RT-161
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Long-term results in
radiofrequency catheter ablation of type I atrial flutter
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Giuseppe Inama, Lorena Gramegna,
Paolo Pessano, Marcello Disertori.
Divisione di Cardiologia, Ospedale S. Chiara, Trento, Italy
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Abstract
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The introduction of an effective nonpharmacologic
technique, as radiofrequency catheter ablation (RF) opened new prospectives for the
management of atrial flutter. The limit of the RF procedure was in all the reports the
high number of recurrences of atrial flutter requiring new procedures and sometimes
antiarrhythmic drugs. The challenge was to find an index of successful ablation after the
abrupt termination of atrial flutter during RF. We performed in the last consecutive 50
patients who underwent RF ablation for atrial flutter, after the interruption of the
flutter, the usual reinduction attempt and also the atrial pacing in low right atrium and
in proximal coronary sinus to demonstrate the atrial activation sequence with
bidirectional conduction block in the isthmus. We also observed, after ablation, an
increased duration of the P-wave in D2 during pacing in low right atrium and an
increased delay stimulus-P wave: this is an additional marker of a slower intra-atrial
electrical conduction. All the patients were discharged without antiarrhythmic therapy and
seen every 3 months. The mean follow-up period is 14.8 ± 8 months. Nine patients (18%)
had recurrences of atrial flutter and underwent repeated RF ablation.
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Key Words
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Catheter ablation of supraventricular
tachyarrhythmias
atrial flutter (typical - type I), index of successful ablation,
anatomic/electrophysiologic approach, bidirectional conduction block, right atrial
activation sequence, OA
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