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Is 8-mm more effective than 4-mm tip electrode catheter for ablation of typical atrial flutter?



Is 8-mm more effective than 4-mm tip electrode catheter for ablation of typical atrial flutter?



Circulation 100(7): 768-771



Background-The prospective, randomized study comparing 4- with 8-mm tip electrodes for radiofrequency linear ablation of typical atrial flutter is not available. Methods and Results-A total of 104 consecutive patients with typical atrial flutter were randomly assigned to undergo radiofrequency linear ablation using a 4- (Group I, n=54) or 8-mm tip electrode (Group II, n=50) catheter (temperature-control model, preset 70degreeC). If complete bidirectional isthmus block could not be achieved after 5 pulses, the ablation catheter was changed to the other type; the maximal radiofrequency pulse number was limited to <10 pulses. Complete or incomplete isthmus conduction block was assessed by activation sequence in a multielectrode Halo catheter during low lateral right atrial and proximal coronary sinus pacing. Before shifting to the other catheter type, the 8-mm electrode catheter achieved higher complete isthmus block rate (92% versus 67%, P<0.05) with fewer pulses (2+-1 versus 3+-1, P<0.05), shorter procedure time (24+-15 versus 31+-12 minutes, P<0.05), and shorter fluoroscopic time (14+-10 versus 23+-15 minutes, P<0.05). After 5 failed ablation pulses, 12 (67%) of 18 patients in group I attained complete isthmus block by using an 8-mm tip catheter, but none of 4 patients in group II achieved complete block by changing to a 4-mm tip catheter. Conclusions-The 8-mm tip electrodes are more effective than the standard 4-mm length electrodes in linear ablation for typical atrial flutter. This clinical benefit may be of particular value for some patients with broad and/or thick isthmus.

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Accession: 010885924

Download citation: RISBibTeXText

PMID: 10449701

DOI: 10.1161/01.CIR.100.7.768



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