title: Radiofrequency catheter selection based on cavotricuspid angiography compared with a control group with an externally cooled-tip catheter: a randomized pilot study.
abstract: BACKGROUND
  Radiofrequency ablation (RFA) of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) can be performed using either externally cooled-tip RFA catheters or large-tip (8 mm) catheters. However, experimental and clinical studies suggest that the efficacy of both catheters may vary with CTI anatomy and catheters orientation.
  
  
  OBJECTIVE
  The aim of this prospective study was to evaluate: a RFA catheter selection based on CTI angiography compared with a control group with an externally cooled-tip catheter together with the risk of an expensive crossover catheter in both groups.
  
  
  METHODS
  Over a period of 16 months, 119 patients were included and randomized.
  
  
  RESULTS
  When comparing the angiographic group (n = 56) and the externally cooled-tip RFA catheter group (n = 63), the duration of application time with a median of 7 min (interquartile range 4.5-11) versus a median of 10 min (interquartile range 6-20; P = 0.008) and the duration of X-ray exposure with a median of 7 min (interquartile range 4-10) versus a median of 10 min (interquartile range 5-15; P = 0.025) were significantly lower in the angiographic group versus externally cooled-tip catheter group. Furthermore, the number of catheters crossover was significantly higher in the angiographic group versus externally cooled-tip catheter group I (27% vs 7%; P = 0.007).
  
  
  CONCLUSIONS
  This study shows that a strategy with a catheter selection based on a CTI angiographic evaluation is superior to an empirical use of an externally cooled-tip catheter during CTI RFA. Thus, angiographic isthmus evaluation predicts the effectiveness of a RFA catheter and the risk of an expensive catheter crossover.
authors.affiliation: The Jean Monnet University, Faculty of Medicine J. Lisfranc, Department of Cardiology, Saint-Etienne, France. dakosta@aol.com
authors.forename: Antoine
authors.initials: A
authors.lastname: Da Costa
authors.forename: Cécile
authors.initials: C
authors.lastname: Romeyer-Bouchard
authors.forename: Yann
authors.initials: Y
authors.lastname: Jamon
authors.forename: Laurence
authors.initials: L
authors.lastname: Bisch
authors.forename: Karl
authors.initials: K
authors.lastname: Isaaz
mesh_terms: D000368:Aged; D001282:Atrial Flutter / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000295:instrumentation* / Q000379:methods; D008297:Male; D025321:Surgery, Computer-Assisted / Q000295:instrumentation* / Q000379:methods; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging* / Q000601:surgery