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Multidetector 16-slice CT scan evaluation of cavotricuspid isthmus anatomy before radiofrequency ablation

Journal of Interventional Cardiac Electrophysiology volume 20, pages 29–35 (2007)Cite this article

Abstract

Introduction

The anatomy of the cavotricuspid isthmus (CTI) is an important determinant of the ease of radiofrequency ablation. We evaluated the anatomy of the region with a multidetector 16-slice computed tomography (CT) scan and correlated this with subsequent procedural difficulty.

Methods

Twenty-nine patients (mean age 64 ± 15 years) with typical atrial flutter or paroxysmal atrial fibrillation underwent ablation of the CTI. A multidetector 16-slice CT scan with contrast injection was performed in all before the procedure.

Results

The CTI showed marked variability as evidenced by the following measurements: length (8.2 to 32.2 mm), width (26 to 56.5 mm), depth (0 to 11 mm), thickness (0.2 to 7.5 mm), the angle between the inferior vena cava and the CTI (59.9 to 129.5°), and the length of the Eustachian valve (4.8 to 26.1 mm) present in 72% of patients. The appearance of the CTI was classified as follows into three categories: concave (72%), flat (17%), or with a sub-Eustachian recess (28%). Procedures were classified as difficult in case of failure to achieve bidirectional block or if radiofrequency duration was greater than 99% confidence interval. In the multivariate analysis, a significant correlation was present between the thickness of the CTI and procedural difficulty (p = 0.0005).

Conclusions

The multidetector 16-slice CT scan with contrast injection accurately evaluates the anatomy of the CTI. The only independent anatomic parameter that predicts a more difficult procedure is the thickness of the CTI.

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Authors and Affiliations

  1. Department of cardiology, CHU Brugmann, Place Van Gehuchten 4, 1020, Brussel, Belgium

    Sébastien Knecht, José Castro-Rodriguez, Thierry Verbeet, Nasroola Damry, Marielle Morissens, Emmanuel Tran-Ngoc, Béatrice Peperstraete, Valentin Tatnga, Merieme Elkholti & Pierre Decoodt

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  1. Sébastien Knecht
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  2. José Castro-Rodriguez
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  4. Nasroola Damry
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  7. Béatrice Peperstraete
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  8. Valentin Tatnga
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  10. Pierre Decoodt
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Correspondence to Sébastien Knecht.

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Knecht, S., Castro-Rodriguez, J., Verbeet, T. et al. Multidetector 16-slice CT scan evaluation of cavotricuspid isthmus anatomy before radiofrequency ablation. J Interv Card Electrophysiol 20, 29–35 (2007). https://doi.org/10.1007/s10840-007-9159-0

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  • DOI: https://doi.org/10.1007/s10840-007-9159-0

Keywords

  • Catheter ablation
  • Atrial flutter
  • Cavotricuspid isthmus
  • CT Scan