Published Online
on August 23, 2004

A more recent version of this article appeared on August 31, 2004

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Submitted on October 1, 2003
Revised on March 19, 2004
Accepted on March 29, 2004

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, and 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.).

^* To whom correspondence should be addressed. E-mail: dakosta{at}aol.com.

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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