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- Title
Two-dimensional echocardiographic features of the inferior right atrial isthmus: the role of vestibular thickness in catheter ablation of atrial flutter.
- Authors
Marcos-Alberca, Pedro; Sánchez-Quintana, Damián; Cabrera, José A.; Farré, Jerónimo; Rubio, José M.; de Agustín, Jose A.; Almería, Carlos; Pérez-Isla, Leopoldo; Macaya, Carlos
- Abstract
Objectives The aim of this study was to examine the feasibility of transthoracic two-dimensional (2D)-echocardiography in defining the cavo-tricuspid isthmus (CTI) anatomy and its value concerning the ease of catheter ablation of isthmic atrial flutter (AF). Methods CTI analysis was accomplished in 39 cases: 16 necropsy specimens and 23 patients. Sixteen were patients with isthmus-dependent AF and seven controls with other supraventricular re-entrant tachycardias. Two-dimensional transthoracic echocardiography and a right atrium angiogram were performed before radiofrequency catheter ablation (RFCA). Results The measurements of the CTI with angiography were compared with those taken with echocardiography and correlation was excellent (r= 0.91; P < 0.0001). In normal patients, the dimension of the vestibular thickness was successfully compared and validated with the histological examination of the necropsy specimens: histology median 6.8 mm, range 4.4–10.5 vs. echo median 6.2 mm, range 5.4–8.7; P: NS. Vestibular thickness was greater in complex than in simple RFCA (13.6 ± 1.9 mm vs. 10.0 ± 2.3 mm; P = 0.01). When vestibular thickness ≥11.5 mm, the ablation prone to be complex (sensitivity 83.3%, specificity 80%, positive predictive value 71.4%, and negative predictive value 88.9%). Conclusions Two-dimensional transthoracic echocardiography clearly depicts the inferior isthmus and, displaying the thickness of the tricuspid vestibule, it was related with complexity of the ablation procedure in isthmus-dependent AF.
- Subjects
HEART anatomy; HEART beat; ANGIOGRAPHY; CARDIAC output; CARDIOLOGY; CATHETER ablation; CHI-squared test; STATISTICAL correlation; DIAGNOSTIC imaging; ECHOCARDIOGRAPHY; CARDIAC patients; HEART atrium; SCIENTIFIC observation; STATISTICS; OPERATIVE surgery; U-statistics; ATRIAL flutter; DATA analysis; DATA analysis software; DESCRIPTIVE statistics
- Publication
European Heart Journal - Cardiovascular Imaging, 2014, Vol 15, Issue 1, p32
- ISSN
2047-2404
- Publication type
Article
- DOI
10.1093/ehjci/jet112