A randomized-controlled trial comparing conventional with minimal catheter approaches for the mapping and ablation of regular supraventricular tachycardias.
OBJECTIVE
To compare the use of a minimal (MIN) with a conventional (CON) catheter approach for the mapping and ablation of regular supraventricular tachycardias (SVT) and typical atrial flutter (AFL) in the setting of a randomized-controlled trial.


RESULTS
Two hundred patients (age 51.2 +/- 15.9 years, 99 male) were randomized to a MIN or CON group. The MIN approach involved using two catheters for AFL, one to three for other SVT (ablation catheter included), whereas the CON approach involved three and five catheters, respectively. Acute procedural success was similar between the two groups. There was no significant difference in overall procedure times, fluoroscopy times, or radiation doses. Procedure times were shorter for AFL ablation in MIN compared with CON [60 (30-150) vs. 85 (40-200) min, median (range), P = 0.03] from subgroup analysis. A median of three (one to six) catheters was used in MIN and five (three to seven) in CON (P < 0.0001). Catheter costs were significantly lower in MIN compared with CON [6.1 (2-61) vs. 8.5 (4.4-21.3) units, P < 0.0001, where one unit is equivalent to the cost of a diagnostic quadripolar catheter]. At 6-week follow-up, two patients in MIN (2.1%) and three patients in CON (3.2%) had documented recurrence of the index arrhythmia.


CONCLUSIONS
The use of a MIN approach in the treatment of SVT and AFL is as effective, quick, and safe as using a CON approach and is therefore more cost-effective.
Liew
Reginald
R
Department of Cardiology, Barts and the London NHS Trust, London, UK. reginald.liew.k.c@nhc.com.sg
Baker
Victoria
V
Richmond
Laura
L
Rajappan
Kim
K
Gupta
Dhiraj
D
Finlay
Malcolm
M
Thomas
Glyn
G
Earley
Mark
M
Sporton
Simon
S
Harris
Stuart
S
Schilling
Richard
R
D018780:Body Surface Potential Mapping / Q000295:instrumentation / Q000379:methods*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D013617:Tachycardia, Supraventricular / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome