documented by shortening of the transisthmus interval (from 168 to 108 ms) during pacing from the proximal coronary sinus after adenosine infusion with associated transient atrioventricular block. ABL D: distal bipole of the ablation catheter; ABL P: proximal bipole of the ablation catheter; CS 9,10: proximal bipole of the coronary sinus catheter

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