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Type: Journal article
Title: Prospective randomised comparison of irrigated-tip and large-tip catheter ablation of cavotricuspid isthmus-dependent atrial flutter
Author: Scavee, C.
Jais, P.
Hsu, L.
Sanders, P.
Hocini, M.
Weerasooriya, R.
MacLe, L.
Raybaud, F.
Clementy, J.
Haissaguerre, M.
Citation: European Heart Journal, 2004; 25(11):963-969
Publisher: W B Saunders Co Ltd
Issue Date: 2004
ISSN: 0195-668X
Statement of
Christophe Scavée, Pierre Jaïs, Li-Fern Hsu, Prashanthan Sanders, Meleze Hocini, Rukshen Weerasooriya, Laurent Macle, Florence Raybaud, Jacques Clementy and Michel Haïssaguerre
Abstract: <h4>Background</h4>Radiofrequency (RF) ablation of cavotricuspid isthmus (CTI) dependent flutter can be performed using different types of ablation catheters. It has been proposed that irrigated and large-tip catheters are capable of creating larger lesions, resulting in greater efficacy. This prospective, randomised clinical study compared the efficacy of irrigated and large-tip catheters of different designs.<h4>Methods</h4>Eighty patients (69 men, 66+/-11 years) undergoing de novo RF ablation of CTI-dependent flutter were randomised to ablation using one of the following catheters: (i) externally-irrigated 20), (ii) internally-cooled (n=20), (iii) single sensor, 8-mm tip (n=20), or (iv) double sensor, 8-mm tip (n=20). The study endpoint was the demonstration of bidirectional CTI conduction block within 12 min of cumulative RF delivery. Crossover to the externally-irrigated catheter was permitted if this was not achieved. The ablation and procedural parameters, safety and efficacy were compared.<h4>Results</h4>The primary endpoint was achieved in 64 patients (80%), including all 20 patients randomised to the externally-irrigated catheter. Crossover was required in 16 patients: 9 initially using the internally-cooled catheter (45%), 3 using single-sensor, 8-mm-tip (15%), and 4 using double-sensor, 8-mm-tip (20%) catheters. The higher initial failure rate with the internally-cooled-tip catheter was significant compared to the externally-irrigated (p = 0.001) and single-sensor, 8-mm-tip (p = 0.04) catheters. The externally-irrigated catheter achieved the study endpoint more frequently with fewer RF applications of shorter duration compared to the internally-cooled-tip catheter and 8-mm-tip catheters, the difference being significant compared with internally cooled ablation. No major complications were observed.<h4>Conclusion</h4>Among commonly used ablation catheters, the externally-irrigated catheter has a higher efficacy for rapid achievement of CTI block.
Keywords: Atrial flutter
Catheter ablation
Rights: © 2004 by the European Society of Cardiology
DOI: 10.1016/j.ehj.2004.03.017
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