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Recently, ablation index (AI) has emerged as a novel marker for estimating ablation lesions. We investigated the relationship between CTI depth and ablation parameters on the procedural results of typical atrial flutter ablation<jats:bold>.<\/jats:bold> A total of 107 patients who underwent CTI ablation were retrospectively enrolled in this study. All patients underwent computed tomography before catheter ablation. From the receiver-operating curve, the best cut-off value of CTI depth was\u2009&lt;\u20094.1\u00a0mm to predict first-pass success. Although the average AI was not different between deep CTI (DC; CTI depth\u2009\u2265\u20094.1) and shallow CTI (SC; CTI depth\u2009&lt;\u20094.1), DC required a longer ablation time and showed a lower first-pass success rate (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). In addition, the catheter inversion technique was more frequently required in the DC (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). The lowest AI sites of the first-pass CTI line were determined in both the ventricular (2\/3 segment of CTI) and inferior vena cava (IVC, 1\/3 segment of CTI) sides. The best cut-off values of the weakest AIs at the ventricular and IVC sides for predicting first-pass success were\u2009&gt;\u2009420 and\u2009&gt;\u2009386, respectively. Among patients with these cut-off values, the first-pass success rate was 89% in the SC and 50% in the DC (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01). Although ablation parameters were not significantly different, the first-pass success rate was lower in the DC than in the SC. Further investigation might be required for better outcomes in deep CTIs.<\/jats:p>","DOI":"10.1038\/s41598-021-01846-7","type":"journal-article","created":{"date-parts":[[2021,11,17]],"date-time":"2021-11-17T11:03:51Z","timestamp":1637147031000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Impact of cavotricuspid isthmus depth on the ablation index for successful first-pass typical atrial flutter ablation"],"prefix":"10.1038","volume":"11","author":[{"given":"Manabu","family":"Kashiwagi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akio","family":"Kuroi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yosuke","family":"Katayama","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kosei","family":"Terada","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suwako","family":"Fujita","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takeshi","family":"Hozumi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kunihiro","family":"Shimamura","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasutsugu","family":"Shiono","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Tanimoto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Kubo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atsushi","family":"Tanaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Akasaka","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,11,17]]},"reference":[{"key":"1846_CR1","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1161\/01.CIR.93.2.284","volume":"93","author":"B Cauchemez","year":"1996","unstructured":"Cauchemez, B. et al. 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