Schreieck Juergen, Zrenner Bernhard, Kumpmann Johanna, Ndrepepa Gjin, Schneider Michael A E, Deisenhofer Isabel, Schmitt Claus
Deutsches Herzzentrum München and 1. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
J Cardiovasc Electrophysiol. 2002 Oct;13(10):980-5. doi: 10.1046/j.1540-8167.2002.00980.x.
Cooled-tip and 8-mm-tip catheters have been found to be more effective than conventional 4-mm-tip catheters for radiofrequency (RF) ablation of common atrial flutter. The aim of this study was to compare the efficacy and safety of cooled-tip and 8-mm-tip catheters for flutter ablation in a randomized, prospective study.
In 100 consecutive patients referred for ablation of common atrial flutter, cavotricuspid ablation was performed with a closed cooled-tip catheter (n = 50) or an 8-mm-tip ablation catheter (n = 50). RF current was applied for 60 to 120 seconds at powers of 40 to 50 W with the closed cooled-tip catheter and in a temperature-controlled mode (65 degrees C/70 W) with the 8-mm-tip catheter. The endpoint was achievement of a bidirectional isthmus conduction block. Cross-over was performed after 15 unsuccessful RF applications for each of the catheters. Complete bidirectional isthmus block was achieved in 99% of patients. Cross-over was performed in 11 patients after primary use of the cooled-tip catheter and in 9 patients after primary ablation with the 8-mm-tip catheter. No significant differences were found in the procedure parameters, such as overall RF applications (12.4 +/- 11.3 vs 12.9 +/- 8.6), ablation duration (42 +/- 43 min vs 39 +/- 27 min), and fluoroscopy time (17.0 +/- 18.7 min vs 15.7 +/- 10.7 min). In a mean follow-up of 8.3 months, 1 patient in the cooled-tip group and 3 patients in the 8-mm-tip group had recurrence of common atrial flutter.
Use of the closed cooled-tip ablation catheter and the 8-mm-tip catheter have equal and high efficacy for RF ablation of common atrial flutter.
对于常见心房扑动的射频消融，已发现冷盐水灌注导管和8毫米尖端导管比传统的4毫米尖端导管更有效。本研究的目的是在一项随机、前瞻性研究中比较冷盐水灌注导管和8毫米尖端导管进行扑动消融的疗效和安全性。
在连续100例因常见心房扑动而接受消融治疗的患者中，使用闭合冷盐水灌注导管（n = 50）或8毫米尖端消融导管（n = 50）进行三尖瓣峡部消融。使用闭合冷盐水灌注导管时，以40至50瓦的功率施加射频电流60至120秒；使用8毫米尖端导管时，在温度控制模式（65摄氏度/70瓦）下施加射频电流。终点是实现双向峡部传导阻滞。每种导管在15次射频应用失败后进行交叉操作。99%的患者实现了完全双向峡部阻滞。初次使用冷盐水灌注导管后，11例患者进行了交叉操作；初次使用8毫米尖端导管消融后，9例患者进行了交叉操作。在操作参数方面，如总的射频应用次数（12.4±11.3对12.9±8.6）、消融持续时间（42±43分钟对39±27分钟）和透视时间（17.0±18.7分钟对15.7±10.7分钟），未发现显著差异。在平均8.3个月的随访中，冷盐水灌注组有1例患者、8毫米尖端组有3例患者出现常见心房扑动复发。
对于常见心房扑动的射频消融，使用闭合冷盐水灌注消融导管和8毫米尖端导管具有同等且较高的疗效。
