Circulation, Vol 90, 2804-2814, Copyright © 1994 by American Heart Association
G Kirkorian, E Moncada, P Chevalier, G Canu, JP Claudel, C Bellon, L Lyon and P Touboul
BACKGROUND: Previous reports have shown that radiofrequency ablation can
terminate atrial flutter and prevent recurrences. However, different
methods have been used, and the current experience remains limited. The
objective of the present study was to determine the efficacy of
radiofrequency ablation of atrial tissue in patients with atrial flutter
using an anatomically guided approach. METHODS AND RESULTS: We treated 22
patients aged 30 to 73 years. Atrial flutter was recurrent for a mean of 5
years despite the administration of multiple antiarrhythmic drugs.
Radiofrequency current was directed to the atrial isthmus between the
inferior vena cava and the tricuspid ring, regardless of the morphology of
local electrograms. Radiofrequency energy was applied during typical atrial
flutter in 12 patients, atypical atrial flutter in 2 patients, and
successively both forms in 8 patients. In 19 patients, atrial flutter
abruptly terminated. In 3 patients, atrial flutter persisted despite 37,
48, and 25 applications, respectively. Atrial recordings demonstrated that
atrial flutter termination occurred as a consequence of conduction block at
the site of radiofrequency energy application, regardless of the type of
atrial flutter. The number of applications before termination ranged from 1
to 82 (mean, 32). Atrial flutter could no longer be induced in every case.
There were no complications. During a 13-month mean follow-up, atrial
flutter recurred in only 2 of the 19 patients who had a successful
ablation. Four patients experienced chronic atrial fibrillation, and 2 of
them returned to sinus rhythm with antiarrhythmic therapy. CONCLUSIONS:
Radiofrequency ablation of atrial flutter using anatomic guidance is
feasible and effective. Further experience is needed to delineate its role
as an alternative approach to the management of refractory atrial flutter.
ARTICLES
Radiofrequency ablation of atrial flutter. Efficacy of an anatomically guided approach
Hospital Cardiovasculaire et Pneumologique Louis Pradel, Lyon, France.
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