Characterization of a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter: A randomized study comparing three catheters

• DOI: 10.1111/pace.13170
• Publication Date: 2017-08-28T11:22:36Z
• Authors: José Manuel Rubín; David Calvo; Diego Pérez; Ana Fidalgo; Jesús María de la...; Lidia Martínez; Esmeralda Capín; Haritz Arrizabalaga; Lidia Carballeira; Daniel García; Cesar Morís
• Keywords: Male; Catheters; Vena Cava, Inferior; Equipment Design; 03 medical and health sciences; 0302 clinical medicine; Atrial Flutter; Catheter Ablation; Humans; Female; Prospective Studies; Tricuspid Valve; Aged

AbstractIntroductionOur aim was to characterize a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter in a prospective, noncrossover randomized study.MethodsOne hundred and fifty patients referred for cavotricuspid isthmus (CTI)‐dependent atrial flutter ablation were randomized to undergo an ablation with an 8‐mm‐tip catheter (group 1), a 3.5‐mm open irrigation‐tip catheter (group 2), and a 3.5‐mm open irrigation porous‐tip catheter (group 3). A stepwise approach was performed, changing the ablation site from medial to septal aspects of the CTI, in case it was not effective without crossover between catheters.ResultsCTI block was achieved in all the patients using only one catheter. There was a 68% efficacy in group 1, 40% in group 2, and 28% in group 3 to achieve CTI block within 10 minutes (P = 0.001) and 96%, 70%, and 70% in groups 1, 2, and 3, respectively, within 20 minutes (P = 0.002) of radiofrequency ablation. The 8‐mm catheter was also faster in fluoroscopy time and CTI block time. There were no differences in efficiency in the both irrigated catheters. There were no significant differences in complications among three catheters.ConclusionsWith this stepwise approach, it is possible to achieve CTI block in all cases, using a single catheter without crossover, with good times of procedure and with a low complication rate. The 8‐mm solid catheter is faster than the other irrigated‐tip catheters. The 3.5‐mm open irrigation porous‐tip catheter is as effective and safe as the conventional irrigated‐tip catheter.