Interv Akut Kardiol. 2010;9(1):9-11

Catheter ablation of cavotricuspid isthmus in patients with permanent atrial flutter and dysfunction of left ventricle

David Břečka, Tomáš Minařík

Interní klinika, Fakultní nemocnice, Ostrava

Introduction: Catheter ablation of cavotricuspid isthmus (CTI) has become the first line therapy in patients (pts) with typical atrial flutter.

Methods: Retrospective analysis of patients (n = 61) with permanent typical atrial flutter and systolic dysfunction of left ventricle (left

ventricular ejection fraction (LVEF) ≤ 50 %). All patients underwent catheter ablation of CTI and the effect of ablation on cardiac rhythm

and LVEF after a minimum of 3 months follow-up was analysed with respect to the degree of LV systolic dysfunction and presence of

structural heart disease.

Results: Sinus rhythm (SR) was observed in 51 pts (83.6 %), with 30 only having SR (49.2 %) and 21 having SR with paroxysmal atrial

fibrillation (34.4 %). In 5 pts (8.2 %) we repeated the ablation for recurrence of typical atrial flutter. The mean LVEF after the procedure

increased from 37.8 ± 9.9 % to 43.5 ± 11.4 % (by 15 % in the whole group, p = 0.001), in subgroup with SR, the increase of LVEF was 18.8 %

(p < 0.001). In patients with nonischaemic cardiomyopathy the increase was 19.7 % (p = 0.01) compared to 12.2 % (p = 0.066) in those

with ischaemic heart disease (patients who underwent PCI or CABG).

Conclusions: Catheter ablation of CTI is an effective nonpharmacological therapy of typical atrial flutter, but a relatively large proportion

of patients develop atrial fibrillation (especially its paroxysmal form) during follow-up. The LVEF significantly improved after ablation.

A higher increase was observed in patients with severe LV systolic dysfunction. By contrast, a larger proportion of patients remained

in sinus rhythm in the subgroup with LVEF > 35 %. A more pronounced effect on systolic function of LV was observed in subjects with

nonischaemic cardiomyopathy, compared to patients with ischaemic heart disease.

Keywords: atrial flutter, catheter ablation, cavotricuspid isthmus, left ventricular dysfunction

Published: March 1, 2010  Show citation