Document Detail

Catheter selection for ablation of the cavotricuspid isthmus for treatment of typical atrial flutter.
MedLine Citation:
PMID:  17333369     Owner:  NLM     Status:  MEDLINE    
Radiofrequency catheter ablation (RFA) represents the first line therapy of the cavotricuspid isthmus-dependent atrial flutter (CTI-AFL) with a high efficacy and low secondary effects. RFA of CTI-dependent AFL can be performed by using various types of ablation catheters. Recent evaluations comparing externally cooled tip RFA (ecRFA) catheters and large-tip (8 mm) catheters have revealed that these catheters have a higher efficacy for CTI-AFL ablation compared to 4-mm catheters. The reliability of RFA catheters for AFL is variable and an optimal catheter selection may enhance the RFA effectiveness. The main goal of this article is to review the elements that improve the management of CTI RFA. Preliminary examinations of histopathologic and anatomical elements that may interfere with conventional CTI RFA are presented. Experimental studies concerning the electrobiology of large-tip and cooled-tip catheters are compared. The different catheter designs between cooled-tip and 8-mm-tip catheters are examined (size of the deflectable curve, rotation stability, and size of the distal nonsteerable catheter part) because of their critical role in CTI RFA results. A thorough review of clinical trials of each catheter is presented, and comparison of both catheters in this clinical setting is analyzed. In addition, the role of CTI morphology on AFL RF duration is underlined such as the value of right atrial angiography as an adjunct tool for CTI RFA catheter selection. Based on randomized studies, 8-mm-tip catheters seem to be more effective for ablation in case of straight angiographic isthmus morphology. On the other hand, ecRFA catheters appear to be more effective in cases of complex CTI anatomy or difficult CTI RFA. To reduce X-ray exposition and RFA application time, few studies report that CTI angiographic evaluation before RFA allows a catheter selection based on both CTI morphology and length. Moreover, preliminary data of randomized studies showed that an angiographic isthmus evaluation may predict both the effectiveness of a RFA catheter and the risk of an expensive catheter crossover.
Antoine Da Costa; Yann Jamon; Cécile Romeyer-Bouchard; Jérôme Thévenin; Marc Messier; Karl Isaaz
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Publication Detail:
Type:  Journal Article     Date:  2007-03-01
Journal Detail:
Title:  Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing     Volume:  17     ISSN:  1383-875X     ISO Abbreviation:  J Interv Card Electrophysiol     Publication Date:  2006 Nov 
Date Detail:
Created Date:  2007-03-16     Completed Date:  2007-09-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9708966     Medline TA:  J Interv Card Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  93-101     Citation Subset:  IM    
Department of Cardiology, Faculty of Medicine J. Lisfranc, Jean Monnet University, Saint-Etienne Cedex 2, France.
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MeSH Terms
Atrial Flutter / surgery*
Catheter Ablation* / standards
Coronary Angiography
Equipment Design
Heart Atria / radiography
Tricuspid Valve / surgery
Venae Cavae / surgery

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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