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, Michel Haïssaguerre

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79 Citations (Scopus)

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

Original languageEnglish
Pages (from-to)963-969
Number of pages7
JournalEuropean heart journal
Volume25
Issue number11
DOIs
Publication statusPublished or Issued - 1 Jun 2004

Keywords

  • Atrial flutter
  • Catheter ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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