Clinical Trial: Intracardiac Echocardiography in Atrial Flutter Ablation

Study Status: Recruiting
Recruit Status: Recruiting
Study Type: Interventional

Official Title: The Usefulness of Intracardiac Echocardiography in Atrial Flutter Ablation - a Randomized Study

Brief Summary:

Background: Radiofrequency ablation of typical atrial flutter present the most effective treament option in treatment of atrial flutter. Despite its high efficacy, due tovariant anatomy of cavotricuspid isthmus (CTI), i.e. location of right coronary artery, pouches, the achievment of complete bidirectional block across the CTI is sometimes chalenging. Intracardiac echocardiography (ICE) is a very usefull tool for on-line vizualization of the anatomy of the atria and also for the location of catheter position on CTI during ablation. If the routine use of ICE is associated with easier atrial fluter ablation is not clear.

Methods: One hundred consecutive patients indicated for typical atrial flutter ablation will be enrolled into the study. The patients will be randomized into group (A) ablation with use of ICE and (B) ablation without ICE. The ablation will be done in both groups by two diagnostic catheters (10-pole positioned in coronary sinus and 20-pole halo catheter positioned in the right atrium) and radiofrequency ablation catheter. The end-point of the ablation is the achievment of the bicidrectional block across the CTI. The end-points of the study are 1) the total length of the procedure, 2) the fluoroscopy time and 3) the ablation time. The safety end-point is clinically significant bleeding from the groin due to additional puncture for ICE catheter.

Discussion: We hypothesize the use of ICE wil shorten the radiofrequency energy delivery, fluoroscopy time and the length of the procedure without increasing the bleeding.

Detailed Summary:

Introduction Radiofrequency ablation (RFA) of typical atrial flutteru is the most successful method for treatment of atrial flutter. The acute (peri-procedural) efficacy is more than 95%. (1) Typical atrial flutter circuit uses the area between inferior caval vein and tricuspid anulus, so a RFA of typical flutter is performed by providing a linear lesion from inferior caval vein to tricuspid valve (this area is called as cavo-tricuspid isthmus). The recurrence of atrial flutter after ablation, which are caused by non-transmural RF lesion, are in less than 10% of cases. (2) During atrial flutter ablation, typically three electrophysiological catheters are used. Two catheters are diagnostic (one 10-pole inserted into coronary sinus and the other 20-pole inserted in the right atrium with the distal tip laterally from the cavo-ticuspid isthmus). The third is ablation catheter, inserted in the CT isthmus. The location of all three catheters is monitored by fluoroscopy and by the EP signals on catheters. Also the ablation catheter during the ablation is monitored by fluoroscopy and by the signals on the catheter.

Despite its high efficacy, the RFA of atrial flutter can be sometimes very difficult. The most difficulties are done by anatomical differences in patients. (3, 4) In the area of CTI, the rudimentary Eustachian valve can be present, which can hide the effective ablation of the CI tissue. Moreover, deep pouches can be present in the TI area, which, if unrecognized, can present the area of insufficient ablation. Both of them, Eustachian valve or pouches, are not visible by fluoroscopy. In rare cases, a complete block in the CTI are is not achieved, typically due to some anatomical difficulties. Furthermore, this anatomical obstacles can lead to prolonged fluoroscopy time (to find the location of conduction in CTI rea), more RF energy delivery and prolonged procedure time.
Sponsor: Charles University, Czech Republic

Current Primary Outcome:

• Procedure duration [ Time Frame: intraoperative ]
  The total lenght of the procedure in minuts will be measured.
• Fluoroscopy time during ablation [ Time Frame: intraoperative ]
  The total fluoroscopy time will be measured.
• Total ablation time [ Time Frame: intraoperative ]
  The time of radiofrequenc energy delivery during ablation will me measured.
• Bleeding [ Time Frame: 24 hours ]
  The bleeding complication required intervention or prolonged hospitalization will be measured.

Original Primary Outcome: Same as current

Current Secondary Outcome:

Original Secondary Outcome:

Information By: Charles University, Czech Republic

Dates:
Date Received: April 22, 2015
Date Started: June 2014
Date Completion: December 2016
Last Updated: July 31, 2016
Last Verified: July 2016