Why the study?
Although ablation of typical atrial flutter can be easily achieved with radiofrequency energy, no studies had compared the effectiveness of different ablation catheters.
Does the use of different radiofrequency ablation catheters and settings improve ablation success or reduce lesion time in patients with typical atrial flutter?
Does the use of different radiofrequency ablation catheters and settings improve ablation success or reduce lesion time in patients with typical atrial flutter?
While different ablation catheters achieve similarly high success rates for typical atrial flutter, contact force-sensing catheters with high-power short-duration settings significantly reduce total lesion time.
Equivalent success across catheters permits flexibility in typical flutter ablation; supports HPSD efficiency but leaves open randomized confirmation.
INTRODUCTION: Although ablation of typical atrial flutter (AFL) can be easily achieved with radiofrequency energy (RF), no studies compare the effectiveness of different ablation catheters. Our study aimed to compare the efficacy of various types of ablation catheters in treating typical AFL. METHODS: We analyzed patients with AFL who underwent RF ablation by a single operator at our institution. Successful ablation was evidenced by a bidirectional conduction block (trans-isthmus conduction time ≥ 130 ms or double potentials ≥ 90 ms). Logistic regression was used to compare success rate and linear regression to compare lesion time. RESULTS: Out of 222 patients, only six did not meet the success criteria (2.7%). The catheters used were non-irrigated, large-tip, internally irrigated (Chili II Boston Scientific), and externally irrigated (non-force-sensing) catheters (Cool Path, Abbott). An externally irrigated force-sensing catheter (TactiCath, Abbott) was used with > 10 gm of force and (LPLD) setting (30 W- 45 °C- 60 s), and high-power short-duration (HPSD) setting (50 W- 43 °C - 12 s). No complications were encountered. The catheter type had no statistically significant association with ablation success. With the use of externally irrigated catheter with contract force-sensing and HPSD settings, statistically significantly shortening of lesion time was achieved 758.3 s, [CI - 1128.29, - 388.35 s] followed by LPLD by 419.0 s [CI - 808.49, - 29.47 s]. CONCLUSIONS: The typical atrial flutter radiofrequency ablation procedure had a high success rate, which was not influenced by the type of ablation catheter. Contact force ablation catheter and HPSD are associated with shorter total lesion time.
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Gorantla et al. (2023) studied this question.
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