Ablation of Typical Atrial Flutter Using a Three-Dimensional Ultrasound Mapping System

Aims: The aim of the study was to test the feasibility of the new Realtime Position Management mapping system for ablation of typical atrial flutter.Methods and Results: The ultrasound multi-transducer catheters of the RPM Mapping System are placed in the coronary sinus and at the right ventricular apex. Position and movement of the ablation catheter can be depicted on the monitor at any time. Several guiding marks are set in the right atria and thus, define the subsequent lesion lines. A total of 15 patients were treated. In 13 patients complete bi-directional block was established after the ablation. In two patients only significant conduction delay was measured after the end of the procedure. A total of 10.2 ± 6.3 cooled RF-applications were needed to reach the end-point of the procedure. The total energy was 18.76 ± 13.23 J. The fluoroscopy time for ablation was 22.2 ± 8.34 min. During a mean follow-up of 8.4 ± 3.2 months no recurrence of atrial flutter occurred. One patient developed atypical flutter and another patient had atrial fibrillation. Both patients were treated with antiarrhythmic drugs. There was one ablation related complication, a pericardial effusion.Conclusion: The Realtime Position Management system is easy to manage and control. The precision of anatomical linear lesions is improved and fluoroscopic exposure time considerably reduced after learning curve.