The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography
Abstract Background The aim of this study was to explore whether the pouch depth influenced the radiofrequency (RF) duration and total delivered RF energy for cavotricuspid isthmus (CTI) ablation and define the cutoff value for a deep pouch‐specified ablation strategy. Methods This study included 94...
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doaj-30554dd3781b4163afb632207bd3c31f2020-11-25T03:59:52ZengWileyJournal of Arrhythmia1880-42761883-21482018-08-0134441041710.1002/joa3.12075The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiographyYukiko Shimizu0Kazuyasu Yoshitani1Kenta Murotani2Kazuto Kujira3Yuma Kurozumi4Rei Fukuhara5Ryoji Taniguchi6Masanao Toma7Tadashi Miyamoto8Yoshio Kita9Yoshiki Takatsu10Yukihito Sato11Department of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanCenter for Clinical Research Aichi Medical University Nagakute JapanDepartment of Cardiovascular Medicine Toyohashi Heart Center Toyohashi JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanDepartment of Cardiology Hyogo Prefectural Amagasaki General Medical Center Amagasaki JapanAbstract Background The aim of this study was to explore whether the pouch depth influenced the radiofrequency (RF) duration and total delivered RF energy for cavotricuspid isthmus (CTI) ablation and define the cutoff value for a deep pouch‐specified ablation strategy. Methods This study included 94 atrial fibrillation (AF) patients (56 males, age 68 ± 8.0 years). With intracardiac echocardiography, the isthmus length and pouch depth were precisely measured. After a standard AF ablation, all patients underwent the CTI ablation along the lateral isthmus. If bidirectional block could not be achieved, the ablation catheter was deflected more than 90 degrees to ablate inside the pouch (knuckle‐curve ablation). Results Seventy‐two patients (76.6%) had a sub‐Eustachian pouch. Bidirectional block could be achieved in all patients. By a univariate logistic regression analysis, only the pouch depth was significantly correlated with the RF duration (P = .005) and RF energy (P = .006). A multivariate logistic regression analysis also revealed the pouch depth was the sole factor that influenced the RF duration (P = .001) and RF energy (P = .001). Among the 72 patients, 21 patients needed a knuckle‐curve ablation. Using a receiver operating characteristic curve, the optimal cutoff value of the pouch depth for a knuckle‐curve ablation was 3.7 mm with a sensitivity of 90% and specificity of 69%. Conclusions The sub‐Eustachian pouch depth was the sole factor that influenced the RF duration and energy in the CTI ablation. If the pouch was deeper than 3.7 mm, a deep pouch‐specified ablation strategy would be needed.https://doi.org/10.1002/joa3.12075atrial fluttercavotricuspid isthmusintracardiac echocardiographypouchradiofrequency catheter ablation |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yukiko Shimizu Kazuyasu Yoshitani Kenta Murotani Kazuto Kujira Yuma Kurozumi Rei Fukuhara Ryoji Taniguchi Masanao Toma Tadashi Miyamoto Yoshio Kita Yoshiki Takatsu Yukihito Sato |
spellingShingle |
Yukiko Shimizu Kazuyasu Yoshitani Kenta Murotani Kazuto Kujira Yuma Kurozumi Rei Fukuhara Ryoji Taniguchi Masanao Toma Tadashi Miyamoto Yoshio Kita Yoshiki Takatsu Yukihito Sato The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography Journal of Arrhythmia atrial flutter cavotricuspid isthmus intracardiac echocardiography pouch radiofrequency catheter ablation |
author_facet |
Yukiko Shimizu Kazuyasu Yoshitani Kenta Murotani Kazuto Kujira Yuma Kurozumi Rei Fukuhara Ryoji Taniguchi Masanao Toma Tadashi Miyamoto Yoshio Kita Yoshiki Takatsu Yukihito Sato |
author_sort |
Yukiko Shimizu |
title |
The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography |
title_short |
The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography |
title_full |
The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography |
title_fullStr |
The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography |
title_full_unstemmed |
The deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—Cavotricuspid isthmus ablation using intracardiac echocardiography |
title_sort |
deeper the pouch is, the longer the radiofrequency duration and higher the radiofrequency energy needed—cavotricuspid isthmus ablation using intracardiac echocardiography |
publisher |
Wiley |
series |
Journal of Arrhythmia |
issn |
1880-4276 1883-2148 |
publishDate |
2018-08-01 |
description |
Abstract Background The aim of this study was to explore whether the pouch depth influenced the radiofrequency (RF) duration and total delivered RF energy for cavotricuspid isthmus (CTI) ablation and define the cutoff value for a deep pouch‐specified ablation strategy. Methods This study included 94 atrial fibrillation (AF) patients (56 males, age 68 ± 8.0 years). With intracardiac echocardiography, the isthmus length and pouch depth were precisely measured. After a standard AF ablation, all patients underwent the CTI ablation along the lateral isthmus. If bidirectional block could not be achieved, the ablation catheter was deflected more than 90 degrees to ablate inside the pouch (knuckle‐curve ablation). Results Seventy‐two patients (76.6%) had a sub‐Eustachian pouch. Bidirectional block could be achieved in all patients. By a univariate logistic regression analysis, only the pouch depth was significantly correlated with the RF duration (P = .005) and RF energy (P = .006). A multivariate logistic regression analysis also revealed the pouch depth was the sole factor that influenced the RF duration (P = .001) and RF energy (P = .001). Among the 72 patients, 21 patients needed a knuckle‐curve ablation. Using a receiver operating characteristic curve, the optimal cutoff value of the pouch depth for a knuckle‐curve ablation was 3.7 mm with a sensitivity of 90% and specificity of 69%. Conclusions The sub‐Eustachian pouch depth was the sole factor that influenced the RF duration and energy in the CTI ablation. If the pouch was deeper than 3.7 mm, a deep pouch‐specified ablation strategy would be needed. |
topic |
atrial flutter cavotricuspid isthmus intracardiac echocardiography pouch radiofrequency catheter ablation |
url |
https://doi.org/10.1002/joa3.12075 |
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