title: Successful irrigated-tip catheter ablation of atrial flutter resistant to conventional radiofrequency ablation.
abstract: BACKGROUND
  Catheter ablation of typical right atrial flutter is now widely performed. The best end point has been demonstrated to be bidirectional isthmus block. We investigated the use of irrigated-tip catheters in a small subset of patients who failed isthmus ablation with conventional radiofrequency (RF) ablation.
  
  
  RESULTS
  Of 170 patients referred for ablation of common atrial flutter, conventional ablation of the cavotricuspid isthmus with >21 applications failed to create a bidirectional block in 13 (7.6%). An irrigated-tip catheter ablation was performed on identified gaps in the ablation line according to a protocol found to be safe in animals: a moderate flow rate of 17 mL/min and temperature-controlled (target, 50 degrees C) RF delivery with a power limit of 50 W. Bidirectional isthmus block was achieved in 12 patients by use of a mean delivered power of 40+/-6 W with a single application in 6 patients and 2 to 6 applications in the other 6. No side effects occurred during or after the procedure.
  
  
  CONCLUSIONS
  Irrigated-tip catheter ablation is safe and effective for achieving cavotricuspid isthmus block when conventional RF energy has failed.
authors.affiliation: Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France.
authors.forename: P
authors.initials: P
authors.lastname: Jaïs
authors.forename: M
authors.initials: M
authors.lastname: Haïssaguerre
authors.forename: D C
authors.initials: DC
authors.lastname: Shah
authors.forename: A
authors.initials: A
authors.lastname: Takahashi
authors.forename: M
authors.initials: M
authors.lastname: Hocini
authors.forename: T
authors.initials: T
authors.lastname: Lavergne
authors.forename: S
authors.initials: S
authors.lastname: Lafitte
authors.forename: A
authors.initials: A
authors.lastname: Le Mouroux
authors.forename: B
authors.initials: B
authors.lastname: Fischer
authors.forename: J
authors.initials: J
authors.lastname: Clémenty
mesh_terms: D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D017097:Electric Impedance; D005260:Female; D006329:Heart Conduction System / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010138:Pacemaker, Artificial; D012965:Sodium Chloride; D007507:Therapeutic Irrigation; D017211:Treatment Failure
chemical_list: D012965:Sodium Chloride