Skip Navigation



European Heart Journal Advance Access published online on June 28, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl121
This Article
Right arrow Full Text (Rapid PDF)
Right arrow All Versions of this Article:
27/15/1833    most recent
ehl121v1
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Da Costa, A.
Right arrow Articles by Isaaz, K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Da Costa, A.
Right arrow Articles by Isaaz, K.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received March 3, 2006
Revised May 27, 2006
Accepted June 1, 2006

Clinical research

Cavotricuspid isthmus angiography predicts atrial flutter ablation efficacy in 281 patients randomized between 8 mm- and externally irrigated-tip catheter

Antoine Da Costa 1 *, Cécile Romeyer-Bouchard 1, Dauphinot Virginie 2, Damien Lipp 1, Loucif Abdellaoui 1, Marc Messier 3, Jérôme Thévenin 1, Jean-Claude Barthélémy 2, and Karl Isaaz 1

1 Department of Cardiology, Faculty of Medicine J. Lisfranc, The Jean Monnet University, 42 055 Saint-Etienne, Cedex 2, France
2 Clinical Physiology and Exercise Laboratory, The Jean Monnet University, 42000 Saint-Etienne, France
3 The Bakken Research Center, 5 Endepolsdomein, 6229 GW Maastricht, The Netherlands

* To whom correspondence should be addressed.
Antoine Da Costa, E-mail: dakosta{at}aol.com


  Abstract

Aims Radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)-dependent atrial flutter can be performed using various types of ablation catheters. Recent evaluations comparing externally cooled-tip RFA (ecRFA) catheters and large-tip (8 mm) catheters found that ecRFA catheter may have a higher efficacy for CTI ablation. The aim of this prospective study was to compare both catheters by stratifying on CTI morphology in order to explain, in part, the discrepancies between previous randomized studies, and to validate predictive factors of difficult CTI ablation on clinical, echocardiographic, and angiographic data.

Methods and results Over a period of 24 months, 281 patients were included and stratified on CTI morphology: ‘straight’, ‘concave’, and ‘pouch-like recess’. In straight CTI (n=150), the duration of application time with a median of 6 min [interquartile range (IQR) 4-9] vs. a median of 12 min (IQR 16-19; P<0.0001) and the duration of X-ray exposure with a median of 6 min (IQR 4.4-9.7) vs. a median of 10.4 min (IQR 7-17; P<0.0001) were significantly lower with an 8 mm-tip when compared with ecRFA catheter. In contrast, in concave CTI (n=95), a trend towards both shorter application time with a median of 12.5 min (IQR 6-23) vs. a median of 19 min (IQR 7-28; P=0.08) and X-ray duration exposure with a median of 10.4 min (IQR 6-20) vs. a median of 13 min (IQR 8-24; P=0.08) with an ecRFA catheter when compared with 8 mm-tip catheter were evidenced. No significant difference was shown between 8 mm-tip and ecRFA catheters in the pouch-like recess group (n=36). Predictive factors of difficult ablation include right CTI length and morphology.

Conclusion This study demonstrates that the 8 mm-tip catheter is more effective for ablation in case of a straight angiographic isthmus morphology and that the ecRFA catheter tends to be more effective in case of concave angiographic isthmus morphology. Thus, angiographic isthmus evaluation may predict both the effectiveness of an RF catheter, and the risk of an expensive crossover. These data may explain, in part, the discrepancies of previous studies comparing both catheters.

Keywords: Atrial flutter; Catheter ablation; Externally cooled-tip catheter; Large-tip catheter; Angiography; Structure; Anatomy.
Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 EuropaceHome page
S. Takatsuki, F. Extramiana, M. Hayashi, A. Haggui, A. Messali, P. Milliez, A. Leenhardt, and B. Cauchemez
High take-off left inferior pulmonary vein as an obstacle in creating a conduction block at the lateral mitral isthmus
Europace, July 1, 2009; 11(7): 910 - 916.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
M. Linhart, H. Mollnau, A. Bitzen, S. Wurtz, J. W. Schrickel, R. Andrie, F. Stockigt, C. Weiss, G. Nickenig, L. M. Lickfett, et al.
In vitro comparison of platinum-iridium and gold tip electrodes: lesion depth in 4 mm, 8 mm, and irrigated-tip radiofrequency ablation catheters
Europace, May 1, 2009; 11(5): 565 - 570.
[Abstract] [Full Text] [PDF]

Home page
 EuropaceHome page
J.-A. Cabrera, S. Y. Ho, and D. Sanchez-Quintana
How anatomy can guide ablation in isthmic atrial flutter
Europace, January 1, 2009; 11(1): 4 - 6.
[Full Text] [PDF]

Home page
 ESC Textbook of Cardiovascular MedicineHome page
J.#x.;n. Farré, H. J.J. Wellens, J.#x. M. Rubio, and J. Benezet
CHAPTER 28 Supraventricular Tachycardias
ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract] [Full Text] [PDF]

Home page
 RadiologyHome page
F. Saremi, L. Pourzand, S. Krishnan, O. Ashikyan, S. V. Gurudevan, J. Narula, K. Kaushal, and A. Raney
Right Atrial Cavotricuspid Isthmus: Anatomic Characterization with Multi-Detector Row CT
Radiology, June 1, 2008; 247(3): 658 - 668.
[Abstract] [Full Text] [PDF]


Disclaimer: Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.