Author + information
- Received November 5, 2019
- Revision received March 24, 2020
- Accepted April 22, 2020
- Published online August 17, 2020.
- Zachary T. Yoneda, MDa,∗,
- M. Benjamin Shoemaker, MD, MSCIa,∗,
- Travis Richardson, MDa,
- Diane Crawford, RNa,
- Arvindh Kanagasundram, MDa,
- Sharon Shen, MDa,
- Juan Carlos Estrada, MD, MPHa,
- Benjamin Holmes, MDa,
- Ricardo Lugo, MDb,
- Julia McHugh, MDa,
- Pablo Saavedra, MDa,
- George Crossley III, MDa,
- Christopher R. Ellis, MDa,
- Jay A. Montgomery, MDa,∗ and
- Gregory F. Michaud, MDa,∗ ()
- aCardiovascular Division, Vanderbilt University Medical Center, Nashville, Tennessee
- bDepartment of Cardiology, Ascension Saint Thomas West, Nashville, Tennessee
- ↵∗Address for correspondence:
Dr. Gregory F. Michaud, Vanderbilt University Medical Center, Cardiovascular Division, 1215 21st Avenue South, Medical Center East, 5th Floor South Tower, Nashville, Tennessee 37232.
Objectives This study sought to define the association between conduction recovery across the cavotricuspid isthmus (CTI) and typical atrial flutter (AFL) recurrence when CTI ablation is performed with pulmonary vein isolation (PVI) compared with a stand-alone procedure.
Background CTI ablation is commonly performed at the same time as PVI to treat AFL or as an empiric therapy. Conduction recovery is a recognized problem after linear ablation in the left atrium (e.g., mitral isthmus ablation) and is proarrhythmic. Less is known about conduction recovery after CTI ablation and possible differences in outcomes when performed at the time of PVI compared with at the time of a stand-alone procedure.
Methods Eligible participants who underwent stand-alone CTI ablation were compared with those who underwent a combined (CTI+PVI) procedure. CTI conduction recovery was assessed at the time of a second ablation. Conduction recovery across the CTI (primary outcome) and recurrence of typical AFL (secondary outcome) were studied using multivariable logistic regression.
Results Among 295 eligible participants (median age: 64 years [interquartile range: 55 to 69 years]; 33% women), recovery was assessed in 232 and was more common after combined versus stand-alone CTI ablation (52% [72 of 139] vs. 13% [12 of 93]; p < 0.001). In multivariable analysis, CTI ablation performed as a combined procedure increased odds of CTI conduction recovery 7.8-fold (odds ratio: 7.8; 95% confidence interval: 3.3 to 18.3; p < 0.001) and clinical AFL recurrence 4.1-fold (odds ratio: 4.1; 95% confidence interval: 1.0 to 16.9; p = 0.049).
Conclusions CTI ablation performed at the time of atrial fibrillation ablation is associated with higher rates of conduction recovery and typical flutter recurrence.
↵∗ Drs. Yoneda, Shoemaker, Montgomery, and Michaud contributed equally to this work.
Dr. Kanagasundram has received speaking fees from Biosense Webster and Janssen. Dr. Crossley has received consulting fees or honoraria from Bayer Healthcare, Boston Scientific, Janssen Pharmaceuticals, Medtronic, and Spectranetics. Dr. Ellis has received research funding from Medtronic, Atricure, Thoratec, and Boston Scientific; and consulting fees from Medtronic, Sentre Heart, Spectranetics, Biosense Webster, Boston Scientific, and Atricure. Dr. Michaud has received consulting fees or honoraria from Boston Scientific, Medtronic, Biotronik, Abbott, and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Francis Marchlinski, MD, served as Guest Editor for this paper. Katja Zeppenfeld, MD, served as Guest Editor-in-Chief, for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received November 5, 2019.
- Revision received March 24, 2020.
- Accepted April 22, 2020.
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