Prospective Randomized Comparison of Closed Cooled-Tip versus 8-mm-Tip Catheters for Radiofrequency Ablation of Typical Atrial Flutter

Authors

  • JUERGEN SCHREIECK M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • BERNHARD ZRENNER M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • JOHANNA KUMPMANN,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • GJIN NDREPEPA M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • MICHAEL A.E. SCHNEIDER M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • ISABEL DEISENHOFER M.D.,

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • CLAUS SCHMITT M.D.

    1. Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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  • Presented in part at the 23rd Annual Scienti. c Session of the North American Society of Pacing and Electrophysiology, San Diego, California, May 8, 2002.

Address for correspondence: Juergen Schreieck, M.D., Deutsches Herzzentrum München, Lazarettstrasse 36, D-80636 München, Germany. Fax: 49-89-12184593; E-mail: Schreieck@dhm.mhn.de

Abstract

Cooled-Tip vs 8-mm-Tip Ablation of Atrial Flutter.Introduction: Cooled-tip and 8-mm-tip catheters have been found to be more effective than conventional 4-mm-tip catheters for radiofrequency (RF) ablation of common atrial flutter. The aim of this study was to compare the efficacy and safety of cooled-tip and 8-mm-tip catheters for flutter ablation in a randomized, prospective study.

Methods and Results: In 100 consecutive patients referred for ablation of common atrial flutter, cavotricuspid ablation was performed with a closed cooled-tip catheter (n = 50) or an 8-mm-tip ablation catheter (n = 50). RF current was applied for 60 to 120 seconds at powers of 40 to 50 W with the closed cooled-tip catheter and in a temperature-controlled mode (65°C/70 W) with the 8-mm-tip catheter. The endpoint was achievement of a bidirectional isthmus conduction block. Cross-over was performed after 15 unsuccessful RF applications for each of the catheters. Complete bidirectional isthmus block was achieved in 99% of patients. Cross-over was performed in 11 patients after primary use of the cooled-tip catheter and in 9 patients after primary ablation with the 8-mm-tip catheter. No significant differences were found in the procedure parameters, such as overall RF applications (12.4 ± 11.3 vs 12.9 ± 8.6), ablation duration (42 ± 43 min vs 39 ± 27 min), and fluoroscopy time (17.0 ± 18.7 min vs 15.7 ± 10.7 min). In a mean follow-up of 8.3 months, 1 patient in the cooled-tip group and 3 patients in the 8-mm-tip group had recurrence of common atrial flutter.

Conclusion: Use of the closed cooled-tip ablation catheter and the 8-mm-tip catheter have equal and high efficacy for RF ablation of common atrial flutter.

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