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The benefit of tissue contact monitoring with an electrical coupling index during ablation of typical atrial flutter—a prospective randomised control trial

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Abstract

Introduction

We sought to investigate the use of tissue contact monitoring by means of the electrical coupling index (ECI) in a prospective randomised control trial of patients undergoing cavotricuspid isthmus (CTI) ablation for atrial flutter.

Methods

Patients with ECG-documented typical flutter undergoing their first CTI ablation were randomised to ECI™-guided or non-ECI™-guided ablation. An irrigated-tip ablation catheter was used in all cases. Consecutive 50-W, 60-s radiofrequency lesions were applied to the CTI, from the tricuspid valve to inferior vena cava, with no catheter movement permitted during radiofrequency (RF) delivery. The ablation endpoint was durable CTI block at 20 min post-ablation. Patients underwent routine clinic follow-up post-operatively.

Results

A total of 101 patients (79 male), mean age 66 (+/−11), 50 ECI-guided and 51 control cases were enrolled in the study. CTI block was achieved in all. There were no acute complications. All patients were alive at follow-up. CTI block was achieved in a single pass in 36 ECI-guided and 30 control cases (p = 0.16), and at 20 min post-ablation, re-conduction was seen in 5 and 12 cases, respectively (p = 0.07). There was no significant difference in total procedure time (62.7 ± 33 vs. 62.3 ± 33 min, p = 0.92), RF requirement (580 ± 312 vs. 574 ± 287 s, p = 0.11) or fluoroscopy time (718 ± 577 vs. 721 ± 583 s, p = 0.78). After 6 ± 4 months, recurrence of flutter had occurred in 1 (2 %) ECI vs. 8 (16 %) control cases (OR 0.13, 95 % CI 0.01–1.08, p = 0.06).

Conclusions

ECI-guided CTI ablation demonstrated a non-statistically significant reduction in late recurrence of atrial flutter, at no cost to procedural time, radiation exposure or RF requirement.

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Abbreviations

CTI:

Cavotricuspid isthmus

ECI:

Electrical coupling index

RF:

Radiofrequency

AFL:

Typical atrial flutter

AF:

Atrial fibrillation

CF:

Contact force

FTI:

Force-time integral

CS:

Coronary sinus

LVEF:

Left ventricular ejection fraction

LA:

Left atrium

AAD:

Anti-arrhythmic drug

PPM/ICD:

Permanent pacemaker/implanted cardiac defibrillator

EP:

Electrophysiology

HT:

Hypertension

HF:

Heart failure

DM/IGT:

Diabetes/impaired glucose tolerance

CRF:

Chronic renal failure

IHD:

Ischemic heart disease

PVD:

Peripheral vascular disease

CVA/TIA:

Cerebrovascular accident/transient ischemic attack

HCM:

Hypertrophic cardiomyopathy

OSA:

Obstructive sleep apnoea

COPD:

Chronic obstructive pulmonary disease

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

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Acknowledgments

Dr. Jones’s salary is supported by a grant from the Oxford Biomedical Research Centre.

Author contributions

All of the above-listed authors contributed substantially to the design and execution of this study; Dr. Michael Jones designed the trial methodology, collated the data and drafted the paper submitted for publication; Mr. David Webster approached the participants, made enrolments and randomisation assignment, collated the data and populated the database; Dr. Kelvin Wong critically appraised the protocol, assisted with the conception of the study design and statistics and reviewed the paper for publication; Drs. Hayes and Qureshi assisted in study design conception and data collation and critically appraised the paper for publication; Drs. Rajappan and Bashir contributed to the design of the protocol, the statistical analysis and the analysis of the data and Dr Betts contributed to the formulation of the concept, the creation of the research protocol, the statistical methods and sample size estimate, the interpretation of the data and the critical appraisal of the paper submitted for publication.

Conflict of interest

Dr. Jones received funding from St Jude Medical to support his salary. Dr. Betts has received speaker fees and research grants from St Jude Medical. Dr. Rajappan has received speaker fees from St Jude Medical.

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Authors and Affiliations

  1. Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, United Kingdom

    Michael A. Jones, David Webster, Kelvin C.K. Wong, Christopher Hayes, Norman Qureshi, Kim Rajappan, Yaver Bashir & Timothy R. Betts

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  1. Michael A. Jones
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  2. David Webster
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  3. Kelvin C.K. Wong
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  4. Christopher Hayes
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  5. Norman Qureshi
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  6. Kim Rajappan
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  7. Yaver Bashir
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  8. Timothy R. Betts
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Correspondence to Michael A. Jones.

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Jones, M.A., Webster, D., Wong, K.C. et al. The benefit of tissue contact monitoring with an electrical coupling index during ablation of typical atrial flutter—a prospective randomised control trial. J Interv Card Electrophysiol 41, 237–244 (2014). https://doi.org/10.1007/s10840-014-9943-6

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  • DOI: https://doi.org/10.1007/s10840-014-9943-6

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