title: Atrial flutter ablation: efficacy and cost-effectiveness of a single decapolar electrode to demonstrate bidirectional isthmus block.
abstract: OBJECTIVE
  To evaluate whether a single decapolar electrode is a reliable and cost-effective substitute for the 'Halo' catheter to map the circuit and detect bidirectional isthmus block during atrial flutter (AFL) ablation.
  
  
  RESULTS
  Twenty-four patients underwent AFL ablation by using the decapolar electrode in the infero-lateral wall of right atrium (group A) while a 'Halo' catheter was used in 11 patients (group B). Both groups had similar clinical characteristics. Anti-clockwise rotation (20 patients), clockwise (3 patients) or both forms of AFL (1 patient) were detected in group A. All patients in group B had anti-clockwise AFL. Bidirectional isthmus block was completed in 22 patients of group A and in 9 of group B (P=NS) while incomplete isthmus block was detected in 2 patients in each group (P=NS). Mean fluoroscopy and procedure time was 27 +/- 47 min, 107 +/- 36 min in group A and 14 +/- 19 min, 114 +/- 65 min in group B (P=NS). AFL relapsed in 3 patients of group A (follow-up 7 +/- 4 months) and in 2 of group B (4 +/- 2 months).
  
  
  CONCLUSIONS
  A single decapolar electrode is a reliable method to map the circuit and demonstrate bidirectional isthmus block during AFL ablation. The cost of the decapolar electrode is a quarter of that of the 'Halo' catheter. This represents a significant saving particularly for centres with a substantial number of AFL ablations.
authors.affiliation: Cardiothoracic Centre, Guy's & St Thomas' Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Fragakis
authors.forename: A
authors.initials: A
authors.lastname: Kotsakis
authors.forename: N
authors.initials: N
authors.lastname: Patel
authors.forename: J
authors.initials: J
authors.lastname: Bostock
authors.forename: E
authors.initials: E
authors.lastname: Rosenthal
authors.forename: P
authors.initials: P
authors.lastname: Holt
authors.forename: C
authors.initials: C
authors.lastname: Bucknall
authors.forename: J
authors.initials: J
authors.lastname: Gill
mesh_terms: D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003362:Cost-Benefit Analysis; D004566:Electrodes / Q000191:economics; D022062:Electrophysiologic Techniques, Cardiac / Q000191:economics*; D005500:Follow-Up Studies; D006325:Heart Atria; D006327:Heart Block / Q000175:diagnosis*; D006801:Humans; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000191:economics / Q000379:methods*