Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter...

Area of Science:

• Electrophysiology
• Cardiovascular Medicine
• Medical Technology

Background:

• Catheter ablation is a recommended first-line therapy for symptomatic typical atrial flutter (AFl).
• The conventional multi-catheter approach is standard for cavotricuspid isthmus (CTI) ablation.
• A single-catheter approach has emerged as a feasible alternative for CTI ablation.

Purpose of the Study:

• To compare the safety, efficacy, and efficiency of single-catheter versus multi-catheter approaches for CTI ablation in patients with typical AFl.
• To evaluate procedural outcomes and long-term recurrence rates between the two ablation techniques.

Main Methods:

• A randomized multi-center study involving 253 patients with typical AFl undergoing CTI ablation.
• Patients were randomized to either a single-catheter or a multi-catheter ablation approach.
• Cavotricuspid isthmus block was confirmed using the PR interval on surface ECG in the single-catheter arm. Procedural and follow-up data were collected and compared.

Main Results:

• The single-catheter group (128 patients) demonstrated significantly shorter procedure times (37 vs. 48 minutes), less fluoroscopy time (430 vs. 712 seconds), and reduced radiofrequency time (428 vs. 643 seconds) compared to the multi-catheter group (125 patients).
• A higher first-pass CTI block rate was observed in the single-catheter arm (45% vs. 31%).
• After 12 months of follow-up, AFl recurrence rates were similar between the groups (4% vs. 5%), with no significant difference in arrhythmia-free survival.

Conclusions:

• The single-catheter approach for typical AFl ablation is non-inferior to the conventional multi-catheter approach.
• This method offers significant reductions in procedure duration, fluoroscopy exposure, and radiofrequency application time.
• The single-catheter technique represents an efficient alternative for CTI ablation in typical atrial flutter.