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Evaluation of the cavotricuspid isthmus and right atrium by multidetector-row computed tomography in patients with

Sei Komatsu1, Yuji Okuyama, Yosuke Omori

  • 1Cardiovascular Division, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka 543-8502, Japan. donai@muc.biglobe.ne.jp

Heart and Vessels
|November 30, 2005
PubMed

Insights

Multidetector-row computed tomography (MDCT) measurements of the tricuspid isthmus can predict the success of radiofrequency catheter ablation for atrial flutter (AFL). These noninvasive imaging findings correlate with procedure efficiency and outcomes.

Area of Science:

  • Cardiovascular Imaging
  • Electrophysiology
  • Medical Device Technology

Background:

  • Radiofrequency catheter ablation is a common treatment for atrial flutter (AFL).
  • Anatomical variations, including the size of the right atrium (RA), cavotricuspid isthmus, and Eustachian valve, can influence ablation success.
  • Accurate pre-procedural assessment of these anatomical features is crucial for optimizing ablation strategies.

Purpose of the Study:

  • To investigate the relationship between cavotricuspid isthmus dimensions measured by multidetector-row computed tomography (MDCT) and fluoroscopy.
  • To determine if MDCT measurements can predict the success of linear radiofrequency catheter ablation for common AFL.
  • To assess the correlation between isthmus measurements and procedural parameters like fluoroscopy time, energy delivered, and application time.

Main Methods:

  • Eight-detector MDCT was used to measure the tricuspid isthmus in 23 patients undergoing linear ablation for common AFL.
  • Key parameters measured included the trace of the isthmus (Ti), the size of the tricuspid isthmus (DTi), and the distance from the tricuspid valve and inferior vena cava (LDTi).
  • One patient with a deep right atrial pouch was excluded, leaving 22 patients for analysis.

Main Results:

  • Twenty-one out of 22 patients (95.5%) were successfully ablated without AFL recurrence; one additional patient achieved clinical success despite incomplete block.
  • The measured parameters (Ti, DTi, LDTi) showed strong correlations with fluoroscopy time (r = 0.84-0.88), total delivered energy (r = 0.80-0.83), and application time (r = 0.80-0.87) (all P < 0.0001).
  • DTi and LDTi reflect right atrial size, potentially guiding the selection of appropriately sized ablation catheters.

Conclusions:

  • Noninvasive measurement of the tricuspid isthmus using MDCT provides valuable information for successful linear ablation of atrial flutter.
  • These anatomical measurements are significant predictors of procedural efficiency and clinical outcomes in AFL ablation.
  • MDCT assessment of the tricuspid isthmus can aid in pre-procedural planning and optimize catheter selection for atrial flutter ablation.

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