title: Comparison of the efficacy of cooled-tip and 8-mm-tip catheters for radiofrequency catheter ablation of the cavotricuspid isthmus: a meta-analysis.
abstract: BACKGROUND
  Cooled-tip RFA (cRFA) and conventional 8-mm-tip catheters were found to be more effective and as safe as conventional 4-mm-tip catheters for atrial flutter (AFL) radiofrequency ablation (RFA), facilitating the rapid achievement of bi-directional isthmus block (BIB), but studies comparing cRFA and 8-mm-tip catheters are not randomized or results are discussed. Thus, we performed a meta-analysis of available randomized trials to evaluate the effectiveness in terms of primary success and procedure parameters.
  
  
  METHODS
  Reports of trials were identified through a Medline, Embase, Current Contents, Cardline, and an extensive bibliography search. Trials that met the following criteria were included: (1) prospective, randomized, controlled, and open trials; (2) patients assigned to an 8-mm-tip or a cRFA catheter for AFL RFA; (3) endpoints events related to primary success rate (BIB achievement), and procedure parameters (number of RF applications, x-ray exposure and ablation duration).
  
  
  RESULTS
  Seven trials met the inclusion criteria. They included 603 patients with established AFL randomized to an 8-mm-tip or cRFA catheter group. Comparing 8-mm groups with cRFA groups, the meta-analysis showed similar BIB achievement relative risk (RR) 0.96, 95% confidence interval (CI): 0.92 to 1.01, (P = 0.13); total RF application time weighted mean difference (WMD) 0.88, 95% CI: -0.36 to 2.12, (P = 0.16); duration of x-ray exposure (min) (WMD = 1.07, 95% CI: -0.81 to 0.295, (P = 0.26); ablation procedure duration (min) (WMD = 0.68, 95% CI: -3.37 to 4.73; P = 0.74).
  
  
  CONCLUSIONS
  The present meta-analysis confirms that cooled-tip and large-tip catheters are equally efficient for cavotricuspid isthmus ablation with both similar primary success rates and procedure parameters.
authors.affiliation: Division of Cardiology, University Jean Monnet of Saint-Etienne, France. dakosta@aol.com
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.forename: Michel
authors.initials: M
authors.lastname: Cucherat
authors.forename: Nathalie
authors.initials: N
authors.lastname: Pichon
authors.forename: Marc
authors.initials: M
authors.lastname: Messier
authors.forename: Sylvie
authors.initials: S
authors.lastname: Laporte
authors.forename: Cécile
authors.initials: C
authors.lastname: Roméyer-Bouchard
authors.forename: Patrick
authors.initials: P
authors.lastname: Mismetti
authors.forename: Michel
authors.initials: M
authors.lastname: Lopez
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D003080:Cold Temperature; D004867:Equipment Design; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D014261:Tricuspid Valve; D014682:Vena Cava, Inferior