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Characterization of a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter: A randomized study comparing three catheters
Author(s) -
Rubín José Manuel,
Calvo David,
Pérez Diego,
Fidalgo Ana,
la Hera Jesús María,
Martínez Lidia,
Capín Esmeralda,
Arrizabalaga Haritz,
Carballeira Lidia,
García Daniel,
Morís Cesar
Publication year - 2017
Publication title -
pacing and clinical electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.686
H-Index - 101
eISSN - 1540-8159
pISSN - 0147-8389
DOI - 10.1111/pace.13170
Subject(s) - medicine , catheter , catheter ablation , atrial flutter , ablation , fluoroscopy , radiofrequency ablation , surgery , cardiology
Our aim was to characterize a stepwise approach in cavotricuspid isthmus ablation for typical atrial flutter in a prospective, noncrossover randomized study. Methods One 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. Results CTI 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. Conclusions With 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.