Larger-tip ablation electrodes do require the use of higher-power radiofrequency generators up to 100 W. Shorter procedure times are reported with the larger-tip ablation catheters than standard 4- or 5-mm-tip ablation catheters, with comparable or greater efficacy, no significant increase in complications, and improved quality of life. confirmed this by showing successful ablation using 8-mm catheter tips in patients resistant to ablation using 4-mm catheter tips. The success of 8-mm and 10-mm-sized catheter tips has been demonstrated in multiple trials over the past 10 years. Furthermore, the reported rate of failure to achieve CTI block of 5% with gold and platinum-iridium-tip catheters was similar to our data. Past studies comparing the efficacy of gold, platinum-iridium, and externally irrigated-tip catheters showed mixed results, with either equivalency of effectiveness and an advantage with gold-tip catheters and irrigated catheters, in the acute success of the procedure. Our data suggest similar acute effectiveness of all catheters in achieving CTI block. Our data also show that externally irrigated catheters with force sensing can accomplish a set of effective lesions faster than non-irrigated and internally irrigated catheters. Our study indicates that HPSD lesions applied with force-sensing catheters achieve the bidirectional CTI block in the shortest time. When the different settings of contact force catheters were compared with the different types of catheters, the HPSD had the shortest lesion time, followed by the LPLD (Table (Table2 2). Compared with the non-irrigated catheter, the contact force catheter was significantly associated with a shorter lesion time by 629.92 s (− 993.59, − 266.25). Lesion time for non-irrigated catheters was 1162.8 s. We could not identify factors associated with ablation failure due to the low incidence of unsuccessful cases. The type of catheter used did not affect the success rate ( p value > 0.9). Conduction time increased after ablation to an average clockwise conduction time of 146.8 s and a counterclockwise time of 147.9 s. For patients with sinus rhythm, the mean pre-ablation clockwise and counterclockwise times were 55.32 s and 55.67 s, respectively. Were we unable to achieve a bidirectional block in only six patients (2.7%), despite employing multiple catheter/sheath configurations. In some cases, the gaps were identified with high-density activation mapping. The gaps in the ablation line were most often identified during coronary sinus pacing and ablation catheter mapping. The RF application was made point-by-point in a contiguous fashion. With force-sensing catheters, lesions were applied with force ranging from 10–20 g. For non-irrigated catheters, power was set to 70–100 W and maximum temperature of 60 ☌, and typically a 60-s application for internally irrigated catheters, settings were power of 30 W and temperature of 43 ☌ externally irrigated catheter for low-power long-duration (LPLD) settings were power of 30 W and temperature of 45 ☌ or for high-power short-duration (HPSD), power of 50 W and temperature of 43 ☌, and 12 s in duration. We classified the ablation catheters into the following categories: non-irrigated 8 and 10 mm, (Blazer II Boston Scientific, Marlborough, MA, USA), internally irrigated 4 mm (Chili II, Boston Scientific, Marlborough, MA, USA), externally irrigated 4 mm (Cool Path, Abbott, Minneapolis, MN, USA), and externally irrigated force-sensing 3.5 mm (TactiCath, Abbott, Minneapolis, MN, USA). Therefore, we undertook a retrospective analysis of consecutive patients undergoing AFL ablation using different ablation catheters to assess the effectiveness of these catheters and different ablation settings in treating the AFL.īaseline demographic data, including ethnicity, age, gender, past medical history, and medications use, were collected. Furthermore, there are no comparative studies on force-sensing catheters and various ablation settings. irrigated catheters, they provided conflicting results. Although some randomized clinical trials have been published to assess the effectiveness of different large-tip catheters vs. The quest to develop better, safer, and faster ablation of atrial fibrillation techniques has resulted in new catheter development applicable to atrial flutter ablation. Radiofrequency energy is commonly used, but cryoablation has also been employed. A meta-analysis of 21 studies examining atrial flutter success rate suggested a single procedure success of 92% and multiple procedure success rates of 97%. Catheter ablation is a first-line treatment method. The overall incidence of AFL is approximately 88 per 100,000 person-years and increases with age. Atrial flutter (AFL) is a common arrhythmia frequently and very effectively treated with catheter ablation.
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