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(Circulation. 2004;110:1030-1035.)
© 2004 American Heart Association, Inc.

Original Articles

Effect of Isthmus Anatomy and Ablation Catheter on Radiofrequency Catheter Ablation of the Cavotricuspid Isthmus

Antoine Da Costa, MD; Emmanuel Faure, MD; Jérôme Thévenin, MD; Marc Messier, PhD; Samuel Bernard, RN; Kihel Abdel, RN; Christophe Robin, MD; Cécile Romeyer, MD; Karl Isaaz, MD FESC

From the University Hospital Jean Monnet, Division of Cardiology, Saint-Etienne, France, and Bakken Research Center, Maastricht, the Netherlands (M.M.).

Correspondence to Dr Antoine Da Costa, Service de Cardiologie, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, 42 055 Saint-Etienne Cedex 2, France. E-mail dakosta{at}aol.com

Received October 1, 2003; de novo received December 4, 2003; revision received March 19, 2004; accepted March 29, 2004.

Background— Cavotricuspid isthmus (CTI) characteristics are rarely documented when comparing catheters in radiofrequency ablation (RFA) of atrial flutter (AFL). Our objectives were (1) to evaluate the impact of CTI morphology and length on ablation procedures and (2) to compare the efficacy of an 8-mm-tip catheter with an irrigated cooled-tip RFA in the subgroup presumed to be more difficult to treat (with a long CTI, >35 mm).

Methods and Results— Over a period of 17 months, 185 patients accepted the protocol and underwent an isthmogram in preparation for RFA. Groups were classified according to CTI length and CTI morphology. RFA was performed with an 8-mm-tip catheter for patients with a short CTI, 35 mm (n=123), whereas randomization between an 8-mm-tip and a cooled-tip catheter applied to patients with a longer CTI, >35 mm (n=62). For long CTI, 32 patients were assigned to an 8-mm catheter and 30 patients to the cooled-tip RFA ablation group. In this subset, RF application (18.2±17 versus 19±13 minutes) and x-ray exposure (20.8±18 versus 18±13 minutes) did not differ between the 8-mm-tip and the cooled-tip procedures. Number of applications (9.9±11 versus 18.6±15 minutes; P<0.0001) and x-ray exposure (11.7±11 versus 19.5±16 minutes, P=0.0001) differed significantly between patients with short and long CTIs. Patients with short and straight CTIs required 3 times fewer RFA applications and shorter x-ray exposure compared with other CTI morphologies (pouch-like recesses and concave characteristics).

Conclusions— The number of RF applications required for a complete isthmus block in long CTIs is not influenced by the choice between an 8-mm or cooled-tip catheter. Procedure parameters, however, are significantly influenced by CTI length and morphology. Pouch-like recesses and concave characteristics account for much longer ablation times at all CTI lengths.

Key Words: atrial flutter • catheter ablation • angiography • structure

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