Abstract
Aims– The objective of this study was to identify clinical, electrocardiographic, and echocardiographic characteristics of atrial flutter catheter ablation in patients with aneurismal dilated atrium using EnSite System noncontact mapping.
We perform reconstruction of the cavotricuspid isthmus in order to verify if the isthmus anatomy correlated with the isthmus ablation outcome. We tried to locate the sites of conduction gaps and to verify if sites of conduction gaps resistant to ablation correlated with specific anatomical particularities.
Methods and Results – Isthmus was arbitrarily divided in an anterior—close to the tricuspid annulus—central, and inferior—close to the inferior vena cava orifice—portion.
A gap of the resumed conduction through the IVC-TA isthmus was delineated as a mechanism of recurrence and ablated with one and three radio-frequency applications. In 45 of the 79 patients a total of 52 gaps were found. Seventy-three percent of gaps were in the central portion of the isthmus, 8 % was in an anterior portion close to the tricuspid annulus, and 19 % were in an inferior portion near the edge of the inferior vena cava orifice. No specific anatomical structures were identified as being correlated with these sites. In the 16 patients with a total of 18 gaps, all these gaps were located at the same site: the border between the central and inferior portion of the isthmus at the level of a prominent Eustachian ridge.
Conclusion At patients with right aneurismal atrium the isthmus presents anatomical variants which may represent a site of conduction gaps “resistant” to ablation.
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Chiriac, L., Cristian, G., Bolohan, R., T¸intoiu, I.C. (2014). Cavotricuspid Isthmus Anatomy Particularities in Atrial Flutter Ablation. In: Kibos, A., Knight, B., Essebag, V., Fishberger, S., Slevin, M., Țintoiu, I. (eds) Cardiac Arrhythmias. Springer, London. https://doi.org/10.1007/978-1-4471-5316-0_36
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