Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter

Natale, Andrea; Newby, Keith H.; Pisanó, Ennio; Leonelli, Fabio M.; Fanelli, Raffaele; Potenza, Domenico; Beheiry, Salwa; Tomassoni, Gery

doi:10.1016/s0735-1097(00)00635-5

Cited by 351 publications

(216 citation statements)

References 22 publications

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“…Natale et al 32 have suggested catheter ablation as the first-line therapy in patients with AFl and normal or mildly enlarged left atrial size. They found a higher success rate, better quality of life, lower occurrence of AF, and less need for rehospitalization at follow-up when compared with drug treatment.…”

Section: Resultsmentioning

confidence: 99%

Contemporary Management of Atrial Flutter

Wellens

2002

Circulation

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Section: Resultsmentioning

confidence: 99%

Contemporary Management of Atrial Flutter

Wellens

2002

Circulation

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“…This is based on decades of experience demonstrating the safety and efficacy of catheter ablation of AFL as well as data from clinical trials comparing ablation with AAD therapy. 230,504,511,1397 The writing group recommends that if a patient has a history of typical AFL or typical AFL is induced at the time of AF ablation, delivery of a cavotricuspid isthmus linear lesion is recommended (Class I, LOE B-R, Table 3). …”

Section: Section 5: Strategies Techniques and Endpointsmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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“…[3][4][5][6] Despite a high success rate, ablation of the CTI can be extremely difficult in some patients. 7,8 The vast span seen in ablations (1 to 30 or more RF applications) must thus reflect phenomena as yet unqualified.…”

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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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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Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter

Abstract: In a selected group of patients with atrial flutter, RF ablation could be considered a first-line therapy due to the better success rate and impact on quality of life, the lower occurrence of atrial fibrillation and the lower need for rehospitalization at follow-up.

Cited by 351 publications

References 22 publications

Contemporary Management of Atrial Flutter

Contemporary Management of Atrial Flutter

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

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

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