Common atrial flutter ablation in real life. The French Electra survey

Radiofrequency ablation has a well-established indication in the treatment of symptomatic junctional tachycardia. However, ablation procedure modalities are not uniform. We undertook this survey to analyze different management of patients undergoing this procedure in French Electrophysiology center. The survey was e-mailed to 140 French electrophysiologists in November 2012. Participants were interviewed on their own strategy in the center. Answers had to be related to the most frequent routine attitude. When appropriate, physicians could answer "no standardized attitude" or "other". Among the 103 physicians who answered, 31% practice in a university hospital, 34% in a non-university hospital and 30% in a private institution. The rate of annual ablations of all types per physician is < 50, 50–100 and < 100 in 18%, 24% and 57% of the cases, respectively. Atrial fibrillation ablation was performed routinely in 79% of the center. AFI ablation is performed after the first episode by 95% of physicians. Cavotricuspid isthmus (CTI) responsibility is validated by 68% of them before ablation. The preferred method for validation is post-pacing interval in 25%, activation mapping via multi-electrode catheter in 14% and both in 29% of the cases. An 8 mm and 4 mm irrigated ablation catheter is used by 80% and 14% of physicians respectively for a first procedure, 56% and 36% in case of redo. A long sheath is used first-line in only 3% for a first procedure and 12% for redo. ICT block is confirmed systematically after ablation by 77% of participants. Patients are discharged on the day of ablation by 5%, next day by 77% and 2 days later by 16% of participants. Ablation is systematically performed under general anesthesia by 7% of them. In case of anticoagulation with vitamin K antagonist, 92% do not interrupt it, 5% switch to an unfractionated heparin and 3% switch to a low weight heparin. In case of New Oral Anticoagulation, 42% do not, while 14% interrupt it before procedure. In patients with sinus rhythm at admission time and no long-term anticoagulation, 76% do not perform trans-esophageal echocardiogram. After AFI successful ablation without documented AF but CHADSVASC > 3, anticoagulation is prescribed for 1 month by 35%, lifetime 23%, non-standardized 28% of participants. Most French electrophysiologiests ablate after the first episode of AFI, validate CTI responsibility before ablation and its blocking after ablation. They ablate under local anaesthesia, use an 8 mm catheter rather than an irrigated tip catheter especially for the first procedure and do not interrupt VKA. Most frequently, patients are discharged the day following ablation.