Cavotricuspid isthmus ablation guided by force-time integral - A randomized study.

Area of Science:

• Electrophysiology
• Cardiac Ablation Techniques
• Arrhythmia Management

Background:

• Force-time integral (FTI) measures lesion quality in cardiac ablation.
• A 400 gram-seconds (gs) FTI target improves pulmonary vein isolation durability.
• Optimal FTI targets for cavotricuspid isthmus (CTI) ablation are not established.

Purpose of the Study:

• To determine if 600 gs FTI lesions reduce transisthmus conduction recovery after CTI ablation compared to 400 gs FTI lesions.

Main Methods:

• Fifty patients with CTI-dependent flutter were randomized into two groups.
• Group 1 received 400 gs FTI lesions (n=26), Group 2 received 600 gs FTI lesions (n=24).
• The primary endpoint was recovery of transisthmus conduction within 20 minutes post-ablation.

Main Results:

• Conduction recovery rates were similar: 19.2% in the 400 gs group vs. 16.7% in the 600 gs group (P=.81).
• First-pass CTI block rates were also comparable (50% vs. 54.2%, P=.77).
• No significant differences were observed in lesion count, ablation time, procedure time, or fluoroscopy duration.

Conclusions:

• Using 600 gs FTI lesions for CTI ablation does not decrease the rate of transisthmus conduction recovery compared to 400 gs FTI lesions.
• Achieving first-pass CTI block was associated with a lower rate of acute conduction recovery.