The electroanatomic characteristics of the cavotricuspid isthmus: Implications for the catheter ablation of atrial flutter

Shih Lin Chang, Ching Tai Tai, Yenn Jiang Lin, Mary Gertrude Ong, Wanwarang Wongcharoen, Li Wei Lo, Sheng Hsiung Chang, Ming Hsiung Hsieh, Shih Ann Chen

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Electroanatomic Characteristics of the Isthmus. Introduction: Radiofrequency ablation (RFA) of typical AFL is sometimes difficult because of the poor electroanatomic approach to the cavotricuspid isthmus (CTI). The aim of this study was to correlate the anatomy of the CTI between contact mapping (NavX) and right atrial angiography (RAG), and to investigate the impact of the electroanatomic characteristics of the CTI on the RFA of typical atrial flutter (AFL). Methods: One hundred patients with typical AFL undergoing RFA were studied. The image-guided group consisted of 50 consecutive patients with the guidance of NavX. NavX geometry and RAG were performed to investigate the morphology of the CTI. The bipolar voltages of the CTI were collected during sinus rhythm by a NavX. The control group consisted of 50 consecutive patients with the guidance of conventional fluoroscopy. Results: There was a good correlation between the angiography and NavX for the anatomy of the CTI. The pouch type had a longer length of CTI than the flat type (33.4 ± 5.0 vs 22.6 ± 8.4 mm, P <0.0001) and deeper depth than the concave type (6.5 ± 2.2 vs 3.7 ± 0.8 mm, P <0.0001) on the angiography. The pouch-type CTI had a longer ablation time and larger pulses of RFA than the other two types. The control group had a longer ablation time, fluoroscopy time, and larger pulses of RFA than image-guided group. Conclusions: The 3-D mapping system provided a good reconstruction of CTI, which may help in the RFA in patients with a complex anatomy of the CTI.

Original languageEnglish
Pages (from-to)18-22
Number of pages5
JournalJournal of Cardiovascular Electrophysiology
Volume18
Issue number1
DOIs
Publication statusPublished - Jan 2007

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Atrial Flutter
Catheter Ablation
Angiography
Anatomy
Fluoroscopy
Control Groups

Keywords

  • Atrial flutter
  • Cavotricuspid isthmus
  • Pouch

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology

Cite this

The electroanatomic characteristics of the cavotricuspid isthmus : Implications for the catheter ablation of atrial flutter. / Chang, Shih Lin; Tai, Ching Tai; Lin, Yenn Jiang; Ong, Mary Gertrude; Wongcharoen, Wanwarang; Lo, Li Wei; Chang, Sheng Hsiung; Hsieh, Ming Hsiung; Chen, Shih Ann.

In: Journal of Cardiovascular Electrophysiology, Vol. 18, No. 1, 01.2007, p. 18-22.

Research output: Contribution to journalArticle

Chang, Shih Lin ; Tai, Ching Tai ; Lin, Yenn Jiang ; Ong, Mary Gertrude ; Wongcharoen, Wanwarang ; Lo, Li Wei ; Chang, Sheng Hsiung ; Hsieh, Ming Hsiung ; Chen, Shih Ann. / The electroanatomic characteristics of the cavotricuspid isthmus : Implications for the catheter ablation of atrial flutter. In: Journal of Cardiovascular Electrophysiology. 2007 ; Vol. 18, No. 1. pp. 18-22.
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abstract = "Electroanatomic Characteristics of the Isthmus. Introduction: Radiofrequency ablation (RFA) of typical AFL is sometimes difficult because of the poor electroanatomic approach to the cavotricuspid isthmus (CTI). The aim of this study was to correlate the anatomy of the CTI between contact mapping (NavX) and right atrial angiography (RAG), and to investigate the impact of the electroanatomic characteristics of the CTI on the RFA of typical atrial flutter (AFL). Methods: One hundred patients with typical AFL undergoing RFA were studied. The image-guided group consisted of 50 consecutive patients with the guidance of NavX. NavX geometry and RAG were performed to investigate the morphology of the CTI. The bipolar voltages of the CTI were collected during sinus rhythm by a NavX. The control group consisted of 50 consecutive patients with the guidance of conventional fluoroscopy. Results: There was a good correlation between the angiography and NavX for the anatomy of the CTI. The pouch type had a longer length of CTI than the flat type (33.4 ± 5.0 vs 22.6 ± 8.4 mm, P <0.0001) and deeper depth than the concave type (6.5 ± 2.2 vs 3.7 ± 0.8 mm, P <0.0001) on the angiography. The pouch-type CTI had a longer ablation time and larger pulses of RFA than the other two types. The control group had a longer ablation time, fluoroscopy time, and larger pulses of RFA than image-guided group. Conclusions: The 3-D mapping system provided a good reconstruction of CTI, which may help in the RFA in patients with a complex anatomy of the CTI.",
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AU - Ong, Mary Gertrude

AU - Wongcharoen, Wanwarang

AU - Lo, Li Wei

AU - Chang, Sheng Hsiung

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AB - Electroanatomic Characteristics of the Isthmus. Introduction: Radiofrequency ablation (RFA) of typical AFL is sometimes difficult because of the poor electroanatomic approach to the cavotricuspid isthmus (CTI). The aim of this study was to correlate the anatomy of the CTI between contact mapping (NavX) and right atrial angiography (RAG), and to investigate the impact of the electroanatomic characteristics of the CTI on the RFA of typical atrial flutter (AFL). Methods: One hundred patients with typical AFL undergoing RFA were studied. The image-guided group consisted of 50 consecutive patients with the guidance of NavX. NavX geometry and RAG were performed to investigate the morphology of the CTI. The bipolar voltages of the CTI were collected during sinus rhythm by a NavX. The control group consisted of 50 consecutive patients with the guidance of conventional fluoroscopy. Results: There was a good correlation between the angiography and NavX for the anatomy of the CTI. The pouch type had a longer length of CTI than the flat type (33.4 ± 5.0 vs 22.6 ± 8.4 mm, P <0.0001) and deeper depth than the concave type (6.5 ± 2.2 vs 3.7 ± 0.8 mm, P <0.0001) on the angiography. The pouch-type CTI had a longer ablation time and larger pulses of RFA than the other two types. The control group had a longer ablation time, fluoroscopy time, and larger pulses of RFA than image-guided group. Conclusions: The 3-D mapping system provided a good reconstruction of CTI, which may help in the RFA in patients with a complex anatomy of the CTI.

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