EFFICACY OF INTRACARDIAC ECHOCARDIOGRAPHY IN THE COURSE OF RADIOFREQUENCY CATHETER ABLATION OF RECURRENT ATRIAL FLUTTER

To study potentialities of improvement of efficacy of radiofrequency ablation (RFA) of recurrent atrial flutter with the aid of intra-procedural imaging of the cavo-tricuspid isthmus (CTI) structures using intracardiac echocardiography, 50 patients aged 63.1±6.9 years (men: 64.5%) were assessed and surgically treated. The radiofrequency ablation was performed in 21 patients (Group I) under control of intracardiac echocardiography and in 29 patients (Group II) under fluoroscopic control. After the procedure, 24 hour ECG Holter monitoring was performed in 6, 12, and 18 months; ECG was recorded during episodes of arrhythmia. The procedure duration was longer in Group I by 7.4±1.9 min. In group I, the fluoroscopy time was significantly shorter (4.0±1.0 min and 6.4±2.5 min, respectively; p=0.003). The bidirectional block in cavo-tricuspid isthmus was reached in 90.1% patients of Group I and 86.2% patients of Group II. Within 18 months of follow-up, the atrial flutter recurrence occurred in 1 patient of Group I (4.8%) and in 5 patients of Group II (17.2%). The cavo-tricuspid isthmus size in Group I was 28±6.4 mm (18 50 mm). In 19 patients (90.4%), the myocardial thickening of more than 7 mm was found in the proximal part of the cavo-tricuspid isthmus; the valve was of conic form, with the length of >14 mm. In two patients (14.3%), a “fossa” in the distal part of cavo-tricuspid isthmus (depth: 7 mm) close to the Eustachian channel was found. Thus, intracardiac echocardiography is a highly effective and safe method of the tachycardia substrate imaging and assessment of the ablative catheter location during the procedure; it permits one to improve the outcomes of isthmus-dependent atrial flutter, as well as to decrease the fluoroscopy exposure of the patient and the medical personnel.

atrial flutter, cavo-tricuspid isthmus, radiofrequency catheter ablation, recurrence, intracardiac echocardiography, fluoroscopy

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