{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,13]],"date-time":"2025-11-13T02:07:30Z","timestamp":1762999650654,"version":"3.40.5"},"reference-count":21,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pacing Clinical Electrophis"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Anatomical studies demonstrate significant variation in cavotricuspid isthmus (CTI) architecture.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010eight patients underwent CTI ablation at two tertiary centers. Operators delivered 682 lesions with a target ablation index (AI) of 600 Wgs. Ablation parameters were recorded every 10\u201320\u00a0ms. Post hoc, Visitags were trisected according to CTI position: inferior vena cava (IVC), middle (Mid), or ventricular (V) lesions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no complications. 92.1% of patients (n\u00a0=\u00a035) remained in sinus rhythm after 14.6 \u00b1 3.4 months. For the whole CTI, peak AI correlated with mean impedance drop (ID) (R<jats:sup>2\u00a0<\/jats:sup>=\u00a00.89, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001). However, analysis by anatomical site demonstrated a non\u2010linear relationship Mid CTI (R<jats:sup>2\u00a0<\/jats:sup>=\u00a00.15, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.21). Accordingly, while mean AI was highest Mid CTI (IVC: 473.1 \u00b1 122.1 Wgs, Mid: 539.6 \u00b1 103.5 Wgs, V: 486.2 \u00b1 111.8 Wgs, ANOVA <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001), mean ID was lower (IVC: 10.7 \u00b1 7.5\u2126, Mid: 9.0 \u00b1 6.5\u2126, V: 10.9 \u00b1 7.3\u2126, <jats:italic>p<\/jats:italic>\u00a0=\u00a0.011), and rate of ID was slower (IVC: 0.37 \u00b1 0.05 \u2126\/s, Mid: 0.18 \u00b1 0.08 \u2126\/s, V: 0.29 \u00b1 0.06 \u2126\/s, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001). Mean contact force was similar at all sites; however, temporal fluctuations in contact force (IVC: 19.3 \u00b1 12.0\u00a0mg\/s, Mid: 188.8 \u00b1 92.1\u00a0mg\/s, V: 102.8 \u00b1 32.3\u00a0mg\/s, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001) and catheter angle (IVC: 0.42\u00b0\/s, Mid: 3.4\u00b0\/s, V: 0.28\u00b0\/s, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a0.0001) were greatest Mid CTI. Use of a long sheath attenuated these fluctuations and improved energy delivery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ablation characteristics vary across the CTI. At the Mid CTI, higher AI values do not necessarily deliver more effective ablation; this may reflect localized fluctuations in catheter angle and contact force.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pace.14228","type":"journal-article","created":{"date-parts":[[2021,3,30]],"date-time":"2021-03-30T08:09:28Z","timestamp":1617091768000},"page":"1039-1046","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A multi\u2010center experience of ablation index for evaluating lesion delivery in typical atrial flutter"],"prefix":"10.1111","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6177-2221","authenticated-orcid":false,"given":"Edd","family":"Maclean","sequence":"first","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"},{"name":"William Harvey Research Institute Queen Mary University of London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ron","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gurpreet","family":"Dhillon","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Syed","family":"Ahsan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fakhar","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"Earley","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pier D.","family":"Lambiase","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"James","family":"Rosengarten","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony W.","family":"Chow","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehul","family":"Dhinoja","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rui","family":"Providencia","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vias","family":"Markides","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tom","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology Royal Brompton Hospital  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ross J.","family":"Hunter","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"},{"name":"William Harvey Research Institute Queen Mary University of London  London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonathan M.","family":"Behar","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology St Bartholomew's Hospital, W Smithfield  London UK"},{"name":"William Harvey Research Institute Queen Mary University of London  London UK"},{"name":"Department of Cardiac Electrophysiology Royal Brompton Hospital  London 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