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Background <p>Cavotricuspid isthmus (CTI) ablation is widely performed as a standard treatment for common atrial flutter. However, chronic-phase reconduction of the CTI block remains a significant challenge.</p> Methods <p>We retrospectively analyzed patients who underwent CTI ablation. From pre-ablation CT images, we assessed the height of the Eustachian ridge (ER), cavotricuspid isthmus–inferior vena cava (CTI–IVC) angle and other anatomical features. Maximum catheter displacement was defined as the greatest lateral deviation from the CTI ablation line annotated by VISITAG module. Contact force, radiofrequency (RF) application time, the number of RF applications, ablation index, and other procedural parameters were also recorded.</p> Results <p>We enrolled a total of 286 patients who underwent CTI ablation and received second ablation for any indications. The median interval between the first and second ablation was 686&#xa0;days (interquartile range [IQR]: 258 to 1571&#xa0;days). Among them, CT images of the CTI were evaluable in 211 patients. Patients with CTI reconduction (<i>N</i> = 48, 22.7%) showed a significantly greater ER height compared to those without (<i>N</i> = 163, 77.3%; 3.6&#xa0;mm [IQR: 2.8–5.7&#xa0;mm] versus 2.3&#xa0;mm [IQR: 1.2–3.8&#xa0;mm], <i>P</i> &lt; 0.001). A total of 51 patients had analyzable CT images and underwent CARTO-guided initial ablation. Patients with CTI reconduction (<i>N</i> = 13, 25.5%) were associated with significantly greater maximum catheter displacement (6.3&#xa0;mm [IQR:5.1–7.8&#xa0;mm] versus 4.7&#xa0;mm [IQR: 3.6–6.2&#xa0;mm], <i>P</i> = 0.02), and more RF applications (20.0 [IQR: 16.0–24.0] versus 10.0 [IQR: 8.2–14.0], <i>P</i> &lt; 0.001).</p> Conclusion <p>A prominent ER was associated with reduced catheter stability during ablation, leading to greater catheter displacement and increased RF applications. This anatomical feature may contribute to chronic-phase CTI reconduction.</p> Graphical Abstract <p></p>

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Analysis of reconduction after cavotricuspid isthmus ablation based on computed tomography anatomy and procedural factors with emphasis on catheter stability

  • 期刊论文

  • 发表日期：

    2025年11月13日

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  • Tomoyuki Inoue,
  • Munekazu Tanaka,
  • Kyohei Yamaji,
  • Akifumi Morinaga,
  • Fumiya Yoneda,
  • Reo Hata,
  • Hirohiko Kohjitani,
  • Shushi Nishiwaki,
  • Satoshi Shizuta,
  • Koh Ono

摘要

Background

Cavotricuspid isthmus (CTI) ablation is widely performed as a standard treatment for common atrial flutter. However, chronic-phase reconduction of the CTI block remains a significant challenge.

Methods

We retrospectively analyzed patients who underwent CTI ablation. From pre-ablation CT images, we assessed the height of the Eustachian ridge (ER), cavotricuspid isthmus–inferior vena cava (CTI–IVC) angle and other anatomical features. Maximum catheter displacement was defined as the greatest lateral deviation from the CTI ablation line annotated by VISITAG module. Contact force, radiofrequency (RF) application time, the number of RF applications, ablation index, and other procedural parameters were also recorded.

Results

We enrolled a total of 286 patients who underwent CTI ablation and received second ablation for any indications. The median interval between the first and second ablation was 686 days (interquartile range [IQR]: 258 to 1571 days). Among them, CT images of the CTI were evaluable in 211 patients. Patients with CTI reconduction (N = 48, 22.7%) showed a significantly greater ER height compared to those without (N = 163, 77.3%; 3.6 mm [IQR: 2.8–5.7 mm] versus 2.3 mm [IQR: 1.2–3.8 mm], P < 0.001). A total of 51 patients had analyzable CT images and underwent CARTO-guided initial ablation. Patients with CTI reconduction (N = 13, 25.5%) were associated with significantly greater maximum catheter displacement (6.3 mm [IQR:5.1–7.8 mm] versus 4.7 mm [IQR: 3.6–6.2 mm], P = 0.02), and more RF applications (20.0 [IQR: 16.0–24.0] versus 10.0 [IQR: 8.2–14.0], P < 0.001).

Conclusion

A prominent ER was associated with reduced catheter stability during ablation, leading to greater catheter displacement and increased RF applications. This anatomical feature may contribute to chronic-phase CTI reconduction.

Graphical Abstract