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"Largest Amplitude Ablation" is the Optimal Approach for Typical Atrial Flutter Ablation:: A Subanalysis from the AURUM 8 Study.
MedLine Citation:
PMID:  22458432     Owner:  NLM     Status:  Publisher    
Voltage-Guided Cavotricuspid Isthmus Ablation. Introduction: The recently proposed "maximum voltage-guided" (MVG) technique for radiofrequency catheter ablation of atrial flutter targets high-voltage electrograms along cavotricuspid isthmus (CTI) to ablate the functionally important anatomic muscle bundles alone, without drawing a complete anatomic line across the CTI. This innovative approach may shorten ablation time and procedure duration. Methods and Results: Within the multicenter AURUM 8 study, which compared 8-mm gold- and Pt-Ir-tip catheters in atrial flutter ablation, we made a post hoc comparison of procedural data from 72 patients treated with MVG technique with data from 281 patients undergoing anatomic CTI ablation (unmatched) and with data from 72 patients selected from among those 281 patients such that they were matched with the MVG group with respect to selected baseline parameters and catheter type (matched). The MVG technique markedly reduced (P < 0.001) ablation time (mean 6.9 minutes vs 10.9/9.7 minutes [unmatched/matched]), number of lesions (8.3 vs 13.7/12.9), fluoroscopy time (9.5 minutes vs 20.6/17.9 minutes), procedure duration (59 minutes vs 93/86 minutes), and energy delivered (19 kJ vs 34/30 kJ) compared with anatomic CTI ablation. The incidence of charring was higher for MVG than for anatomic ablation technique (31.9% vs 18.5/15.3%, P < 0.05), where Pt-Ir tip catheters were 6-fold more susceptible to charring than gold-tip catheters (P < 0.001), likely because of a lower thermal conductivity of the Pt-Ir material. The acute success rate was slightly better for MVG than for anatomic ablation technique (97.2% vs 92.2/91.7%, P = n.s.). Conclusion: Major procedural parameters are remarkably improved with MVG technique. Gold-tip catheters are substantially less susceptible to charring and may therefore be preferred over Pt-Ir-tip catheters for MVG ablation technique. (J Cardiovasc Electrophysiol, Vol. pp. 1-7).
Thorsten Lewalter; Lars Lickfett; Christian Weiss; Christian Mewis; Sebastian Spencker; Werner Jung; Wilhelm Haverkamp; Harald Schwacke; Thomas Deneke; Jochen Proff; Uwe Dorwarth; Wolfgang Bauer
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-3-27
Journal Detail:
Title:  Journal of cardiovascular electrophysiology     Volume:  -     ISSN:  1540-8167     ISO Abbreviation:  -     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-3-30     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9010756     Medline TA:  J Cardiovasc Electrophysiol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2012 Wiley Periodicals, Inc.
Universitätsklinikum Bonn, Bonn, Germany Städtisches Klinikum Lüneburg, Lüneburg, Germany Herz-und Gefäßzentrum Nymphenburg, Munich, Germany DRK Kliniken Köpenick, Berlin, Germany Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany Charité Universitätsmedizin, Campus Virchow Klinikum, Berlin, Germany Diakonissen-Stiftungs-Krankenhaus Speyer, Speyer, Germany Krankenhaus Porz am Rhein, Cologne, Germany Biotronik SE & Corporation KG, Erlangen, Germany Klinikum Bogenhausen, Munich, Germany Universitätsklinikum Würzburg, Würzburg, Germany.
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