Skip to main content
SpringerLink
Log in

Lesion size index-guided cavotricuspid isthmus linear ablation

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

The lesion size index (LSI) predicts radiofrequency (RF) ablation lesion size and is an established parameter for pulmonary vein isolation. However, the effectiveness and safety of LSI for cavotricuspid isthmus (CTI) linear ablation remain unclear.

Methods

This single-center retrospective study included 50 of patients (67 ± 10 years, 68% male) who underwent de novo CTI linear ablation between July 2020 and December 2020. The LSI target was set at 5.0 and 4.0 for the anterior 2/3 and posterior 1/3 segments, respectively. Acute procedural parameters of ablation were evaluated.

Results

Acute bidirectional CTI block was achieved in all patients with an RF application time of 4.0 min (3.1–5.0 min), RF application number of 15 ± 7, and length of CTI of 36.9 ± 9.3 mm. First-pass bidirectional conduction block of the CTI was achieved in 39/50 (78%) patients. No major complications were observed. The contact force (CF) per application was significantly lower in the gap tag group than in the non-gap tag group (7 g [7–8 g] vs. 10 g [7–12 g], P = 0.0284).

Conclusions

LSI-guided CTI linear ablation is an effective and safe treatment approach. CF affects gap formation, even when the target LSI is the same.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Riva S, Tondo C, Carbucicchio C, Galimberti P, Fassini G, Bella PD, et al. Incidence and clinical significance of transformation of atrial fibrillation to atrial flutter in patients undergoing long-term antiarrhythmic drug treatment. Europace. 1999;1:242–7.

    Article  CAS  PubMed  Google Scholar 

  2. Pérez FJ, Schubert CM, Parvez B, Pathak V, Ellenbogen KA, Wood MA, et al. Long-term outcomes after catheter ablation of cavo-tricuspid isthmus dependent atrial flutter: a meta-analysis. Circ Arrhythmia Electrophysiol. 2009;2:393–401.

    Article  Google Scholar 

  3. Natale A, Newby KH, Pisanó E, Leonelli F, Fanelli R, Potenza D, et al. Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol. 2000;35:1898–904.

    Article  CAS  PubMed  Google Scholar 

  4. Calzolari V, de Mattia L, Indiani S, Crosato M, Furlanetto A, Licciardello C, et al. In vitro validation of the lesion size index to predict lesion width and depth after irrigated radiofrequency ablation in a porcine model. JACC Clin Electrophysiol. 2017;3:1126–35.

    Article  PubMed  Google Scholar 

  5. Kanamori N, Kato T, Sakagami S, Saeki T, Kato C, Kawai K, et al. Optimal lesion size index to prevent conduction gap during pulmonary vein isolation. J Cardiovasc Electrophysiol. 2018;29:1616–23.

    Article  PubMed  Google Scholar 

  6. Mattia L, Crosato M, Indian S, Causin E, Licciardello C, Antonio P, et al. Prospective evaluation of lesion index-guided pulmonary vein isolation technique in patients with paroxysmal atrial fibrillation: 1-year follow-up corresponding author. J Atr Fibrillation. 2018;10:1858.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8.

    Article  CAS  PubMed  Google Scholar 

  8. Cabrera JA, Sánchez-Quintana D, Farré J, Rubio JM, Siew YH, et al. The inferior right atrial isthmus: further architectural insights for current and coming ablation technologies. J Cardiovasc Electrophysiol. 2005;16:402–8.

    Article  PubMed  Google Scholar 

  9. Giehm-Reese M, Kronborg MB, Lukac P, Kristiansen SB, Jensen HK, Gerdes C, Kristensen J, Nielsen JM, Nielsen JC. Recurrent atrial arrhythmia in a randomised controlled trial comparing contact force-guided and contact force-blinded ablation for typical atrial flutter. J Interv Card Electrophysiol. 2022;63:699–707.

    Article  PubMed  Google Scholar 

  10. Sakama S, Yagishita A, Sakai T, Morise M, Ayabe K, Amino M, Ikari Y, Yoshioka K. Ablation index-guided cavotricuspid isthmus ablation with contiguous lesions using fluoroscopy integrated 3D mapping in atrial flutter. J Interv Card Electrophysiol. 2022;64:217–22.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Schillaci V, Strisciuglio T, Stabile G, Salito A, Arestia A, Agresta A, Shopova G, De Simone A, Solimene F. Cavotricuspid isthmus ablation by means of very high power, short-duration, temperature-controlled lesions. J Interv Card Electrophysiol. 2022. https://doi.org/10.1007/s10840-022-01197-x.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Zhang T, Wang Y, Han Z, Zhao H, Liang Z, Wang Y, et al. Cavotricuspid isthmus ablation using ablation index in typical right atrial flutter. J Cardiovasc Electrophysiol. 2019;30:2414–9.

    Article  PubMed  Google Scholar 

  13. Venier S, Andrade JG, Khairy P, Mondésert B, Dyrda K, Rivard L, et al. Contact-force-guided vs. contact-force-blinded catheter ablation of typical atrial flutter: a prospective study. Europace. 2017;19:1043–8.

  14. Jones MA, Webster D, Wong KCK, Hayes C, Qureshi N, Rajappan K, et al. The benefit of tissue contact monitoring with an electrical coupling index during ablation of typical atrial flutter—a prospective randomised control trial. J Interv Card Electrophysiol. 2014;41:237–44.

    Article  PubMed  Google Scholar 

  15. Reddy VY, Dukkipati SR, Neuzil P, Natale A, Albenque JP, Kautzner J, et al. Randomized, controlled trial of the safety and effectiveness of a contact force-sensing irrigated catheter for ablation of paroxysmal atrial fibrillation: results of the TactiCath contact force ablation catheter study for atrial fibrillation (TOCCASTAR) Study. Circulation. 2015;132:907–15.

    Article  PubMed  Google Scholar 

  16. Kumar S, Morton JB, Lee G, Halloran K, Kistler PM, Kalman JM, et al. High incidence of low catheter-tissue contact force at the cavotricuspid isthmus during catheter ablation of atrial flutter: Implications for achieving isthmus block. J Cardiovasc Electrophysiol. 2015;26:826–31.

    Article  PubMed  Google Scholar 

  17. Lozano Granero C, Franco E, Matía Francés R, Hernández-Madrid A, Sánchez-Pérez I, Zamorano Gómez JL, Moreno J. Impact of power and contact force on index-guided radiofrequency lesions in an ex vivo porcine heart model. J Interv Card Electrophysiol. 2022;63:687–97.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, 252-0374, Japan

    Yusuke Murayama, Jun Kishihara, Hidehira Fukaya, Yutaro Mitani, Daiki Saito, Gen Matsuura, Tetsuro Sato, Hironori Nakamura, Naruya Ishizue, Jun Oikawa, Shinichi Niwano & Junya Ako

Authors
  1. Yusuke Murayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jun Kishihara
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Hidehira Fukaya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yutaro Mitani
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daiki Saito
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gen Matsuura
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Tetsuro Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Hironori Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Naruya Ishizue
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jun Oikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Shinichi Niwano
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Junya Ako
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jun Kishihara.

Ethics declarations

Ethics approval

This study conformed to the Declaration of Helsinki and was approved by the Ethics Board of the Committee of Kitasato University Hospital (No. B21-163).

Consent to participate

All patients provided informed consent.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Murayama, Y., Kishihara, J., Fukaya, H. et al. Lesion size index-guided cavotricuspid isthmus linear ablation. J Interv Card Electrophysiol 66, 485–492 (2023). https://doi.org/10.1007/s10840-022-01360-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-022-01360-4

Keywords

Search

Navigation