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  • Title: Evaluation of an individualized strategy of cavotricuspid isthmus ablation as an adjunct to atrial fibrillation ablation.
    Author: Shah DC, Sunthorn H, Burri H, Gentil-Baron P.
    Journal: J Cardiovasc Electrophysiol; 2007 Sep; 18(9):926-30. PubMed ID: 17655668.
    Abstract:
    OBJECTIVES: To evaluate supplementary cavotricuspid isthmus (CTI) ablation as an adjunct to atrial fibrillation (AF) ablation in selected patients. BACKGROUND: It is unclear whether routine CTI ablation is beneficial in all patients undergoing AF ablation. METHODS AND RESULTS: In patients undergoing AF ablation, additional CTI block was created only for those with typical atrial flutter (Afl) before or during the ablation. Out of 188 consecutive patients (108 male, 56 +/- 9 years), 75 underwent CTI ablation (Group CTI+) and left atrial (LA) ablation (circular mapping-guided extensive pulmonary vein isolation in all and linear LA ablation when required), while 113 underwent LA ablation alone (Group CTI-). Group CTI+ patients had smaller LA and less frequently persistent/permanent AF and linear LA ablation. Over a follow-up of 30 +/- 10 months, complications (4% vs 5%, P = NS), typical Afl occurrence (1.3% and 2.6%, P = NS) and AF recurrence (25% and 28%, P = NS) were similar. Atypical Afl was more common in Group CTI- (4 vs 14%, P = 0.026). Eighty-two percent and 79% of patients in Groups CTI+ and CTI-, respectively, remained arrhythmia free in stable sinus rhythm without antiarrhythmic drug treatment (P = NS). CONCLUSIONS: Avoiding supplementary CTI ablation in AF ablation patients without evidence of typical flutter does not result in a higher incidence of typical Afl. Despite more persistent/permanent AF and larger LA in patients without evidence of typical flutter, a strategy of selective supplementary ablation resulted in similar and low AF recurrence rates in the group without CTI ablation compared with the group with CTI ablation.
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