Journal of Interventional Cardiac Electrophysiology

, Volume 8, Issue 2, pp 149–154

Large Tip Electrodes for Successful Elimination of Atrial Flutter Resistant to Conventional Catheter Ablation

Authors

    • Department of CardiologyUniversity Hospital Eppendorf
  • Stephan Willems
    • Department of CardiologyUniversity Hospital Eppendorf
  • Christian Weiss
    • Department of CardiologyUniversity Hospital Eppendorf
  • Joerg Flecke
    • Department of CardiologyUniversity Hospital Eppendorf
  • Tim Risius
    • Department of CardiologyUniversity Hospital Eppendorf
  • Thomas Rostock
    • Department of CardiologyUniversity Hospital Eppendorf
  • Matthias Hoffmann
    • Department of CardiologyUniversity Hospital Eppendorf
  • Thomas Meinertz
    • Department of CardiologyUniversity Hospital Eppendorf
Article

DOI: 10.1023/A:1023665002255

Cite this article as:
Ventura, R., Willems, S., Weiss, C. et al. J Interv Card Electrophysiol (2003) 8: 149. doi:10.1023/A:1023665002255

Abstract

The most widely accepted criterion for successful radiofrequency catheter (RFC) ablation of typical atrial flutter is the development of bi-directional isthmus block. In a subset of patients, conventional RFC ablation fails to achieve this endpoint because deeper and wider lesions are required. We investigated the efficacy of a long 8-mm tip catheter in these cases.

One hundred and seventy-four consecutive patients (137 male; 61 ± 9 years) with recurrent typical atrial flutter underwent conventional RFC ablation first with a standard 4 mm tip catheter. In resistant cases (n = 52), ablation was continued using a large tip 8-mm catheter when the 4-mm tip catheter failed. Resistant atrial flutter was identified when 21 RFC pulses failed to reach the selected endpoint of bi-directional isthmus block or in cases of transient bi- directional block (at least 3 episodes).

In 122 of the 174 patients (70%) conventional atrial flutter ablation was successfully performed with 13 ± 5 RFC applications. In the remaining 52 subjects (30%), the ablation procedure was completed using the large tip electrode catheter. In 30 of these 52 patients (58%), the catheter was changed because of persistent intra-atrial conduction after 21 RFC pulses and in 22 (42%) because of intermittent conduction block after 11 ± 5 applications. Using the large tip electrode catheter, the selected endpoint was achieved in all patients of both groups with 3 ± 2 RFC pulses (power output of 50–60 W, pulse duration of 60 sec). No post-procedure complications were observed. After 15 ± 5 months of follow-up, 16 patients (9%) had recurrence of atrial flutter. Five of the patients had been in the resistant group. In patients with atrial flutter resistant to conventional ablation therapy, the long tip (8-mm) catheter appears to be a safe and effective alternative to use of the conventional 4-mm tip catheter.

resistantatrial flutterablationlong-tip catheter

Copyright information

© Kluwer Academic Publishers 2003