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A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes

Cavotricuspid isthmus (CTI) ablation is a current first-line management method for typical atrial flutter. A voltage-directed technique that systematically targets points of maximal voltage has be found to reduce procedure and fluoroscopy times without increasing recurrence. We hypothesized that thi...

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Autores principales: Somani, Riyaz, Andre Ng, G., Hobson, Niel A., Redfearn, Damian P., Caldwell, Jane C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MediaSphere Medical 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252642/
https://www.ncbi.nlm.nih.gov/pubmed/32477813
http://dx.doi.org/10.19102/icrm.2018.090603
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author Somani, Riyaz
Andre Ng, G.
Hobson, Niel A.
Redfearn, Damian P.
Caldwell, Jane C.
author_facet Somani, Riyaz
Andre Ng, G.
Hobson, Niel A.
Redfearn, Damian P.
Caldwell, Jane C.
author_sort Somani, Riyaz
collection PubMed
description Cavotricuspid isthmus (CTI) ablation is a current first-line management method for typical atrial flutter. A voltage-directed technique that systematically targets points of maximal voltage has be found to reduce procedure and fluoroscopy times without increasing recurrence. We hypothesized that this technique’s efficiency would be enhanced by using signals from radial minielectrodes of a novel catheter (IntellaTip MiFi™; Boston Scientific, Natick, MA, USA). Prospectively, atrial flutter patients underwent voltage-directed ablation with a nonirrigated 8-mm-tip catheter. Ablation was either directed by conventional bipolar electrodes (group A, n = 13) or mini-electrodes (group B, n = 17) with the goal of achieving bidirectional block at the CTI and a subsequent observation time of 30 minutes. Total radiofrequency application time and lesion numbers were not significantly different. Group B had a lower mean power [38.7 watts (W) ± 2.0 W versus 44.8 W ± 1.9 W; p < 0.05] and a tendency for longer fluoroscopy and procedure times. In three of the cases in group B, a switch to an irrigated catheter was required in order to achieve bidirectional block. In group A, bidirectional block was obtained in all patients using the nonirrigated catheter with no significant increase in reconnection. Differences in the catheter performance between the two groups were driven by poorer performance of the MiFi™ catheter (Boston Scientific, Natick, MA, USA) in patients presenting in atrial flutter. Electroanatomical mapping revealed a more proximal localization of the maximal voltage by the minielectrodes as compared with the conventional bipolar electrodes, resulting in less efficient identification and ablation of the conducting muscle bundles. Final results indicated CTI ablation using minielectrodes is not superior to conventional bipolar electrodes in the use of 8-mm, nonirrigated electrodes.
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spelling pubmed-72526422020-05-28 A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes Somani, Riyaz Andre Ng, G. Hobson, Niel A. Redfearn, Damian P. Caldwell, Jane C. J Innov Card Rhythm Manag Original Research Cavotricuspid isthmus (CTI) ablation is a current first-line management method for typical atrial flutter. A voltage-directed technique that systematically targets points of maximal voltage has be found to reduce procedure and fluoroscopy times without increasing recurrence. We hypothesized that this technique’s efficiency would be enhanced by using signals from radial minielectrodes of a novel catheter (IntellaTip MiFi™; Boston Scientific, Natick, MA, USA). Prospectively, atrial flutter patients underwent voltage-directed ablation with a nonirrigated 8-mm-tip catheter. Ablation was either directed by conventional bipolar electrodes (group A, n = 13) or mini-electrodes (group B, n = 17) with the goal of achieving bidirectional block at the CTI and a subsequent observation time of 30 minutes. Total radiofrequency application time and lesion numbers were not significantly different. Group B had a lower mean power [38.7 watts (W) ± 2.0 W versus 44.8 W ± 1.9 W; p < 0.05] and a tendency for longer fluoroscopy and procedure times. In three of the cases in group B, a switch to an irrigated catheter was required in order to achieve bidirectional block. In group A, bidirectional block was obtained in all patients using the nonirrigated catheter with no significant increase in reconnection. Differences in the catheter performance between the two groups were driven by poorer performance of the MiFi™ catheter (Boston Scientific, Natick, MA, USA) in patients presenting in atrial flutter. Electroanatomical mapping revealed a more proximal localization of the maximal voltage by the minielectrodes as compared with the conventional bipolar electrodes, resulting in less efficient identification and ablation of the conducting muscle bundles. Final results indicated CTI ablation using minielectrodes is not superior to conventional bipolar electrodes in the use of 8-mm, nonirrigated electrodes. MediaSphere Medical 2018-06-15 /pmc/articles/PMC7252642/ /pubmed/32477813 http://dx.doi.org/10.19102/icrm.2018.090603 Text en Copyright: © 2018 Innovations in Cardiac Rhythm Management http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Somani, Riyaz
Andre Ng, G.
Hobson, Niel A.
Redfearn, Damian P.
Caldwell, Jane C.
A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes
title A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes
title_full A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes
title_fullStr A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes
title_full_unstemmed A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes
title_short A Comparison of the Efficacy of Voltage-directed Cavotricuspid Isthmus Ablation Using Mini Versus Conventional Electrodes
title_sort comparison of the efficacy of voltage-directed cavotricuspid isthmus ablation using mini versus conventional electrodes
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7252642/
https://www.ncbi.nlm.nih.gov/pubmed/32477813
http://dx.doi.org/10.19102/icrm.2018.090603
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