Fluoroless cavotricuspid isthmus ablation of typical atrial flutter achieves success with shorter radiofrequency and procedural times

Introduction and objectives

Cavotricuspid isthmus (CTI) ablation for typical atrial flutter (AFL) has improved in recent years, especially with three-dimensional (3D) electroanatomic mapping systems. These tools allow a better understanding of the arrhythmia with higher ablation success rates while reducing radiation exposure. However, most ablation procedures still require varying amounts of fluoroscopy. Our aim was to examine whether fluoroless CTI ablation is effective and safe in reducing AFL recurrence, compared with CTI ablation using fluoroscopy.

Methods

We conducted a retrospective analysis of CTI ablations performed at a tertiary center between December 2010 and December 2022. Patients were divided into two groups: fluoroless and fluoroscopic, according to the use of radiation. Procedural duration, fluoroscopy time (FT), radiofrequency time (RF), acute complications and recurrence rates at one year were analyzed.

Results

A total of 324 CTI ablations were performed. Mean age was 62.3±14.0 years, with 78.1% male patients. The FT was zero in the fluoroless group (n=31), and 7.0±7.0 minutes in the fluoroscopic group (n=293) (p<0.001). There was no statistically significant difference between the two groups, regarding AFL recurrence at one year. RF was shorter in the fluoroless group (8±4 vs. 14±11 minutes, p<0.001). Total time procedure duration was shorter in the fluoroless group (60±20 minutes vs. 99±45 minutes, p<0.001). There were no acute complications.

Conclusion

Fluoroless CTI ablation, avoiding any radiation exposure to the patient and operator, can be performed in patients with typical AFL, without compromising duration, safety or efficacy of the procedure.