What is the role of catheter ablation in the treatment of atrial flutter?

Updated: Nov 09, 2018
  • Author: Jesse Borke, MD, FACEP, FAAEM; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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Antiarrhythmic drugs alone control atrial flutter in only 50-60% of patients. Since the early 1990s, radiofrequency catheter ablation (RFA) has been used to interrupt the reentrant circuit in the right atrium and prevent recurrences of atrial flutter. The cavotricuspid isthmus (CTI) is the part of the circuit in the right atrium that is targeted by ablation. Radiofrequency ablation is immediately successful in more than 90% of cases and avoids the long-term toxicity observed with antiarrhythmic drugs. It is the long-term treatment of choice in patients with symptomatic atrial flutter.

A study by Saygi et al that involved 153 randomized patients indicated that in cases of CTI-dependent atrial flutter, RFA and cryoablation each cause a similar degree of procedural myocardial injury, as measured by increased troponin I levels after the procedure. [3]  The same investigators found similar procedural success rates between RFA and cryoablation for CTI-dependent atrial flutter, regardless of the CTI morphology (straight, concave, and pouchlike). [4]  However, patients with a longer CTI experienced a lower procedure success rate whether the energy source was RFA or cryoablation. [4]

In patients who have failed antiarrhythmic therapy or who have failed radiofrequency ablation and who are symptomatic, palliative therapy with AV-His Bundle ablation can eliminate rapid ventricular rates, but it does require a permanent pacemaker to be placed, as this procedure creates third-degree heart block.

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