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CLINICAL RESEARCH: ARRHYTHMIAS

Radiofrequency catheter ablation of type 1 atrial flutter using large-tip 8- or 10-mm electrode catheters and a high-output radiofrequency energy generator

Results of a multicenter safety and efficacy study

Gregory Feld, MD^*,*, Marcus Wharton, MD, Vance Plumb, MD, Emile Daoud, MD, Ted Friehling, MD^||, Laurence Epstein, MD^¶ EPT-1000 XP Cardiac Ablation System Investigators¹

^* University of California, San Diego, California, USA
Duke University, Durham, North Carolina, USA
University of Alabama, Birmingham, Alabama, USA
Grant Riverside Hospital, Columbus, Ohio, USA
^|| Inova Fairfax Hospital, Falls Church, Virginia, USA
^¶ Brigham and Women's Hospital, Boston, Massachusetts, USA

Manuscript received June 17, 2003; revised manuscript received October 24, 2003, accepted November 12, 2003.

^* Reprint requests and correspondence: Dr. Gregory K. Feld, UCSD Medical Center, 200 West Arbor Drive, 8411, San Diego, California 92103, USA.
gfeld{at}ucsd.edu

OBJECTIVES: We studied the safety and efficacy of atrial flutter (AFL) ablation using 8- or 10-mm electrode catheters and a 100-W radiofrequency (RF) generator.

BACKGROUND: Large-tip electrode catheters may be more effective for ablation of AFL.

METHODS: There were 169 patients (age 61 ± 12 years). Short-term end points were bidirectional isthmus block and no inducible AFL. After ablation, patients were seen at one, three, and six months, with event monitoring performed weekly and for any symptoms. Three quality-of-life (QOL) surveys were completed during follow-up.

RESULTS: Short-term success was achieved in 158 patients (93%), with 12 ± 11 RF applications. The efficacy of 8- and 10-mm electrodes was similar (p = NS). The number of RF applications (10 ± 8 vs. 14 ± 8) and ablation time (0.5 ± 0.4 h vs. 0.8 ± 0.6 h) were less with the 10- versus 8-mm electrode, respectively (p < 0.01). Of 158 patients with short-term success, 42 patients were not evaluated for success at six months because of study exclusions. Of 116 patients with short-term success evaluated at six months, 112 (97%) patients had no AFL recurrence. Of those without AFL recurrence at six months, 95% and 93% remained free of symptoms at 12 and 24 months, respectively. Ablation of AFL improved QOL scores (p < 0.05) and reduced anti-arrhythmic and rate-control drug use (p < 0.05). Complications occurred in 6 (3.6%) of 169 patients, but there were no deaths.

CONCLUSIONS: Ablation of AFL with 8- or 10-mm electrode catheters and a high-power RF generator was safe and effective and improved QOL. The number and duration of RF applications were lower with 10- versus 8-mm electrode catheters.

Abbreviations and Acronyms   AFL = atrial flutter   CCW = counterclockwise   CW = clockwise   IVC = inferior vena cava   QOL = quality of life   RF = radiofrequency   TV = tricuspid valve

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