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Rates of atrial flutter occurrence and cavotricuspid isthmus reconduction after prophylactic isthmus ablation performed during atrial fibrillation ablation: a clinical study, review, and comparison with previous findings

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

Based on the high rate of coexisting atrial fibrillation (AF) and atrial flutter (AFL), prophylactic cavotricuspid isthmus ablation (CTIA) adjunctive to AF ablation has recently been attempted in patients with AF and without AFL. The present study aimed to determine the rates of AFL occurrence and CTI reconduction after performing CTI ablation adjunctive to AF ablation.

Methods

We analyzed the data of 3833 consecutive patients with AF, who underwent prophylactic CTIA with AF ablation between 2009 and 2020.

Results

In all patients, CTIA and AF ablations were successful. Clinical AFL occurred in seven patients (0.18%, 7/3,833), and the observed rate was lower than those reported for cases of AF ablation without CTIA and for those of CTIA for pure AFL. A second ablation was needed in 745 patients at a median of 253 days (25 and 75 percentiles, 116 and 775 days) after the first ablation. In 12.1% (90/745) of the patients, CTI reconduction was observed. The reconduction rate was lower than that previously reported for CTIA for pure AFL.

Conclusions

The present retrospective study found acceptably low rates of clinical AFL occurrence and CTI reconduction following prophylactic CTIA performed with AF ablation, which was supported by the findings obtained after performing a comparison of the rates with those of other ablations (AF ablation only and CTIA for pure AFL). Considering the high correlation between AF and AFL, the present study provided information regarding the efficacy of adjunctive CTIA.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Abbreviations

AF:

Atrial fibrillation

AFL:

Atrial flutter

CTI:

Cavotricuspid isthmus

CTIA:

Cavotricuspid isthmus ablation

PVI:

Pulmonary vein isolation

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Author information

Authors and Affiliations

  1. Heart Rhythm Center, Okayama Heart Clinic, Takeda 54-1, Naka-Ku, Okayama, 703-8251, Japan

    Hirosuke Yamaji, Shunichi Higashiya, Takashi Murakami, Hiroshi Kawamura, Masaaki Murakami & Shigeshi Kamikawa

  2. Department of Medical Technology, Okayama University Graduate School of Health Okayama, Japan Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan

    Shozo Kusachi

Authors
  1. Hirosuke Yamaji
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  2. Shunichi Higashiya
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  3. Takashi Murakami
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  4. Hiroshi Kawamura
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  5. Masaaki Murakami
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  6. Shigeshi Kamikawa
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  7. Shozo Kusachi
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Contributions

1) Substantial contributions to the conception and design or the acquisition, analysis, or interpretation of the data: H.Y., S.H., T.M., and S.K.

2) Substantial contributions to the drafting of the articles or critical revision for important intellectual content: H.Y., H.K., M.M., S.K., and S.K.

3) Final approval of the version to be published: all authors

4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the article are appropriately investigated and resolved: H.Y., H.Y., S.H., T.M., and S.K.

Corresponding author

Correspondence to Hirosuke Yamaji.

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Ethics approval

Our study complied with the principles stated in the Declaration of Helsinki and was approved by the Institutional Ethics Committee for Human Research of the Okayama Heart Clinic (ID of approval, HY1).

Informed consent

Written informed consent for the use of data without personally identifiable information was obtained from all patients.

Permission to reproduce material from other sources

The present study did not use any reproduced material from other sources.

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The authors declare no competing interests.

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Yamaji, H., Higashiya, S., Murakami, T. et al. Rates of atrial flutter occurrence and cavotricuspid isthmus reconduction after prophylactic isthmus ablation performed during atrial fibrillation ablation: a clinical study, review, and comparison with previous findings. J Interv Card Electrophysiol 64, 67–76 (2022). https://doi.org/10.1007/s10840-021-01087-8

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  • DOI: https://doi.org/10.1007/s10840-021-01087-8

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