Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
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

Dimitrios Asvestas  1 , Vasileios Sousonis  1 , George Kotsovolis  1 , Stavros Karanikas  1 , Anastasia Xintarakou  1 , Eleftherios Sakadakis  1 , Angelos G Rigopoulos  1 , Andreas S Kalogeropoulos  1 , Panos Vardas  1 , Stylianos Tzeis  1
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.

PubMed Disclaimer

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
See this image and copyright information in PMC

References

    1. Pérez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA. Long‐term outcomes after catheter ablation of cavo‐tricuspid isthmus dependent atrial flutter. Circ Arrhythm Electrophysiol. 2009;2(4):393‐401. - PubMed
    1. Brugada J, Katritsis DG, Arbelo E, et al. ESC Guidelines for the management of patients with supraventricular tachycardia: the Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC): developed in collaboration with the Association for European Paediatric and Congenital Cardiology (AEPC). Eur Heart J. 2019;41(5):655‐720. - PubMed
    1. Ullah W, Hunter RJ, Baker V, et al. Target indices for clinical ablation in atrial fibrillation: insights from contact force, electrogram, and biophysical parameter analysis. Circ Arrhythm Electrophysiol. 2014;7(1):63‐68. - PubMed
    1. Yokoyama K, Nakagawa H, Shah DC, et al. Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circ Arrhythm Electrophysiol. 2008;1(5):354‐362. - PubMed
    1. Neuzil P, Reddy VY, Kautzner J, et al. Electrical reconnection after pulmonary vein isolation is contingent on contact force during initial treatment: results from the EFFICAS I study. Circ Arrhythm Electrophysiol. 2013;6(2):327‐333. - PubMed

Publication types

LinkOut - more resources