Evaluating dragging versus point-by-point ablation strategies in cavotricuspidal isthmus ablation for atrial flutter: a retrospective single-center trial

Márton Turcsán^1,2Nina Kozima Király¹Kristof-Ferenc Janosi¹Dorottya Debreceni¹Botond Bocz¹Dalma Torma¹Peter Kupo^1*

• ¹Heart Institute, Medical School, University of Pécs, Pécs, Hungary
• ²Gottsegen National Cardiovascular Center, Budapest, Hungary

Background: Cavotricuspid isthmus (CTI) ablation is the preferred treatment for typical atrial flutter, performed using various techniques. This study aimed to compare procedural and follow-up data between point-by-point and continuous "dragging" radiofrequency (RF) catheter ablation methods. Methods: This retrospective, single-center study included 121 consecutive patients who underwent first-time RF CTI ablation for typical atrial flutter between January 2023 and August 2024. Patients were assigned to point-by-point (n=49) or continuous dragging (n=72) groups. All procedures were performed under conscious sedation using irrigated-tip catheters and intracardiac echocardiography. Patients with prior CTI ablation, cardiac surgery, or concomitant ablation were excluded. Procedural and follow-up outcomes were compared between groups. Results: The continuous dragging technique significantly shortened the time from the first to last ablation [12 (6; 27) min vs. 18 (11; 32) min; p<0.05] and the time from the first ablation to the first CTI block [9 (8; 17) min vs. 13 (8; 25) min; p<0.01]. Additionally, total ablation time [484 (285; 774) s vs. 704 (449; 955) s; p<0.01] and energy usage [20613 (11191.5; 33257.3) J vs. 25717 (17251.8; 36420) J; p<0.05] were lower in the dragging group. The dragging technique also increased the first pass block rate (69.4% vs. 46.2%; p<0.01). There was no significant difference in overall procedure time (58±17 min vs. 61±23 min; p=0.46), fluoroscopy duration [41±6 sec vs. 55±8 sec; p=0.14], or acute reconnection rate (27.8% vs. 30.8%; p=0.80). Both groups achieved a 100% acute success rate with no major complications. There was no significant difference in the rate of recurrence between the two groups (2.77% vs. 2.04%, p=1.0) during the long-term follow-up (13.4±3.8 months). Conclusion: The continuous "dragging" RF ablation technique for CTI ablation in typical atrial flutter enhances procedural outcomes compared to the point-by-point method, demonstrating reduced ablation time, lower energy consumption, and a higher first pass block rate, all without compromising efficacy or safety.