Cor Vasa 2005, 46(9):335-341
Radiofrequency ablation of typical atrial flutter using standard catheters and cooled-tip catheters. Early and medium-term results
- I. interní-kardioangiologická klinika, Fakultní nemocnice u sv. Anny, Brno, Česká republika
Introduction:
Radiofrequency ablation (RFA) of typical atrial flutter requires the creation of complete, uninterrupted, transmural linear radiofrequency lesion to produce bidirectional blockade of the cavotricuspidal isthmus as the critical site of this arrhythmia. Compared with conventional catheters, cooled-tip catheters allow for easier and quicker creation of this line. Our study was designed to compare the efficacy and safety of cooled-tip catheters versus conventional ones in typical atrial flutter ablation and the risk for atrial flutter recurrence and for development of atrial fibrillation following RFA in a minor Central European center.
Methods and results:
Cavotricuspidal isthmus RFA was performed using a conventional catheter (Group A, n = 50) and a cooled-tip catheter (Group B, n = 52) in patients with typical atrial flutter. Radiofrequency energy was delivered for
60 seconds in a thermally controlled mode; at 70 °C and 100 W in Group A, and at 50 °C and 50 W with coolant flow rate of 20 ml/min in Group B. Success was defined as evidence of bidirectional isthmus blockade. Bidirectonal blockade was achieved in 84% of Group A patients and in 98% of Group B patients. Group B showed significantly higher success rates and significantly lower RFA procedures, shorter total and fluoroscopy times, and a significantly lower incidence of flutter recurrence. Development of atrial fibrillation after RFA was independent of the type of ablation procedure but was significantly dependent on the presence of atrial fibrillation in the patient s history. There was no difference in complication rates or length of hospital stay. Even when excluding the effect of the learning curve", there was a significant difference in the numbers of ablation procedures, and total and fluoroscopy times.
Conclusion:
Cooled-tip catheters, when used in the setting of a minor Central European center, are significantly more effective and as safe as conventional catheters. Cooled-tip catheters allow for easier and quicker bidirectional blockade of the cavotricuspidal isthmus while reducing the risk for flutter recurrence.
Keywords: Common atrial flutter; Radiofrequency ablation; Irrigated tip catheter
Published: September 1, 2005 Show citation