Key result
Cavotricuspid isthmus ablation using a mini electrode catheter required significantly more applications to achieve block compared to dumbbell-shaped or cryothermal catheters (13 vs 9 vs 5; P<0.001).
Why the study?
Does a catheter equipped with mini electrodes on the 8 mm tip improve procedural outcomes compared to an 8 mm dumbbell-shaped tip catheter or 8 mm tip cryothermal catheter in patients undergoing CTI ablation?
Cohort (n=85)
Does a catheter equipped with mini electrodes on the 8 mm tip improve procedural outcomes compared to an 8 mm dumbbell-shaped tip catheter or 8 mm tip cryothermal catheter in patients undergoing CTI ablation?
p-value: p=<0.001
The use of a mini-electrode equipped 8 mm tip catheter for CTI ablation is less effective and requires longer procedure times compared to dumbbell-shaped or cryothermal catheters.
Mini-electrode catheters should not yet be preferred for CTI ablation; leaves open optimal tip design in randomized trials.
AIMS: The mini electrodes (ME) placed on the tip of the ablation electrode provide more precise local signal. We evaluated whether ME catheter was effective for the ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter. METHODS AND RESULTS: Eighty-five consecutive patients (68 men; 62 ± 10 years) underwent CTI ablation either using a catheter equipped with ME on the 8 mm tip (ME catheter) in 25 patients (Group A), 8 mm dumbbell-shaped (DS) tip catheter (DS catheter) in 30 patients (Group B), or 8 mm tip cryothermal catheter (Cryo catheter) in 30 patients (Group C). In cases of failed isthmus block, the catheter was changed to the other catheter, but patients remained in the original group following intention-to-treat analysis. The endpoint was achieved in all patients after 13 ± 7 applications in Group A, 9 ± 4 applications in Group B, and 5 ± 2 applications in Group C (P < 0.001). The fluoroscopic and procedure times were significantly longer in Group A (9 ± 7 and 28 ± 17 min, P = 0.001, and P = 0.002, respectively) when compared with Groups B (6 ± 4 and 13 ± 6 min) and C (4 ± 3 and 14 ± 7 min). A crossover was performed in 14 (56%) Group A patients, and 3 (10%) Group C patients. The mean power delivered in Group A was significantly lower than in Group B (31.3 ± 9.1 vs. 38.6 ± 7.6 W, P = 0.015). CONCLUSION: The ME catheter was found to be less effective than the Cryo catheter and a DS catheter for the CTI ablation.
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Iwasawa et al. (2015) conducted a cohort in Cavotricuspid isthmus (CTI)-dependent atrial flutter (n=85). Catheter equipped with mini electrodes on the 8 mm tip vs. 8 mm dumbbell-shaped tip catheter or 8 mm tip cryothermal catheter was evaluated on Number of applications to achieve isthmus block (p=<0.001). Cavotricuspid isthmus ablation using a mini electrode catheter required significantly more applications to achieve block compared to dumbbell-shaped or cryothermal catheters (13 vs 9 vs 5; P<0.001).
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