P1446Cavo-tricuspid atrial flutter catheter ablation with a real zero fluoroscopic approach

Abstract Funding Acknowledgements none Background Catheter ablation(CA)is the first-line therapy of cavo-tricuspid isthmus(CTI)atrial flutter. Sometimes an inversion of ablation catheter is necessary to obtain a complete bidirectional line block. Purpose.The aim of this study was to describe this CA approach using electro-anatomical mapping(EAM)system with a zero-fluoroscopy(ZF)approach.Methods.Ninety-four patients that performed CA of CTI were retrospectively enrolled since 2017 to 2019.The studied population were divided in two groups.Group1(44patients) was composed of patients who underwent CA using ablation catheter without shaft visualization catheter(NSVC)on EAM.Group2(50patients)was composed of patients who underwent CA using ablation catheter with a shaft visualization(SVC). The catheter was looped at the Eustachian ridge after 200 seconds of RF without elimination of local electrogram. Results.ZF CTI ablation was obtained in all patients of group 2 without fluoroscopy use.In six patients of group 1, the catheter inversion was used to obtain a complete CTI block.In NSVC group, the catheter inversion was obtained using fluoroscopy to avoid damages during loop of catheter ablation.In overall population studied SVC had a linear correlation with ZF approach(β=0.629;p < 0.001). No differences were documented regarding acute and late success,complications.The procedural time between two groups was similar (Group1:83.4 ± 22.4 vs.Group2:80.2 ± 34.7minutes). The detailed results were summarize in table1. Conclusions.A real ZF catheter ablation of atrial flutter is safe and feasible.The use of SVC could improve the reproducibility of a successful zero-fluoroscopy CA.The visualization of the shaft’s catheter permit to invert the catheter safely to overcome anatomic complexity of some CTI without fluoroscopy use. detailed results Detailed results Group 1(44 CA) Group 2(50 CA) p value Procedure time (min) 83.4 ± 22.4 80.2 ± 34.7 NS AFL at begin CA (n.) 36 23 FT (min) 9.1 ± 9.8 0 ± 0 < 0.001 PWRF (W) 32 ±2.5 33.6 ±2.2 NS CA line length (mm) 28.1 ± 4.1 27.9 ± 5.5 NS Total RF (min) 27.8 ± 6.3 13.6 ± 7.2 < 0.01 SR during RF 35 23 Conductional block after 30 min 44 50 NS 6 months recurrences 1 1 NS AFL: atrial flutter; FT: fluoroscopy time; PWRF: power radiofrequencies; CA line length: length of line of radiofrequencies; RF: radiofrequencies; SR: sinus rhythm. Detailed results. Abstract Figure.