Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan, USA.
J Cardiovasc Electrophysiol. 2011 Sep;22(9):1007-12. doi: 10.1111/j.1540-8167.2011.02045.x. Epub 2011 Mar 31.
Large-tip (10 mm) catheters (LTCs) and open-irrigation-tip catheters (OITCs), both capable of creating large lesions, are more effective than conventional catheters for cavotricuspid isthmus (CTI) ablation. However, it is not clear whether complete CTI block can be achieved more efficiently using an LTC or an OITC. The purpose of this study was to compare the efficiency of radiofrequency catheter ablation (RFA) of the CTI using LTC versus OITC to eliminate atrial flutter (AFL).
Sixty consecutive patients (age = 62 ± 10 years) with typical AFL were randomized to undergo RFA of CTI using an LTC (10 mm) or an OITC. If complete CTI block was not achieved by ≤30 minutes of RFA, patients were allowed to cross over to ablation with the other catheter. A 3-dimensional electroanatomical mapping system was used for catheter navigation only with the OITC. The mean duration of RFA to achieve CTI block in 50% of the patients was 6.8 ± 2.2 minutes with an LTC and 11.7 ± 2.7 minutes with an OITC (P = 0.001). After 30 minutes of RFA, CTI block was achieved in 26/30 (87%) and 25/30 patients (83%) using an LTC and an OITC, respectively (P = 1.0). After crossover, CTI block was achieved in 4/5 (80%) and in 4/4 patients (100%) with an LTC and OITC, respectively (P = 1.0). LTC was associated with a lower volume of intravenous fluid administration (388 ± 365 mL versus 865 ± 451 mL, P = 0.0001) and a trend for shorter procedure duration (95 ± 31 minutes versus 114 ± 50 minutes, P = 0.09) than the OITC. At 6 ± 3 months, 30/30 patients (100%) in the LTC and 27/30 patients (90%) in the OITC groups remained free from AFL, respectively (P = 0.24). Except for one inconsequential steam-pop during RFA with the OITC, there were no complications.
Complete CTI block is achieved more rapidly using an LTC than an OITC, and with a similar clinical efficacy.
大口径（10 毫米）导管（LTC）和开放式冲洗尖端导管（OITC）都能够产生较大的病变，比传统导管更有效地用于三尖瓣峡部（CTI）消融。然而，目前尚不清楚使用 LTC 或 OITC 是否能更有效地实现完全 CTI 阻断。本研究旨在比较使用 LTC 与 OITC 行射频导管消融（RFA）治疗 CTI 以消除心房扑动（AFL）的效率。
60 例连续的（年龄=62±10 岁）典型 AFL 患者被随机分为两组，分别使用 LTC（10mm）或 OITC 行 CTI 的 RFA。如果≤30 分钟的 RFA 未达到完全 CTI 阻断，则允许患者交叉至另一种导管的消融。仅使用 OITC 进行导管导航时使用三维电解剖标测系统。LTC 组达到 50%患者 CTI 阻断的平均 RFA 时间为 6.8±2.2 分钟，OITC 组为 11.7±2.7 分钟（P=0.001）。在 30 分钟的 RFA 后，LTC 组和 OITC 组分别有 26/30（87%）和 25/30 例（83%）患者达到 CTI 阻断（P=1.0）。交叉后，LTC 组和 OITC 组分别有 4/5（80%）和 4/4（100%）例患者达到 CTI 阻断（P=1.0）。LTC 组与 OITC 组相比，静脉输液量更少（388±365mL 比 865±451mL，P=0.0001），手术时间更短（95±31 分钟比 114±50 分钟，P=0.09）。在 6±3 个月时，LTC 组 30/30 例（100%）和 OITC 组 27/30 例（90%）患者均无 AFL 复发（P=0.24）。除 OITC 行 RFA 时发生一例无并发症的蒸汽爆裂外，无其他并发症发生。
与 OITC 相比，LTC 能更快速地实现完全 CTI 阻断，且具有相似的临床疗效。
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