Is 8-mm More Effective Than 4-mm Tip Electrode Catheter for Ablation of Typical Atrial Flutter?

Tsai, Chin‐Feng; Tai, Ching‐Tai; Yu, Wen‐Chung; Chen, Yi Jen; Hsieh, Ming‐Hsiung; Chiang, Chern‐En; Ding, Yu‐An; Mei, Chao; Chen, Shih‐Ann

doi:10.1161/01.cir.100.7.768

Cited by 125 publications

(87 citation statements)

References 21 publications

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“…[12][13][14][15]19 In addition, experimental studies 20,21 and nonrandomized studies [12][13][14][15] Thus, ablation of typical AFL with an irrigated-tip catheter was recently recommended as first-line therapy. 22 Only 2 randomized studies demonstrated that both catheter techniques were equivalent, although several limitations were underlined.…”

Section: Comparison Between 8-mm-tip and Cooled-tip Cathetersmentioning

confidence: 99%

“…A smaller study with 40 patients reported a linear relationship between isthmus length and number of applications. 11 Although irrigated and 8-mm-tip catheters were found to be more effective and as safe as conventional 4-mm-tip catheters for AFL-RFA, 12,13 the studies comparing these were unfortunately not randomized or showed debatable results. 14,15 There was thus a need for a prospective randomized comparison of the efficacy and safety of cooled-tip and 8-mm-tip catheters while considering the influence of CTI anatomy and length on ablation success.…”

mentioning

confidence: 99%

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Effect of Isthmus Anatomy and Ablation Catheter on Radiofrequency Catheter Ablation of the Cavotricuspid Isthmus

Costa¹,

Faure²,

Thévénin³

et al. 2004

Circulation

112

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Background-Cavotricuspid isthmus (CTI) characteristics are rarely documented when comparing catheters in radiofrequency ablation (RFA) of atrial flutter (AFL). Our objectives were (1) to evaluate the impact of CTI morphology and length on ablation procedures and (2) to compare the efficacy of an 8-mm-tip catheter with an irrigated cooled-tip RFA in the subgroup presumed to be more difficult to treat (with a long CTI, Ͼ35 mm). Methods and Results-Over a period of 17 months, 185 patients accepted the protocol and underwent an isthmogram in preparation for RFA. Groups were classified according to CTI length and CTI morphology. RFA was performed with an 8-mm-tip catheter for patients with a short CTI, Յ35 mm (nϭ123), whereas randomization between an 8-mm-tip and a cooled-tip catheter applied to patients with a longer CTI, Ͼ35 mm (nϭ62). For long CTI, 32 patients were assigned to an 8-mm catheter and 30 patients to the cooled-tip RFA ablation group. In this subset, RF application (18.2Ϯ17 versus 19Ϯ13 minutes) and x-ray exposure (20.8Ϯ18 versus 18Ϯ13 minutes) did not differ between the 8-mm-tip and the cooled-tip procedures. Number of applications (9.9Ϯ11 versus 18.6Ϯ15 minutes; PϽ0.0001) and x-ray exposure (11.7Ϯ11 versus 19.5Ϯ16 minutes, Pϭ0.0001) differed significantly between patients with short and long CTIs.Patients with short and straight CTIs required 3 times fewer RFA applications and shorter x-ray exposure compared with other CTI morphologies (pouch-like recesses and concave characteristics). Conclusions-The number of RF applications required for a complete isthmus block in long CTIs is not influenced by the choice between an 8-mm or cooled-tip catheter. Procedure parameters, however, are significantly influenced by CTI length and morphology. Pouch-like recesses and concave characteristics account for much longer ablation times at all

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Section: Comparison Between 8-mm-tip and Cooled-tip Cathetersmentioning

confidence: 99%

mentioning

confidence: 99%

Effect of Isthmus Anatomy and Ablation Catheter on Radiofrequency Catheter Ablation of the Cavotricuspid Isthmus

Costa¹,

Faure²,

Thévénin³

et al. 2004

Circulation

112

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“…Randomized, prospective studies have shown that large-tip electrode catheters 8,9 or catheters with open or closed irrigated systems 10,11 are more effective than conventional 4-mm-tip catheters . Some authors consider the irrigated system catheter as the best option for the ablation of CTI 12 , while others prefer the 8-mm-tip catheter 8,9 .…”

Section: Introductionmentioning

confidence: 99%

“…Some authors consider the irrigated system catheter as the best option for the ablation of CTI 12 , while others prefer the 8-mm-tip catheter 8,9 . Recent studies have not found any differences between the 2 systems 13,14 .…”

Section: Introductionmentioning

confidence: 99%

Ablação do flutter atrial típico: estudo prospectivo e randomizado do cateter irrigado fechado versus cateter com eletrodo distal de 8 mm

Melo

Scanavacca

Darrieux

et al. 2007

Arq. Bras. Cardiol.

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SummaryObjective: Both ablation catheters with closed irrigated system and 8mm tip-catheters have been shown to be more effective for typical atrial flutter radiofrequency (RF) ablation when compared to conventional 4 mm tip catheter. Considering the differences in complexity and costs of both systems, a prospective study was designed to compare the efficacy and safety of cooled-tip and 8mm-tip catheters for atrial flutter ablation. Methods

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“…At mid-term (months) conduction may still resume in 15 % of cases, even in the absence of flutter recurrence. 93 For radiofrequency ablation large tipped (8 mm electrode length) 94 or irrigated tip catheters 95 are more effective than standard tip (4 mm electrode length) catheters. Supporting sheaths may be used to obtain good contact force on the CTI.…”

Section: Catheter Ablationmentioning

confidence: 99%

Atrial Flutter, Typical and Atypical: A Review

Cosío

2017

Arrhythmia &Amp; Electrophysiology Review

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Clinical electrophysiology has made the traditional classification of rapid atrial rhythms into flutter and tachycardia of little clinical use. Electrophysiological studies have defined multiple mechanisms of tachycardia, both re-entrant and focal, with varying ECG morphologies and rates, authenticated by the results of catheter ablation of the focal triggers or critical isthmuses of re-entry circuits. In patients without a history of heart disease, cardiac surgery or catheter ablation, typical flutter ECG remains predictive of a right atrial re-entry circuit dependent on the inferior vena cava–tricuspid isthmus that can be very effectively treated by ablation, although late incidence of atrial fibrillation remains a problem. Secondary prevention, based on the treatment of associated atrial fibrillation risk factors, is emerging as a therapeutic option. In patients subjected to cardiac surgery or catheter ablation for the treatment of atrial fibrillation or showing atypical ECG patterns, macro-re-entrant and focal tachycardia mechanisms can be very complex and electrophysiological studies are necessary to guide ablation treatment in poorly tolerated cases.

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Is 8-mm More Effective Than 4-mm Tip Electrode Catheter for Ablation of Typical Atrial Flutter?

Abstract: 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.

Cited by 125 publications

References 21 publications

Effect of Isthmus Anatomy and Ablation Catheter on Radiofrequency Catheter Ablation of the Cavotricuspid Isthmus

Effect of Isthmus Anatomy and Ablation Catheter on Radiofrequency Catheter Ablation of the Cavotricuspid Isthmus

Ablação do flutter atrial típico: estudo prospectivo e randomizado do cateter irrigado fechado versus cateter com eletrodo distal de 8 mm

Atrial Flutter, Typical and Atypical: A Review

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