Comparative characteristics of different methods of radiofrequency catheter ablation in atrial flutter

Abstract

Catheter ablation occupies the first place in the treatment of atrial macro reentry arrhythmias. The main controllable parameters in ablations are energy, duration of exposure and use of catheter tip cooling. With traditional ablation techniques, there is a high risk of insufficient tissue damage due to electrode instability. Regarding the issue of stability, a new technique was proposed – reducing the application time with increasing the energy. The aim of this work was to compare the results of radiofrequency catheter ablation (RFA) using an 8 mm uncooled electrode to a 4 mm cooled electrode and a 4 mm cooled electrode with increased energy. Materials and methods. The work is based on a retrospective analysis of the results of catheter ablations in patients with atrial flutter. Patients were divided into 3 groups depending on the parameters of the used radio frequency energy and the type of ablation electrode. Results. It was found that in the group with increased energy, there were the shortest time from the start of RFA to the achievement of success criteria and the lowest radiation exposure. The obtained differences were statistically significant in comparison with two groups of patients who underwent traditional methods. Such differences were associated both with a reduction in the time of the application itself due to the use of high energy as well as the need to apply a smaller number of applications owing to a lower probability of the electrode displacement from the target area. Conclusions. The use of a high-energy protocol allows to success criteria for cavo-tricuspid isthmus ablation more quickly compared to traditional techniques (by 30 % and 22 %, respectively) with less radiation exposure (by 27 % and 24 %, respectively). The use of the high-energy protocol does not lead to an increase in the frequency of complications and can be considered safe for clinical use.

Keywords

• atrial flutter
• atrial fibrillation
• paroxysmal tachycardia
• reciprocating tachycardias