Betz, Johanna
[VerfasserIn]
;
Rittger, Harald
[AkademischeR BetreuerIn];
Rittger, Harald
[Sonstige Person, Familie und Körperschaft];
Achenbach, Stephan
[Sonstige Person, Familie und Körperschaft]
Mini-Elektroden-Technologie zur fluoroskopiefreien, substratorientierten Ablation von typischem Vorhofflattern
Beschreibung:
Background: Atrial flutter (AFL) is a common supraventricular arrhythmia, that can both massively impair quality of life due to severe symptoms and significantly increase the risk of thromboembolic events. Radiofrequency ablation of the cavotricuspid isthmus (CTI) in the right atrium is a well-established, efficient and curative treatment of typical AFL. Due to the inter-individually different anatomy, some procedures may be challenging and hence reduce the otherwise high procedural success and may lead to increased fluoroscopy times. Therefore, optimizing procedural strategies to improve ablation success is necessary. Minielectrode (ME) catheter technology may facilitate voltage-guided ablation by high-resolution electroanatomic mapping (HR-EAM) and precisely targeted energy application. Objective and methods: To evaluate the performance of ME technology for zero-fluoroscopy substrate-guided CTI ablation, 82 patients underwent near zero-fluoroscopy substrate-guided CTI ablation using an 8-mm tip catheter with 3 MEs in its tip. To make the images comparable and reproducible, the isthmus was divided into three longitudinal and five transverse segments, resulting in a grid system with 15 sections. Voltages were measured, plotted, and compared with both bipolar and ME. Procedural data were compared with a historical control group of 92 patients who had comparable demographic characteristics and were treated by linear ablation technique. Ablation success was considered to be persistent bidirectional conduction block across the CTI. Results: Using the substate-guided ablation strategy, ablation duration (336 ± 228 vs. 649 ± 409 s, p < 0.001), energy delivered (14.2 ± 10.6 vs. 28.6 ± 19.6 kJ, p < 0.001), and procedure duration (60.8 ± 33.8 min vs. 76.3 ± 40.9 min, p = 0.008) were significantly reduced compared to the linear technique. At the same time, ablation success remained at a high level (97.6% vs. 94.6%, p = 0.449). In addition, more precise electroanatomic mapping limited ablation to only 22.7% of the ...