%0 Journal Article
%A Marcos Alberca, Pedro
%A Sánchez Quintana, Damián
%A Cabrera, José A.
%A Farré, Jerónimo
%A Rubio, José M.
%A De Agustín Loeches, José Alberto
%A Almería, Carlos
%A Pérez De Isla, Leopoldo
%A Macaya Miguel, Carlos
%T Two-dimensional echocardiographic features of the inferior right atrial isthmus: The role of vestibular thickness in catheter ablation of atrial flutter
%D 2013
%@ 2047-2404
%U https://hdl.handle.net/20.500.14352/131929
%X ObjectivesThe 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).MethodsCTI 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).ResultsThe 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%).ConclusionsTwo-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.
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