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Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis

OBJECTIVES: This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies. METHODS AND RESULTS: This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI a...

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Autores principales: Kajihara, Kenta, Nakano, Yukiko, Hirai, Yukoh, Ogi, Hiroshi, Oda, Noboru, Suenari, Kazuyoshi, Makita, Yuko, Sairaku, Akinori, Tokuyama, Takehito, Motoda, Chikaaki, Fujiwara, Mai, Watanabe, Yoshikazu, Kiguchi, Masao, Kihara, Yasuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BlackWell Publishing Ltd 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229059/
https://www.ncbi.nlm.nih.gov/pubmed/23875907
http://dx.doi.org/10.1111/jce.12231
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author Kajihara, Kenta
Nakano, Yukiko
Hirai, Yukoh
Ogi, Hiroshi
Oda, Noboru
Suenari, Kazuyoshi
Makita, Yuko
Sairaku, Akinori
Tokuyama, Takehito
Motoda, Chikaaki
Fujiwara, Mai
Watanabe, Yoshikazu
Kiguchi, Masao
Kihara, Yasuki
author_facet Kajihara, Kenta
Nakano, Yukiko
Hirai, Yukoh
Ogi, Hiroshi
Oda, Noboru
Suenari, Kazuyoshi
Makita, Yuko
Sairaku, Akinori
Tokuyama, Takehito
Motoda, Chikaaki
Fujiwara, Mai
Watanabe, Yoshikazu
Kiguchi, Masao
Kihara, Yasuki
author_sort Kajihara, Kenta
collection PubMed
description OBJECTIVES: This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies. METHODS AND RESULTS: This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02). CONCLUSION: Changing the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation.
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spelling pubmed-42290592014-12-15 Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis Kajihara, Kenta Nakano, Yukiko Hirai, Yukoh Ogi, Hiroshi Oda, Noboru Suenari, Kazuyoshi Makita, Yuko Sairaku, Akinori Tokuyama, Takehito Motoda, Chikaaki Fujiwara, Mai Watanabe, Yoshikazu Kiguchi, Masao Kihara, Yasuki J Cardiovasc Electrophysiol Original Articles OBJECTIVES: This study aimed to investigate the anatomical characteristics complicating cavotricuspid isthmus (CTI) ablation and the effectiveness of various procedural strategies. METHODS AND RESULTS: This study included 446 consecutive patients (362 males; mean age 60.5 ± 10.4 years) in whom CTI ablation was performed. A total of 80 consecutive patients were evaluated in a preliminary study. The anatomy of the CTI was evaluated by multidetector row-computed tomography (MDCT) prior to the procedure. A multivariate logistic regression analysis revealed that the angle and mean wall thickness of the CTI, a concave CTI morphology, and a prominent Eustachian ridge, were associated with a difficult CTI ablation (P < 0.01). In the main study, 366 consecutive patients were divided into 2 groups: a modulation group (catheter inversion technique for a concave aspect, prominent Eustachian ridge, and steep angle of the CTI or increased output for a thicker CTI) and nonmodulation group (conventional strategy). The duration and total amount of radiofrequency energy delivered were significantly shorter and smaller in the modulation group than those in the nonmodulation group (162.2 ± 153.5 vs 222.7 ± 191.9 seconds, P < 0.01, and 16,962.4 ± 11,545.6 vs 24,908.5 ± 22,804.2 J, P < 0.01, respectively). The recurrence rate of type 1 atrial flutter after the CTI ablation in the nonmodulation group was significantly higher than that in the modulation group (6.3 vs 1.7%, P = 0.02). CONCLUSION: Changing the procedural strategies by adaptating them to the anatomical characteristics improved the outcomes of the CTI ablation. BlackWell Publishing Ltd 2013-12 2013-09-12 /pmc/articles/PMC4229059/ /pubmed/23875907 http://dx.doi.org/10.1111/jce.12231 Text en © 2013 Wiley Periodicals, Inc. http://creativecommons.org/licenses/by-nc-nd/3.0/ This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Kajihara, Kenta
Nakano, Yukiko
Hirai, Yukoh
Ogi, Hiroshi
Oda, Noboru
Suenari, Kazuyoshi
Makita, Yuko
Sairaku, Akinori
Tokuyama, Takehito
Motoda, Chikaaki
Fujiwara, Mai
Watanabe, Yoshikazu
Kiguchi, Masao
Kihara, Yasuki
Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis
title Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis
title_full Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis
title_fullStr Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis
title_full_unstemmed Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis
title_short Variable Procedural Strategies Adapted to Anatomical Characteristics in Catheter Ablation of the Cavotricuspid Isthmus Using a Preoperative Multidetector Computed Tomography Analysis
title_sort variable procedural strategies adapted to anatomical characteristics in catheter ablation of the cavotricuspid isthmus using a preoperative multidetector computed tomography analysis
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229059/
https://www.ncbi.nlm.nih.gov/pubmed/23875907
http://dx.doi.org/10.1111/jce.12231
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