Key result
For cavotricuspid isthmus ablation, 8-mm gold tip, externally irrigated-tip, and 8-mm platinum-iridium tip catheters achieved equivalent rates of bidirectional conduction block (95%, 100%, and 95%).
Why the study?
Does the use of an 8-mm gold tip or externally irrigated-tip catheter improve procedural success compared to an 8-mm platinum-iridium tip catheter in patients undergoing de novo CTI ablation for typical atrial flutter?
RCT (n=60)
randomized
Does the use of an 8-mm gold tip or externally irrigated-tip catheter improve procedural success compared to an 8-mm platinum-iridium tip catheter in patients undergoing de novo CTI ablation for typical atrial flutter?
Gold tip, platinum-iridium, and externally irrigated-tip catheters demonstrate equivalent efficacy for successful de novo ablation of the cavotricuspid isthmus.
Equivalent acute success with gold vs Pt-Ir catheters supports procedural flexibility; leaves open long-term outcome differences in broader cohorts.
INTRODUCTION: Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) can be performed using different types of ablation catheter. Gold tip electrodes have the theoretical advantage of creating bigger lesions than standard platinum-iridium electrode. This prospective, randomized study compares the clinical efficacy of 8-mm gold tip catheter, externally irrigated and 8-mm platinum-iridium tip (Pt tip) catheters. METHODS AND RESULTS: Sixty consecutive patients (51 men, 60 +/- 10 years) undergoing de novo CTI ablation for documented typical atrial flutter were randomized to one of the following ablation catheters: 8-mm gold tip catheter, an externally irrigated-tip (Irr. tip) catheter, or an 8-mm Pt tip catheter. The procedural endpoint was achievement of bidirectional isthmus conduction block with < or = 20 minutes of RF energy application. The latter was achieved equally with the 3 catheters (95% for gold tip, 100% for irrigated tip, 95% for Pt tip) and the durations of RF (10 +/- 6, 10 +/- 4, 13 +/- 8 minutes), fluoroscopy (12 +/- 6, 12 +/- 7, 15 +/- 12 minutes) and the procedure (34 +/- 23, 38 +/- 24, 40 +/- 30 minutes) were similar in all groups. The maximal targeted power could not be reached in at least one location in 40% of patients with gold tip and in 35% of patients with Pt tip catheters whereas it was always achieved with an Irr. tip catheter (P = 0.003, P = 0.008). The reduction in impedance during RF delivery was greater with Irr. tip (11 +/- 7 ohms) than with gold (7 +/- 4 ohms, P = 0.02) or Pt tip (5 +/- 3 ohms, P = 0.001) catheters. CONCLUSION: This study demonstrates equivalent efficacies of gold, platinum-iridium and externally Irr. tip catheters for successful de novo ablation of the CTI.
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Sacher et al. (2007) conducted an RCT in typical atrial flutter (n=60). 8-mm gold tip catheter vs. externally irrigated-tip catheter or 8-mm platinum-iridium tip catheter was evaluated on achievement of bidirectional isthmus conduction block with ≤ 20 minutes of RF energy application. For cavotricuspid isthmus ablation, 8-mm gold tip, externally irrigated-tip, and 8-mm platinum-iridium tip catheters achieved equivalent rates of bidirectional conduction block (95%, 100%, and 95%).
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