Mitral isthmus ablation using steerable sheath and high ablation power: a single center experience.
J Cardiovasc Electrophysiol
; 23(11): 1193-200, 2012 Nov.
Article
em En
| MEDLINE
| ID: mdl-22702402
ABSTRACT
BACKGROUND:
Mitral isthmus ablation is challenging. The use of steerable sheath and high ablation power may improve success rate.METHODS:
This single-center, prospective study enrolled 200 patients who underwent ablation for atrial fibrillation (AF), including mitral isthmus ablation. Mitral isthmus ablation was performed using an irrigated ablation catheter via a steerable sheath (endocardium maximum power 40/50 W limited to annular end, maximum temperature 48 °C; coronary sinus [CS] maximum power 25/30 W, maximum temperature 48 °C). Endpoint was bidirectional mitral isthmus block.RESULTS:
Mitral isthmus block was acutely achieved in 182/200 patients (91%). Sixty-nine percent of patients required CS ablation. Mean total ablation time was 13 ± 6 minutes. There was 1 case of acute circumflex artery occlusion. Mean left atrium (LA) diameter was significantly bigger in patients with unsuccessful mitral isthmus ablation (49 ± 4 mm vs. 43 ± 6 mm; P = 0.0007). In redo procedures, the incidence of reconduction at the mitral isthmus, roof and cavotricuspid isthmus was 44%, 37%, and 29%, respectively. Overall incidence of perimitral flutter was 9%. Prior complex fractionated atrial electrogram ablation was a predictor for microreentrant atrial tachycardia (AT) whereas gaps in linear lesions predicted macroreentrant flutters. After a mean follow-up of 20 ± 9 months, 73% of patients remained free from AF or AT.CONCLUSION:
We reported on a series of mitral isthmus ablation using steerable sheath and high ablation power (50 W). Larger LA diameter was a predictor of failure to achieve mitral isthmus block. The mitral isthmus had a moderately high incidence of re-conduction but was only associated with a relatively low incidence of perimitral flutter.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Fibrilação Atrial
/
Ablação por Cateter
/
Cateteres Cardíacos
/
Valva Mitral
Tipo de estudo:
Diagnostic_studies
/
Etiology_studies
/
Observational_studies
/
Prognostic_studies
/
Risk_factors_studies
Limite:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2012
Tipo de documento:
Article