The sub-Eustachian pouch (pouch of Keith) is a physiologic depression of the CTI just anterior to the Eustachian ridge and laterally to the Thebesian valve at the orifice of the coronary sinus. The tachycardia terminated with ablation, but achievement of bidirectional block across the CTI ablation line was challenging. We used a power-controlled setting with a maximum temperature setting of 40☌ and a flow rate of 17 mL/min. Using an open-irrigated 3.5-mm-tip RF ablation catheter (THERMOCOOL, Biosense Webster) through a Swartz Braided SL1 guiding introducer sheath (St Jude Medical, Saint Paul, MN), ablation along the CTI was performed at a power of 30 W with titration guided by impedance and temperature monitoring. Entrainment maneuvers confirmed the atrial flutter to be CTI-dependent. The right atrial electrograms demonstrated high-to-low activation, and the coronary sinus electrograms demonstrated proximal-to-distal activation. An intracardiac echocardiography catheter (ICE ACUNAV, Siemens, Mountain View, CA) was inserted through the right femoral vein ( Figure 2). Diagnostic catheters were positioned in the high right atrium, annular right atrium across the CTI, coronary sinus, and right ventricle. The patient was brought to the electrophysiology laboratory in atrial flutter. PMID: 36068685 Review.Patient’s electrocardiogram revealing typical atrial flutter.Ī repeat electrophysiologic study was performed. Screening for OSA in patients with AF appears to be a reasonable clinical strategy.Ĭhang JL, Goldberg AN, Alt JA, Mohammed A, Ashbrook L, Auckley D, Ayappa I, Bakhtiar H, Barrera JE, Bartley BL, Billings ME, Boon MS, Bosschieter P, Braverman I, Brodie K, Cabrera-Muffly C, Caesar R, Cahali MB, Cai Y, Cao M, Capasso R, Caples SM, Chahine LM, Chang CP, Chang KW, Chaudhary N, Cheong CSJ, Chowdhuri S, Cistulli PA, Claman D, Collen J, Coughlin KC, Creamer J, Davis EM, Dupuy-McCauley KL, Durr ML, Dutt M, Ali ME, Elkassabany NM, Epstein LJ, Fiala JA, Freedman N, Gill K, Gillespie MB, Golisch L, Gooneratne N, Gottlieb DJ, Green KK, Gulati A, Gurubhagavatula I, Hayward N, Hoff PT, Hoffmann OMG, Holfinger SJ, Hsia J, Huntley C, Huoh KC, Huyett P, Inala S, Ishman SL, Jella TK, Jobanputra AM, Johnson AP, Junna MR, Kado JT, Kaffenberger TM, Kapur VK, Kezirian EJ, Khan M, Kirsch DB, Kominsky A, Kryger M, Krystal AD, Kushida CA, Kuzniar TJ, Lam DJ, Lettieri CJ, Lim DC, Lin HC, Liu SYC, MacKay SG, Magalang UJ, Malhotra A, Mansukhani MP, Maurer JT, May AM, Mitchell RB, Mokhlesi B, Mullins AE, Nada EM, Naik S, Nokes B, Olson MD, Pack AI, Pang EB, Pang KP, Patil SP, Van de Perck E, Piccirillo JF, Pien GW, Piper AJ, Plawecki A, Quigg M, Ravesloot MJL, Redline S, Rotenberg BW, Ryden … See abstract for full author list ➔ Chang JL, et al. ![]() Treatment with CPAP is associated with a lower incidence of newly diagnosed AFib after CTI ablation. OSA is a prevalent condition in patients with AF. Inversely, CPAP was not protective from AFib recurrence when this arrhythmia was documented prior to ablation (P =. Both freedom from AFib prior to ablation and CPAP initiation in those patients without previously documented AFib at inclusion were associated with a reduction of AFib episodes during follow-up (P =. Twenty-one patients (38%) had AFib during follow-up after CTI ablation. We prospectively included 56 patients (mean age: 66 (± 11) years 12 female patients), of whom 46 (82%) had OSA and 25 (45%) had severe OSA. Relationship of the following variables with the occurrence of AFib during follow-up (12 months) was investigated: CPAP initiation, hypertension, BMI, underlying structural heart disease, left atrial diameter, and AFib documentation prior to ablation. We assessed the impact of CPAP in reducing the occurrence of AFib after CTI ablation.Ĭonsecutive patients with AF who were undergoing CTI ablation were screened for OSA. Among other acknowledged variables, the association of obstructive sleep apnea (OSA) could favor incomplete arrhythmia control in this setting. The clinical yield of cavotricuspid isthmus (CTI) radiofrequency ablation of atrial flutter (AF) is limited by a high incidence of atrial fibrillation (AFib) in the long term.
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