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European Heart Journal 2004 25(11):963-969; doi:10.1016/j.ehj.2004.03.017
Copyright © 2004 by the European Society of Cardiology.
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Clinical research

Prospective randomised comparison of irrigated-tip and large-tip catheter ablation of cavotricuspid isthmus-dependent atrial flutter

Christophe Scavée*, Pierre Jaïs, Li-Fern Hsu, Prashanthan Sanders, Meleze Hocini, Rukshen Weerasooriya, Laurent Macle, Florence Raybaud, Jacques Clementy and Michel Haïssaguerre

Hôpital Cardiologique du Haut-Lévêque, Service de Rythmologie, Avenue de Magallen, 33000 Bordeaux-Pessac, France

* Corresponding author. Tel.: +33-5-57656471; fax: +33-5-57656509
E-mail address: scavee{at}ziplip.com

Received 29 September 2003; revised 26 February 2004; accepted 11 March 2004

Abstract

Background 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.

Methods 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 , (ii) internally-cooled , (iii) single sensor, 8-mm tip , or (iv) double sensor, 8-mm tip . 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.

Results 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 and single-sensor, 8-mm-tip 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.

Conclusion Among commonly used ablation catheters, the externally-irrigated catheter has a higher efficacy for rapid achievement of CTI block.

Key Words: Atrial flutter • Catheter ablation


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