Voltage-guided ablation technique for cavotricuspid isthmus-dependent atrial flutter: refining the continuous line

Journal of Cardiovascular Electrophysiology
Peter K JacobsenAllan C Skanes

Abstract

Ablation of the cavotricuspid isthmus has become first-line therapy for "isthmus-dependent" atrial flutter. The goal of ablation is to produce bidirectional cavotricuspid isthmus block. Traditionally, this has been obtained by creation of a complete ablation line across the isthmus from the ventricular end to the inferior vena cava. This article describes an alternative method used in our laboratory. There is substantial evidence that conduction across the isthmus occurs preferentially over discrete separate bundles of tissue. Consequently, voltage-guided ablation targeting only these bundles with large amplitude atrial electrograms results in a highly efficient alternate method for the interruption of conduction across the cavotricuspid isthmus. Understanding the bundle structure of conduction over the isthmus facilitates more flexible approaches to its ablation and targeting maximum voltages in our hands has resulted in reduction of ablation time and fewer recurrences.

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Citations

Mar 29, 2014·Journal of Interventional Cardiac Electrophysiology : an International Journal of Arrhythmias and Pacing·Gerard M Guiraudon, Douglas L Jones
Jun 22, 2013·Journal of Electrocardiology·Tony ChengShiwen Yuan
Oct 26, 2016·Journal of Cardiovascular Electrophysiology·Paul A GouldGerald C Kaye

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