© 2002 by European Society of Cardiology
REGULAR ARTICLES
Primary closed cooled tip ablation of typical atrial flutter in comparison to conventional radiofrequency ablation
Institute of Cardiovascular Research Forststrasse 3, 01099, Dresden, Germany
The purpose of this prospective, non-randomized study was to investigate the effectiveness of cooled radiofrequency ablation (cRFA) compared with conventional radiofrequency application (RFA) for ablation of typical atrial flutter (AF).
METHODS: Isthmus ablation was carried out using a system with a circulating fluid path through the ablation tip to control tip temperature in 100 patients with AF. Thirty consecutive AF patients underwent conventional RFA. The number of applications for cRFA was 13·7±6·9 and for RFA 24·0±14·5 (P< 0·0007) at powers between 35 and 50 W and a tip temperature range of 38–43°C. Ablation duration and fluoroscopy time were 9·9±4·9 and 22·8±10·7 min for cRFA, respectively. In contrast, for RFA, ablation duration and fluoroscopy time were 20·6±14·2 (P< 0·0001) and 27·4±12·7 min, respectively. In 93% of the cooled tip group and in 80% of the control group bi-directional block was confirmed.
At 6-months follow-up, recurrence rates were 9 in the cooled-tip group and 7 in the control group, corresponding 10·4% and 25·9%. There were no significant complications. Compared with RFA, cRFA requires lower application numbers. Recurrence rates are low and the overall success rate is high.
Key Words: Radiofrequency ablation, closed cooled ablation, typical atrial flutter
Correspondence: S. G. Spitzer, M.D., Institute of Cardiovascular Research, Forststrasse 3, 01099 Dresden, Germany. Tel.: +49 351 8064 102; Fax: +49 351 8064 391; E-mail: sgspitzer{at}aol.com
[1] Cauchemez B, Haïssaguerre M, Fischer B, et al. Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Circulation 1996; 93: 284–294.
[2] Cosio FG, Lopez-Gil M, Goicolea A, et al. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993; 71: 705–709.[CrossRef][Web of Science][Medline]
[3] Feld GK, Fleck RP, Chen PS, et al. Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992; 86: 1233–1240.
[4] Kirkorian G, Moncada E, Chevalier P, et al. Radiofrequency ablation of atrial flutter. Efficacy of an anatomically guided approach. Circulation 1994; 90: 2804–2814.
[5] Nakagawa H, Lazzara R, Khastgir T, et al. Role of the tricuspid annulus and the eustachian valve/ridge on atrial flutter. Relevance to catheter ablation of the septal isthmus and a new technique for rapid identification of ablation success. Circulation 1996; 94: 407–424.
[6] Poty H, Saoudi N, Abdel AA, et al. Radiofrequency catheter ablation of type 1 atrial flutter. Prediction of late success by electrophysiological criteria. Circulation 1995; 92: 1389–1392.
[7] Poty H, Saoudi N, Nair M, et al. Radiofrequency catheter ablation of atrial flutter. Further insights into the various types of isthmus block: application to ablation during sinus rhythm. Circulation 1996; 94: 3204–3213.
[8] Shah DC, Haïssaguerre M, Jaïs P, et al. Simplified electrophysiologically directed catheter ablation of recurrent common atrial flutter. Circulation 1997; 96: 2505–2508.
[9] Anselme F, Saoudi N, Poty H, et al. Radiofrequency catheter ablation of common atrial flutter: significance of palpitations and quality-of-life evaluation in patients with proven isthmus block. Circulation 1999; 99: 534–540.
[10] Blanck Z, Cetta T, Sra J, et al. Catheter ablation of atrial flutter using radiofrequency current: cumulative experience in 61 patients. Wisc Med J 1998; 97: 43–48 [published erratum appears in Wisc Med J 1998; 97: 6].
[11] Cheema AN, Grais IM, Burke JH, et al. Late recurrence of atrial flutter following radiofrequency catheter ablation. Pacing Clin Electrophysiol 1997; 20: 2998–3001.[Medline]
[12] De Sisti A, Leclercq JF, Fiorello P, et al. The effects of the ablation of atrial flutter in patients with and without a clinical history of paroxysmal atrial fibrillation. G Ital Cardiol 1998; 28: 1253–1260.[Medline]
[13] Espaliat E, Lagrange P, Boveda S, et al. Radiofrequency ablation in auricular flutter. Predictive factors of primary success and medium term results. Arch Mal Coeur Vaiss 1999; 92: 29–34.[Web of Science][Medline]
[14] Fischer B, Jaïs P, Shah D, et al. Radiofrequency catheter ablation of common atrial flutter in 200 patients. J Cardiovasc Electrophysiol 1996; 7: 1225–1233.[Web of Science][Medline]
[15] Garcia-Cosio F, Lopez GM, Arribas F, et al. The ablation of atrial flutter. The long-term results after 8 years of experience. Rev Esp Cardiol 1998; 51: 832–839.[Medline]
[16] Rao BH, Nair M, Mohan JC, et al. Radiofrequency catheter ablation of common atrial flutter — acute and follow-up results. Indian Heart J 1998; 50: 523–526.[Medline]
[17] Schuhmacher B, Pfeiffer D, Tebbenjohanns J, et al. Acute and Long Term Effects of Consecutive Radiofrequency Applications on Conduction Properties of the Subeustachian Isthmus in Type I Atrial Flutter. J Cardiovasc Electrophysiol 1998; 9: 152–163.[Web of Science][Medline]
[18] Tai CT, Chen SA, Chiang CE. Long-term outcome of radiofrequency catheter ablation for typical atrial flutter: risk prediction of recurrent arrhythmias. J Cardiovasc Electrophysiol 1998; 9: 115–121.[Web of Science][Medline]
[19] Antz M, Willems S, Thuneke F, et al. Werden die Laesionsgeometrie und die Koagelbildung bei Hochfrequenzstromablationen mit gekuehlten Kathetern durch die Flussrate der Spuelfluessigkeit beeinflusst? (abstract). Zeitschrift für Kardiologie 2000; 89: I–103.
[20] Arentz T, v.Rosenthal J, Blum T, et al. Hochfrequenz-Katheterablation von typischem Vorhofflattern: Grosse (8 mm) Spitze oder "cooled tip"? (abstract). Zeitschrift fuer Kardiologie 2000; 89: I–102.
[21] Liem LB, Pomeranz M, Riseling K, et al. Electrophysiological correlates of transmural linear ablation. Pacing Clin Electrophysiol 2000; 23: 40–46.[CrossRef][Medline]
[22] Mittleman RS, Huang SK, de Guzman WT, et al. Use of the saline infusion electrode catheter for improved energy delivery and increased lesion size in radiofrequency catheter ablation. Pacing Clin Electrophysiol 1995; 18: 1022–1027.[CrossRef][Medline]
[23] Nakagawa H, Yamanashi WS, Pitha JV, et al. Comparison of in vivo tissue temperature profile and lesion geometry for radiofrequency ablation with a saline-irrigated electrode versus temperature control in a canine thigh muscle preparation. Circulation 1995; 91: 2264–2273.
[24] Nakagawa H, Wittkampf FH, Yamanashi WS, et al. Inverse relationship between electrode size and lesion size during radiofrequency ablation with active electrode cooling. Circulation 1998; 98: 458–465.
[25] Petersen HH, Chen X, Pietersen A, et al. Temperature-controlled irrigated tip radiofrequency catheter ablation: comparison of in vivo and in vitro lesion dimensions for standard catheter and irrigated tip catheter with minimal infusion rate. J Cardiovasc Electrophysiol 1998; 9: 409–414.[Web of Science][Medline]
[26] Petersen HH, Chen X, Pietersen A, et al. Tissue temperatures and lesion size during irrigated tip catheter radiofrequency ablation: an in vitro comparison of temperature-controlled irrigated tip ablation, power-controlled irrigated tip ablation, and standard temperature-controlled ablation. Pacing Clin Electrophysiol 2000; 23: 8–17.[CrossRef][Medline]
[27] Ruffy R, Imran MA, Santel DJ, et al. Radiofrequency delivery through a cooled catheter tip allows the creation of larger endomyocardial lesions in the ovine heart. J Cardiovasc Electrophysiol 1995; 6: 1089–1096.[Web of Science][Medline]
[28] Sykes C, Riley R, Pomeranz M, et al. Cooled tip ablation results in increased radiofrequency power delivery and lesion size. (abstract). Pacing Clin Electrophysiol 1994; 88: 782.
[29] Wharton JM, Nibley C, Sykes C, et al. Establishment of a dose-response relationship for high power chilled-tip radiofrequency current ablation in sheep. (abstract). J Am Coll Cardiol 1995; 293A.
[30] Wharton JM, Wilber DJ, Calkins H. Utility of tip thermometry during radiofrequency ablation in humans using an internally perfused saline cooled catheter. (abstract). Circulation 1997; 96: I–318.
[31] Wong WS, VanderBrink BA, Riley RE, et al. Effect of saline irrigation flow rate on temperature profile during cooled radiofrequency ablation. J Interv Card Electrophysiol 2000; 4: 271–326.[Medline]
[32] Atiga WL, Worley SJ, Hummel J, et al. Initial results of a prospective, randomized study of cooled RF versus standard RF ablation for typical atrial flutter. (abstract). Circulation 2000; 100: I–374.
[33] Barold HS, Jain MK, Dixon-Tulloch E, et al. A comparison of temperature-controlled cooled tip versus standard temperature-controlled radiofrequency ablation in left ventricular myocardium. (abstract). Circulation 1998; 98: I–644.
[34] Borggrefe MM. German Multicenter Study: Chilled Ablation of Ventricular Tachycardia in Patients With Structural Heart Disease. (abstract). Circulation 1999; 100: I–289.
[35] Calkins H, Epstein A, Ellenbogen KA, et al. Catheter ablation of VT using cooled RF energy: final results of a prospective multicenter clinical trial. (abstract). Circulation 1999; 100: I–373.
[36] Delacretaz E, Stevenson WG, Winters GL, et al. Ablation of ventricular tachycardia with a saline-cooled radiofrequency catheter: anatomic and histologic characteristics of the lesions in humans. J Cardiovasc Electrophysiol 1999; 10: 860–865.[Medline]
[37] Jaïs P, Haïssaguerre M, Shah DC, et al. Successful irrigated-tip catheter ablation of atrial flutter resistant to conventional radiofrequency ablation. Circulation 1998; 98: 835–838.
[38] Jaïs P, Shah DC, Haïssaguerre M, et al. A prospective randomized comparison of irrigated catheter ablation versus conventional tip catheters for ablation of typical atrial flutter. (abstract). Circulation 1999; 100: I–652.
[39] Jaïs P, Shah DC, Haïssaguerre M, et al. Prospective randomized comparison of irrigated-tip versus conventional-tip catheters for ablation of common flutter. Circulation 2000; 101: 772–776.
[40] Lagrange P, Lagrange A, Arentz T, et al. Use of irrigated saline cooling catheters for recurrences of typical atrial flutter. (abstract). Europace 2000; I: D138.
[41] Lagrange P, Lagrange A, Arentz T, et al. First procedure for ablation of common atrial flutter: Comparison of irrigated tip versus 8 mm tip catheters. (abstract). Europace 2000; I: D141.
[42] Spitzer SG, Ebert HH, Karolyi L, et al. Closed cooled ablation for the treatment of atrial flutter. (abstract). Pacing Clin Electrophysiol 1999; 22: A134.
[43] Feinstein AR. Clinical Biostatistics. 1997; St. Louis Mosby Comp.
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