Cavotricuspid Isthmus Ablation Line Reconnections Are Associated with Clinical and Inducible CTI Flutters in Patients Undergoing Pulmonary Vein Isolation for Atrial Fibrillation

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Recurrence of atrial flutter (AFL) after cavotricuspid isthmus (CTI) ablation for typical AFL is uncommon, but the long term integrity of this line in patients without recurrent clinical flutter is unknown. Methods: CTI line was performed in 210/220 AF pts undergoing PVI. 98 had redo for recurrent atrial arrhythmias. CTI ablation was initially successful in 90. Results: Conduction across CTI lines was confirmed in 36: 34/90 due to reconnection across an initially intact line. Inducible CTI flutter was present in 11/36; 0/56 with intact CTI line had flutter (p=0.001). 10/11 inducible patients had clinical CTI flutter prior to the redo. None of the 2 patients who did not receive prior CTI ablation had inducible flutter. Shorter CTI line ablation times were associated with initial line integrity (p=0.03) but not predictive of future reconnections. Conclusion: 1. CTI line reconnection was common and associated with clinical CTI flutter in patients with no documented AFL prior to their first procedure; 2. This study supports the recommendation that a CTI line should only be added to PVI in cases where AFL was documented; 3. Longer ablation times were associated with a failed CTI line but did not predict future reconnections.