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Europace Advance Access originally published online on May 2, 2009
Europace 2009 11(8):1057-1064; doi:10.1093/europace/eup108
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Electrophysiology and Ablation

A randomized-controlled trial comparing conventional with minimal catheter approaches for the mapping and ablation of regular supraventricular tachycardias

Reginald Liew*, Victoria Baker, Laura Richmond, Kim Rajappan, Dhiraj Gupta, Malcolm Finlay, Glyn Thomas, Mark Earley, Simon Sporton, Stuart Harris and Richard Schilling

Department of Cardiology, Barts and the London NHS Trust, London, UK

Aims: To compare the use of a minimal (MIN) with a conventional (CON) catheter approach for the mapping and ablation of regular supraventricular tachycardias (SVT) and typical atrial flutter (AFL) in the setting of a randomized-controlled trial.

Methods and results: Two hundred patients (age 51.2 ± 15.9 years, 99 male) were randomized to a MIN or CON group. The MIN approach involved using two catheters for AFL, one to three for other SVT (ablation catheter included), whereas the CON approach involved three and five catheters, respectively. Acute procedural success was similar between the two groups. There was no significant difference in overall procedure times, fluoroscopy times, or radiation doses. Procedure times were shorter for AFL ablation in MIN compared with CON [60 (30–150) vs. 85 (40–200) min, median (range), P = 0.03] from subgroup analysis. A median of three (one to six) catheters was used in MIN and five (three to seven) in CON (P < 0.0001). Catheter costs were significantly lower in MIN compared with CON [6.1 (2–61) vs. 8.5 (4.4–21.3) units, P < 0.0001, where one unit is equivalent to the cost of a diagnostic quadripolar catheter]. At 6-week follow-up, two patients in MIN (2.1%) and three patients in CON (3.2%) had documented recurrence of the index arrhythmia.

Conclusion: The use of a MIN approach in the treatment of SVT and AFL is as effective, quick, and safe as using a CON approach and is therefore more cost-effective.

Key Words: Catheter ablation, Supraventricular tachycardia, Atrial flutter, Mapping

* Corresponding author: National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752, Singapore. Tel: +65 6436 7542, Fax: +65 6227 3562, Email: reginald.liew.k.c{at}nhc.com.sg

Manuscript submitted 10 February 2009. Accepted after revision 9 April 2009.


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