Cavotricuspid isthmus ablation for atrial flutter guided by contact force related parameters: A systematic review and
Naidong Pang1,2, Jia Gao1, Nan Zhang1
1Department of Cardiology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China.
Insights
Contact force (CF) guided ablation for cavotricuspid isthmus dependent atrial flutter (AFL) improves efficiency by reducing radiofrequency duration and lesions. This method offers comparable safety to conventional techniques but does not enhance acute success or long-term outcomes.
Area of Science:
- Electrophysiology
- Cardiac Ablation
- Atrial Flutter Management
Background:
- Contact force (CF) is established for pulmonary vein isolation but its role in cavotricuspid isthmus (CTI) dependent atrial flutter (AFL) ablation is less understood.
- This study investigates the efficacy and safety of using CF parameters to guide CTI-AFL ablation.
Approach:
- A systematic literature search was conducted across major databases (PubMed, EMbase, Cochrane, Web of Science) up to June 2022.
- Meta-analysis and meta-regression were employed on ten studies involving 761 patients comparing CF-guided versus conventional ablation for CTI-AFL.
Key Points:
- CF-guided ablation resulted in significantly shorter radiofrequency (RF) duration and fewer RF lesions.
- Improved catheter-tissue contact and reduced need for touch-up after the initial ablation line were observed.
- No significant differences were found in procedural/fluoroscopy times, acute conduction recovery, recurrence, or complication rates.
Conclusions:
- CF-related parameters enhance the efficiency of CTI ablation by optimizing catheter contact and reducing RF energy delivery.
- While offering comparable safety to conventional methods, CF guidance does not improve acute success or long-term efficacy in CTI-AFL ablation.
Background:
Contact force (CF) and related parameters have been evaluated as an effective guide mark for pulmonary vein isolation, yet not for linear ablation of the cavotricuspid isthmus (CTI) dependent atrial flutter (AFL). We thus studied the efficacy and safety of CF related parameter-guided ablation for CTI-AFL.
Methods:
Systematic search was performed on databases involving PubMed, EMbase, Cochrane Library and Web of Science (through June 2022). Original articles comparing CF related parameter-guided ablation and conventional parameter-guided ablation for CTI-AFL were included. One-by-one elimination, subgroup analysis and meta-regression were used for heterogeneity test between studies.
Results:
Ten studies reporting on 761 patients were identified after screening with inclusion and exclusion criteria. Radiofrequency (RF) duration was significantly shorter in CF related parameter-guided group (p = 0.01), while procedural time (p = 0.13) and fluoroscopy time (p = 0.07) were no significant difference between two groups. CF related parameter-guided group had less RF lesions (p = 0.0003) and greater CF of catheter-tissue (p = 0.0002). Touch-up needed after first ablation line was less in CF related parameter-guided group (p = 0.004). In addition, there were no statistical significance between two groups on acute conduction recovery rates (p = 0.25), recurrence rates (p = 0.92), and complication rates (p = 0.80). Meta-regression analysis revealed no specific covariate as an influencing factor for above results (p > 0.10).
Conclusion:
CF related parameters guidance improves the efficiency of CTI ablation, with the better catheter-tissue contact, the lower RF duration and the comparable safety as compared with conventional method, but does not improve the acute success rate and long-term outcome.
