Abstract
Background
Radio frequency (RF) energy is capable of interrupting the reentrant circuit of atrial flutter and curing the arrhythmia. The development of 8-mm tip catheter provides more tissue damage and has offered the promise of improved success. The purpose of our study was to determine if the acute and long-term success with the 8-mm tips were superior to the 4- or 5-mm tips.
Materials and methods
The outcomes of the first 20 patients in whom an 8-mm tip catheter was used were compared with the previous 20 patients in whom a 4-or 5-mm tip catheter was used. Procedural (acute) ablation success was defined by creation of bi-directional isthmus block. Long-term success was defined as the prevention of clinically evident atrial flutter (AFl) as determined by the absence of symptoms or maintenance of sinus rhythm on electrocardiogram, six months to one year after the procedure.
Results
Compared to the 4- or 5-mm tip, the 8-mm catheter tip was associated with a reduced ablation duration {22.3 ± 16 versus 11.5 ± 5 min (p = 0.0078)}, a lower mean number of ablations {13.5 ± 9.9 versus 6.8 ± 2.9 (p = 0.0065)} and a reduced procedure time {1.8 ± 0.7 versus 1.1 ± 0.5 h (p = 0.0032)}. Acute success was 95% in the 4- or 5-mm group versus 80% in the 8-mm group (p = NS), but long-term success was higher in the 8-mm group than the 4- or 5-mm group (87.5 versus 63.2%, p = 0.0436).
Conclusions
Eight-millimeter tip catheters for AFl shorten procedure time, reduce the duration and number of ablations and accomplish bi-directional block when compared with smaller tipped catheters. The long-term success rate is better with the 8-mm tips and should be the preferred catheter for RF ablation of AFl.
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References
Cosio, F. G., Lopez, G. M., Goicolea, A., Arribas, F., & Barroso, J. L. (1993). Radio frequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. American Journal of Cardiology, 71, 705–709.
Nakagawa, H., Laser, R., Khastgir, T., Beckman, K. J., McClelland, J. H., & Imai, S., et al. (1996). Role of tricuspid annulus and eustachian valve /ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation, 94, 407–424.
Poty, H., Saoudi, N., Nair, M., Anselme, F., & Letac, B. (1996). Radiofrequency catheter ablation of atrial flutter. Further insights into the various types of isthmus block: Application to ablation during sinus rhythm. Circulation, 94, 3204–3213.
Calkins, H., Canby, R., Weiss, R., Taylor, G., Wells, P., & Chinitz, L., et al. (2004). Results of catheter ablation of typical atrial flutter. American Journal of Cardiology, 94, 437–442.
Paydak, H., Kall, J. G., Burke, M. C., Rubenstein, D., Kopp, D. E., & Verdino, R. J. et al. (1998). Atrial fibrillation after radiofrequency ablation of type I atrial flutter. Time to onset determinants and clinical course. Circulation, 98, 315–322.
Rodriguez, L. M., Nabor, A., & Timmermans, C., et al. (2000). Comparison of results of an 8-mm split tip versus a 4-mm tip ablation catheter to perform radio-frequency ablation of type I atrial flutter. American Journal of Cardiology, 85, 109–112.
Feld, G., Wharton, M., Plumb, V., Daoud, E., Friehling, T., & Epstein, L. (2004). Radio frequency catheter ablation of Type 1 Atrial Flutter using large-tip 8- or 10-mm electrode catheters and high output radio frequency energy generator. Journal of the American College of Cardiology, 43, 1466–1472.
Cheng Feng Tsai, et al. (1999). Is 8 mm more effective than 4 mm tip electrode catheter for ablation of typical atrial flutter. Circulation, 100, 768–771.
Tabuchi, T., Okumura, K., Matsunaga, T., Tsunoda, R., Jougasaki, M., & Yasue, H. (1995). Linear ablation of the isthmus between the inferior vena cava and tricuspid annulus for the treatment of atrial flutter. A study in the canine atrial flutter model. Circulation, 92, 1312–1319.
Iesaka, Y., Takahashi, A., Goya, M., Yamane, T., Tokunga, T., & Amemiya, H., et al. (1998). High energy radiofrequency catheter ablation for common atrial flutter targeting the isthmus between the inferior vena cava and tricuspid valve annulus using a super long tip electrode. Pacing and Clinical Electrophysiology, 21, 401–409.
Phillipon, F., Plumb, V. J., Epstein, A., & Kay, G. N. (1995). The risk of atrial fibrillation following radiofrequency catheter ablation of atrial flutter. Circulation, 92, 430–435.
Lesh, M. D., Van Hare, G. F., Epstein, L. M., Fitzpatrick, A. P., Scheinman, M., & Lee, RJ, et al. (1994). Radiofrequency catheter ablation of atrial arrhythmias. Results and mechanisms. Circulation, 89, 1074–1089.
Jais, P., Shah, D. C., Haissaguerre, M., et al. (2000). Prospective randomized comparison of irrigated tip versus conventional tip catheters for ablation atrial flutter. Circulation, 101, 772–776.
Ventura, R., Willems, S., Christian, W., Flecke, J., Risius, T., & Rostock, T., et al. (2003). Large tip electrodes for successful elimination of atrial flutter resistant to conventional catheter ablation. J Interv Card Electrophysiol, 8, 149–154.
Kasai, A., Anselme, F., & Teo, W. S., et al. (2000). Comparison of effectiveness of an 8 mm versus 4 mm tip electrode catheter for radio-frequency ablation of typical atrial flutter. American Journal of Cardiology, 86, 1029–1031.
Anselme, F., Soudi, N., Poty, H., Douillet, R., & Cribier, A. (1999). Radiofrequency catheter ablation of common atrial flutter. Significance of palpitations and quality-of-life evaluation in patients with proven isthmus block. Circulation, 99, 534–540.
Rosenthal, L. S., Mahesh, M., Beck, T. J., Saul, J. P., Miller, J. M., & Kay, N., et al. (1998). Predictors of fluoroscopy time and estimated exposure during radio frequency catheter ablation procedures. American Journal of Cardiology, 82, 451–458.
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Gosavi, S., Flaker, G. Success rate of catheter ablation in atrial flutter: Comparison of a 4- or 5-mm tip electrode catheter with an 8-mm tip electrode catheter. J Interv Card Electrophysiol 16, 183–186 (2006). https://doi.org/10.1007/s10840-006-9020-x
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DOI: https://doi.org/10.1007/s10840-006-9020-x