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Updated: Jun 17, 2026
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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Prospective randomized comparison of a steerable versus a non-steerable sheath for typical atrial flutter ablation
Seiichiro Matsuo1, Teiichi Yamane, Michifumi Tokuda
1Department of Cardiology, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan. mattsuu@tc4.so-net.ne.jp
Summary
A steerable sheath significantly reduces radiofrequency energy and time needed for cavotricuspid isthmus (CTI) ablation to achieve bidirectional conduction block. This therapeutic option is beneficial for patients with difficult-to-ablate typical atrial flutter (AFL).
Area of Science:
- Electrophysiology
- Cardiovascular Medicine
- Medical Devices
Background:
- Cavotricuspid isthmus (CTI) ablation is a standard treatment for typical atrial flutter (AFL).
- Achieving a complete bidirectional conduction block in the CTI can be challenging in some patients.
- Minimizing radiofrequency (RF) energy and procedure time is crucial for patient safety and procedural efficiency.
Purpose of the Study:
- To evaluate the efficacy of a steerable sheath in CTI ablation for typical AFL and atrial fibrillation.
- To compare the procedural parameters between using a steerable sheath and a non-steerable sheath for CTI ablation.
- To determine if a steerable sheath facilitates achieving bidirectional conduction block more efficiently.
Main Methods:
- A randomized study involving 40 patients undergoing CTI ablation for typical AFL or atrial fibrillation.
- Patients were allocated to either a steerable (group S) or non-steerable (group NS) long sheath group.
- A 8 mm tip catheter was used for ablation, with CTI anatomy assessed by dual-source computed tomography.
Main Results:
- Bidirectional block in the CTI was achieved in all patients.
- Group S demonstrated significantly shorter RF application times (310 vs. 661 s) and lower total RF energy delivery (12,197 vs. 26,906 J) compared to group NS.
- CTI anatomy was similar between the groups, indicating the sheath type was the differentiating factor.
Conclusions:
- The use of a steerable sheath significantly reduces the time and RF energy required to establish bidirectional conduction block in the CTI.
- A steerable sheath is a valuable therapeutic option for CTI ablation, particularly in cases where achieving conduction block is difficult.
- This approach may improve procedural outcomes and patient safety in typical AFL ablation.
