Abstract 16567: Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis
Objectives: This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation using 64-row MDCT and validate efficacy of changing the CTI ablation strategies according to the anatomical information provided by the preprocedural MDCT.
Methods and Results: This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into two groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than in the nonmodulation group (162.2 ± 153.5 vs. 222.7 ± 191.9 s, P < 0.01, and 16,962.4 ± 11,545.6 vs. 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs. 1.7%, P = 0.02).
Conclusion: Variable catheter ablation strategies based on the MDCT findings significantly improved the adaptation of the ablation catheter to the anatomical characteristics associated with the procedural difficulties with the CTI ablation as compared with the conventional strategy.
- © 2013 by American Heart Association, Inc.