1
|
Aldaas OM, Lupercio F, Lin AY, Han FT, Hoffmayer KS, Raissi F, Ho G, Krummen D, Feld GK, Hsu JC. Ablation of mitral annular flutter ablation utilizing a left atrial anterior line versus a lateral mitral isthmus line: a systematic review and meta-analysis. J Interv Card Electrophysiol 2021; 63:87-95. [PMID: 33538952 PMCID: PMC8333257 DOI: 10.1007/s10840-021-00943-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/11/2021] [Indexed: 11/30/2022]
Abstract
Purpose Mitral annular flutter (MAF) is a common arrhythmia after atrial fibrillation ablation. We sought to compare the efficacy and safety of catheter ablation utilizing either a left atrial anterior wall (LAAW) line or a lateral mitral isthmus (LMI) line. Methods We performed a systematic review for all studies that compared LAAW versus LMI lines. Risk ratio (RR) and mean difference (MD) 95% confidence intervals were measured for dichotomous and continuous variables, respectively. Results Four studies with a total of 594 patients were included, one of which was a randomized control trial. In the LMI ablation group, 40% of patients required CS ablation. There were no significant differences in bidirectional block (RR 1.26; 95% CI, 0.94–1.69) or ablation time (MD −1.5; 95% CI, −6.11–3.11), but LAAW ablation was associated with longer ablation line length (MD 11.42; 95% CI, 10.69–12.14) and longer LAA activation delay (MD 67.68; 95% CI, 33.47–101.89.14) when compared to LMI. There was no significant difference in pericardial effusions (RR 0.36; 95% CI, 0.39–20.75) between groups and more patients were maintained sinus rhythm (RR 1.19; 95% CI, 1.03–1.37, p = 0.02) who underwent LAAW compared to LMI. Conclusion Ablation of mitral annular flutter with a LAAW line compared to a LMI line showed no difference in rates of acute bidirectional block, ablation time, or pericardial effusion. However, LAAW ablation required a longer ablation line length, resulted in greater LAA activation delayed and was associated with more sinus rhythm maintenance, with the added advantage of avoiding ablation in the CS.
Collapse
Affiliation(s)
- Omar M Aldaas
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Florentino Lupercio
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Andrew Y Lin
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Frederick T Han
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Kurt S Hoffmayer
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Farshad Raissi
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Gordon Ho
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - David Krummen
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Gregory K Feld
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA
| | - Jonathan C Hsu
- Division of Cardiac Electrophysiology, University of California San Diego Health System, 9452 Medical Center Drive, San Diego, La Jolla, CA, 92037, USA. .,Cardiac Electrophysiology Section, Division of Cardiology, Department of Medicine, University of California - San Diego, 9452 Medical Center Drive, 3rd Floor, Room 3E-417, San Diego, La Jolla, San Diego, CA, 92037, USA.
| |
Collapse
|
2
|
Giehm-Reese M, Lukac P, Kristiansen SB, Jensen HK, Gerdes C, Kristensen J, Nielsen JM, Kronborg MB, Nielsen JC. Outcome after catheter ablation for left atrial flutter. SCAND CARDIOVASC J 2019; 53:133-140. [DOI: 10.1080/14017431.2019.1612086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
| | - Peter Lukac
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Christian Gerdes
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Kristensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | |
Collapse
|