Prospective randomized comparison of 8-mm gold-tip, externally irrigated-tip and 8-mm platinum-iridium tip catheters for cavotricuspid isthmus ablation.
BACKGROUND
Radiofrequency (RF) ablation of the cavotricuspid isthmus (CTI) can be performed using different types of ablation catheter. Gold tip electrodes have the theoretical advantage of creating bigger lesions than standard platinum-iridium electrode. This prospective, randomized study compares the clinical efficacy of 8-mm gold tip catheter, externally irrigated and 8-mm platinum-iridium tip (Pt tip) catheters.


RESULTS
Sixty consecutive patients (51 men, 60 +/- 10 years) undergoing de novo CTI ablation for documented typical atrial flutter were randomized to one of the following ablation catheters: 8-mm gold tip catheter, an externally irrigated-tip (Irr. tip) catheter, or an 8-mm Pt tip catheter. The procedural endpoint was achievement of bidirectional isthmus conduction block with < or = 20 minutes of RF energy application. The latter was achieved equally with the 3 catheters (95% for gold tip, 100% for irrigated tip, 95% for Pt tip) and the durations of RF (10 +/- 6, 10 +/- 4, 13 +/- 8 minutes), fluoroscopy (12 +/- 6, 12 +/- 7, 15 +/- 12 minutes) and the procedure (34 +/- 23, 38 +/- 24, 40 +/- 30 minutes) were similar in all groups. The maximal targeted power could not be reached in at least one location in 40% of patients with gold tip and in 35% of patients with Pt tip catheters whereas it was always achieved with an Irr. tip catheter (P = 0.003, P = 0.008). The reduction in impedance during RF delivery was greater with Irr. tip (11 +/- 7 ohms) than with gold (7 +/- 4 ohms, P = 0.02) or Pt tip (5 +/- 3 ohms, P = 0.001) catheters.


CONCLUSIONS
This study demonstrates equivalent efficacies of gold, platinum-iridium and externally Irr. tip catheters for successful de novo ablation of the CTI.
Sacher
Frédéric
F
Université Bordeaux II-Hôpital Cardiologique du Haut-Lévêque, Bordeaux-Pessac, France. frederic.sacher@chu-bordeaux.fr
O'Neill
Mark D
MD
Jais
Pierre
P
Huffer
Linda L
LL
Laborderie
Julien
J
Derval
Nicolas
N
Deplagne
Antoine
A
Takahashi
Yoshihide
Y
Jonnson
Anders
A
Hocini
Meleze
M
Clementy
Jacques
J
Haissaguerre
Michel
M
D000368:Aged; D001282:Atrial Flutter / Q000473:pathology / Q000601:surgery; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D002404:Catheterization / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D006046:Gold / Q000592:standards; D006801:Humans; D007495:Iridium / Q000592:standards; D008297:Male; D008875:Middle Aged; D010984:Platinum / Q000592:standards; D011446:Prospective Studies; D014261:Tricuspid Valve / Q000473:pathology / Q000601:surgery*
C077763:platinum-iridium alloy; D007495:Iridium; D010984:Platinum; D006046:Gold