What question did this study set out to answer?

To evaluate the efficacy and safety of endocardial catheter fulguration in terminating and preventing recurrent paroxysmal atrial flutter in patients refractory to medical management.

January 1, 1989Pacing and Clinical Electrophysiology

A Clinical Study of the Application of Endocardial Fulguration in the Treatment of Recurrent Atrial Flutter

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Why the study?

Does endocardial catheter fulguration prevent recurrences in patients with refractory paroxysmal common atrial flutter?

Population

8 patients with paroxysmal common atrial flutter refractory to numerous antiarrhythmic agents

Design

Case_series

Follow-up

3 to 17 months

Authors

MCMichel ChauvinObservatoire Régional de la Santé d’Alsace CBC BrechenmacherUniversité de Bordeaux

Discussion

Member takes

Implication

May offer a nonpharmacologic option for drug-refractory paroxysmal atrial flutter; hypothesis-generating and requires prospective validation before practice change.

Key Points

To evaluate the efficacy and safety of endocardial catheter fulguration in terminating and preventing recurrent paroxysmal atrial flutter in patients refractory to medical management.
Treated N=8 patients with paroxysmal common atrial flutter refractory to antiarrhythmic drug therapies for at least 4 months.
Inserted a 7F quadripolar catheter electrode into the lower right atrium to map the reentrant slow pathway using bipolar double potentials and unipolar electrograms.
Administered a direct current shock of 100 to 120 J between the catheter tip electrode and an external chest wall paddle to ablate the reentry site.
Direct current fulguration restored normal sinus rhythm instantaneously in 8 of 8 patients without mechanical or electrical complications.
During follow-up ranging from 3 to 17 months, 6 of 8 patients remained free of atrial flutter recurrence (3 without antiarrhythmic drugs and 3 requiring medication for other supraventricular dysrhythmias).
Atrial flutter recurred within several days in 2 of 8 patients and persisted despite undergoing two additional ablation procedures.

Structured PICO

Does endocardial catheter fulguration prevent recurrences in patients with refractory paroxysmal common atrial flutter?

Population

8 patients with paroxysmal common atrial flutter refractory to numerous antiarrhythmic agents (frequent recurrences over at least 4 months)

Intervention

Endocardial catheter fulguration (DC shock of 100 to 120 J delivered via 7F quadripolar catheter electrode in the lower right atrium)

Outcome

Freedom from relapses of atrial flutter

Endocardial catheter fulguration using DC shock is a feasible and potentially effective therapy for recurrent, drug-refractory paroxysmal atrial flutter.

Limitations

Small sample size / limited experience

Cite This Study

Chauvin et al. (1989) studied this question.

synapsesocial.com/papers/6a71a6abfe4101aa97e0a39c https://doi.org/10.1111/j.1540-8159.1989.tb02650.x

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Implication

May offer a nonpharmacologic option for drug-refractory paroxysmal atrial flutter; hypothesis-generating and requires prospective validation before practice change.

A Clinical Study of the Application of Endocardial Fulguration in the Treatment of Recurrent Atrial Flutter

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

A Clinical Study of the Application of Endocardial Fulguration in the Treatment of Recurrent Atrial Flutter

Discussion

Member takes

Implication

Key Points

Structured PICO

Limitations

Cite This Study

Also Consider

Also Consider