Comparison of a Novel Temperature-Controlled Diamond-Tip Catheter and a Power-Controlled Gold-Tip Catheter for the Irrigated Ablation of Cavotricuspid Isthmus-Dependent Atrial Flutter.

Background/

Objectives

Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) is a recommended treatment option for typical atrial flutter (AFL). While power-controlled ablation has been the current standard, a novel temperature-controlled ablation system has been introduced. We aimed to compare the procedural efficacy and one-year outcome of a temperature-controlled diamond-tip catheter with an established power-controlled gold-tip catheter.

Methods

Consecutive patients undergoing ablation of CTI-dependent AFL using a power-controlled catheter or the novel temperature-controlled catheter were enrolled. Patients were followed up using a 7-day electrocardiogram after 3, 6, and 12 months. The primary endpoint was acute efficacy (procedural success, total RF, and procedure time). The secondary endpoint was the recurrence of typical AFL during follow-up.

Results

In total, 38 patients undergoing temperature-controlled ablation were enrolled and compared to 283 patients undergoing power-controlled ablation. A bidirectional CTI block was achieved in 100% in the temperature-controlled group and 97.5% in the power-controlled group (p = 0.7). The total RF time (median: 192 sec (IQR 138-311) vs. 643 sec (IQR 386-1079), p < 0.001) and total procedure time (median: 45 min (IQR 34-57) vs. 52 min (IQR 39-70), p = 0.01) were shorter with temperature-controlled ablation. At the one-year follow-up, there was no difference in the recurrence of typical AFL between groups.

Conclusions

Utilization of temperature-controlled ablation for typical AFL increased procedural efficiency with shorter RF and procedure times compared to power-controlled ablation. The recurrence rate of typical AFL after one year was low and did not differ amongst groups.