Key result
Mini electrode guidance fails to reduce ablation lesions vs. standard bipolar signals in CTI ablation.
Why the study?
Novel ablation catheters with mini electrode sensing have become available, but their utility in cavotricuspid isthmus ablation for atrial flutter was unclear.
Does ablation guided by mini electrode signals improve procedural characteristics or reduce recurrences compared to standard bipolar signals in patients with CTI-dependent atrial flutter?
RCT (n=61)
Single-blind
Computer-generated block randomization (1:1)
Yes
Does ablation guided by mini electrode signals improve procedural characteristics or reduce recurrences compared to standard bipolar signals in patients with CTI-dependent atrial flutter?
The use of mini electrode signals for maximum voltage-guided ablation of typical atrial flutter does not improve procedural characteristics or clinical outcomes compared to standard bipolar signals.
Answers are grounded in this paper and cite their sources.
Mini electrode guidance yields no procedural or outcome gains in CTI ablation; confirms standard bipolar signals remain adequate in this RCT.
Background Novel ablation catheters with mini electrode (ME) sensing have become available but their utility is unclear. We investigated whether ablation of the cavotricuspid isthmus (CTI) for atrial flutter (AFL) would be improved using ME signals. Methods Sixty‐one patients (76% male, 63 ± 10 years) with CTI‐dependent AFL underwent ablation using a maximum voltage‐guided approach, randomized to either standard 8 mm non‐irrigated catheter with bipolar signals or IntellaTip MiFi catheter using ME signals alone. Results Acute bidirectional block was achieved in 97%. Mean follow‐up was 16.7 ± 10 months. The median number of ablation lesions was 13 in both groups (range 3–62 vs. 1–43, p = .85). No significant differences were observed in AFL recurrences (17% vs. 11%, p = .7), median procedure durations (97 min [interquartile range (IQR), 71–121] vs. 87 min [IQR, 72–107], p = .55) or fluoroscopy times (31 min [IQR, 21–52] vs. 38 min [IQR, 25–70], p = .56). Amplitudes of ME signals were on average 160% greater than blinded bipolar signals. In 23.7% of lesions where bipolar signals were difficult to interpret, 13.6% showed a clear ME signal. Conclusions There was no difference in the effectiveness of CTI ablation guided by ME signals, compared with using bipolar signals from a standard 8 mm ablation catheter. While ME signal amplitudes were larger and sometimes present when the bipolar signal was unclear, this did not improve procedural characteristics or outcomes. The results suggest future research should focus on lesion integrity rather than signal sensing.
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Rowe et al. (2021) conducted an RCT in Atrial flutter (CTI-dependent) (n=61). IntellaTip MiFi catheter using mini electrode (ME) signals vs. Standard 8-mm non-irrigated catheter with bipolar signals was evaluated on Number of ablation lesions required to achieve acute bidirectional block across the CTI (p=0.85). Cavotricuspid isthmus ablation guided by mini electrode signals resulted in no significant difference in the median number of ablation lesions required compared to standard bipolar signals (13 vs 13, p=0.85).
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