Use of the Electroanatomical Mapping CARTO System for Catheter Ablation of Typical Atrial Flutter.

The aim of this study is to clinically evaluated the new real time nonfluroscopic system (CARTO system) in guiding catheter mapping and ablation of typical atrial flutter(AF).We treated five consecutive patients(age 40.4±15.7 years,all males) with typical AF. No patient had structural heart disease, except one with congenital cor triatrium after surgical correction. The cycle length was 205±28 ms. The ablation target site was the isthmus between tricuspid valve annulus and inferior vana cava. The CARTO system was used to provide a real time three dimensional image of the right atrium, and guiding catheter mapping and delivery of radiofrequency (RF) pulses at the isthmus. After ablation, electroanatomical maps were created during coronary sinus and posterolateral right atrium pacing with 500 ms respectively to assess the bidirectional conduction block.All five patients were noninducible and the bidirectional conduction block developed. 12.7±6.5 RF pulses(maximal power 50 W, temperature 60 ℃ )were delivered.The procedure time was 278±49 min, the fluoroscopic time was 16±7 min. No recurrences were observed during follow up of 1～3 months.Conclusion:The study demonstrates that the use of the CARTO system is safe and effective for mapping and ablation of typical AF.Electroanatomical mapping of the isthmus after ablation allowed precise verification of the linear continuity of the lesions along with proof of complete conduction block, while reducing fluoroscopic exposure time.