Implication of cavotricuspid isthmus mapping with single catheter in atrial flutter radiofrequency ablation

Objective:The present study sought to investigate the efficacy and safety of typical atrial flutter transisthmus linear ablation guided by cavotricuspid isthmus mapping with single catheter. Method: 30 patients (18 men aged 38 to 70 years) who had undergone a successful pulmonary vein isolation and cavotricuspid linear ablation procedure were involved.All the patients were routinely performed segmental electrical isolation of pulmonary veins by irrigated radiofrequenly catheter. After pulmonary vein isolation, the decapolar catheter, which was positioned into coronary sinus, was withdrawn and positioned spanning the tricuspid isthmus so that 2 adjacent dipoles were bracketing the targeted cavotricuspid isthmus (CTI) line of block (LOB) with proximal dipoles lateral to the LOB and distal dipoles in the coronary sinus. To verify complete bidirectional conduction block, it was essential to position the mapping catheter across the CTI in order to demonstrate the activation sequence up to the ablation line. Complete isthmus bidirectional conduction block was used as an endpoint for radiofrequency ablation for common atrial flutter. Guided byHis electrogram using radiofrequenly catheter, slow conduction from complete isthmus block after atrial flutter ablation was differentiated. Result:Complete isthmus bidirectional conduction block was achiered at the end of the procedure without any complication.Over a follow-up period of 4 months to 2 years, there was no recurrence of atrial flutter.Conclusion:The method of cavotricuspid isthmus mapping with single catheter in atrial flutter radiofrequency ablation is efficacy and safety. This mapping procedure is simple and may decrease the cost of procedure.