Comparison of 8-mm-tip and irrigated-tip catheters in the ablation of isthmus-dependent atrial flutter: a prospective randomized trial.

INTRODUCTION AND OBJECTIVES: Both 8-mm-tip and irrigated-tip catheters improve outcomes in typical atrial flutter ablation. However, it is not yet known which is preferable. The objective was to compare the effectiveness of 8-mm-tip (Group 1) and open irrigated-tip (Group 2) catheters in the first ablation attempt. METHODS: A prospective randomized trial with a long-term follow-up was performed in patients with documented typical atrial flutter. For both types of catheter, the power was initially set to 50 W. The primary endpoint was ablation of the cavotricuspid isthmus in a procedure lasting, at most, 600 s. RESULTS: Group 1 contained 65 patients and Group 2 contained 66, with no significant intergroup difference in baseline characteristics. Their mean age was 63+/-12 years, 80% were men, and 65% had structural heart disease. The primary endpoint was achieved in 48 patients (73.8%) in Group 1 and 49 (74.2%) in Group 2 (P=NS). In the remaining patients, the procedure was continued at the physician's discretion and ablation was finally achieved in all cases. In the intention-to-treat analysis, there was no significant difference between the groups in the number of applications of the ablation device or in the duration of the ablation procedure, radioscopy or the total procedure. By 16+/-5 months of follow-up (>1 year in 98%), 8 (6.3%) patients had experienced recurrence and 95 (74.2%) were free from any arrhythmia. There was no differences between the groups. CONCLUSIONS: No difference was found between the effectiveness of 8-mm-tip and open irrigated-tip catheters in the first attempt at ablation of typical atrial flutter.

Catéter de 8 mm frente a punta irrigada en la ablación del flutter auricular dependiente del istmo: un estudio prospectivo y aleatorizado / Comparison of 8-mm-tip and irrigated-tip catheters in the ablation of isthmus-dependent atrial flutter: a prospective randomized trial

Introducción y objetivos. En la ablación del flutter auricular típico se utilizan catéteres con puntas de 8 mm e irrigadas para mejorar los resultados; sin embargo, la mejor opción aún no está establecida. Quisimos comparar la efectividad de un catéter de 8 mm (grupo 1) y uno irrigado abierto (grupo 2) en el primer intento de ablación. Métodos. Realizamos un estudio prospectivo, aleatorizado y con seguimiento a largo plazo, incluyendo a pacientes con flutter típico documentado. Para ambos catéteres se programó inicialmente una potencia de 50 W. El objetivo primario fue lograr la ablación del istmo cavotricuspídeo con 600 s de aplicación como máximo. Resultados. Se incluyó a 65 pacientes en el grupo 1 y 66 en el grupo 2 sin diferencias significativas en las características basales. La media de edad era 63 ± 12 años; el 80% eran varones y el 65% tenía cardiopatía estructural. Alcanzaron el punto final primario 48 (73,8%) pacientes del grupo 1 y 49 (74,2%) del grupo 2. En los restantes pacientes se continuó según el criterio del operador y la ablación fue efectiva en todos. Por intención de tratamiento no hubo diferencias significativas en el número de aplicaciones ni en los tiempos de aplicación, radioscopia y el total del procedimiento. A los 16 ± 5 meses de seguimiento (el 98%, más de 1 año) hubo 8 (6,3%) pacientes con recurrencia y 95 (74,2%) libres de toda arritmia, sin diferencia entre ambos grupos. Conclusiones. No encontramos diferencia en la efectividad entre un catéter de 8 mm y uno irrigado abierto en la primera intención de ablación del flutter auricular común (AU)

Introduction and objectives. Both 8-mm-tip and irrigated-tip catheters improve outcomes in typical atrial flutter ablation. However, it is not yet known which is preferable. The objective was to compare the effectiveness of 8-mm-tip (Group 1) and open irrigated-tip (Group 2) catheters in the first ablation attempt. Methods. A prospective randomized trial with a longterm follow-up was performed in patients with documented typical atrial flutter. For both types of catheter, the power was initially set to 50 W. The primary endpoint was ablation of the cavotricuspid isthmus in a procedure lasting, atmost, 600 s.Results. Group 1 contained 65 patients and Group 2 contained 66, with no significant intergroup difference in baseline characteristics. Their mean age was 63±12 years, 80% were men, and 65% had structural heart disease. The primary endpoint was achieved in 48 patients (73.8%) in Group 1 and 49 (74.2%) in Group 2 (P=NS). In the remaining patients, the procedure was continued at the physician’s discretion and ablation was finally achieved in all cases. In the intention-to-treat analysis, there was no significant difference between the groups in the number of applications of the ablation device or in the duration of the ablation procedure, radioscopy or the total (..) (AU)

Short head-up tilt test potentiated with oral nitroglycerine: comparison with a conventional test using isoproterenol.

Conventional tilt test protocols are time consuming and there is no consensus regarding the optimal duration of the test and the provocative drug to be used. This study evaluated the diagnostic power of a short nitroglycerine test against a conventional isoproterenol protocol. A cohort of 128 patients with unexplained syncope was studied. A group of 64 consecutive patients were tilted with a short nitroglycerine test consisting of a passive phase of 15 minutes and if this proved negative, 400 microg of sublingual nitroglycerin spray for a further 15 minutes. The control group consisted of 64 patients tilted with a conventional isoproterenol protocol with a passive phase of 30 minutes and a drug-challenge phase of 20 minutes. In the nitroglycerine protocol 39 (60.9%) patients showed a positive response versus 27(42.2%) in the isoproterenol group (P = 0.034). The duration of the protocol was 23.2 +/- 7.2 minutes in the nitroglycerine group versus 41.1 +/- 15.5 minutes with isoproterenol (P = 0.001). The time until syncope was 18.87 +/- 6.1 versus 29 +/- 18, respectively (P = 0.002). For evaluating unexplained syncope the short tilt test protocol with nitroglycerine is less time consuming, easier to perform, and has a higher rate of positive response than a conventional isoproterenol protocol.

Comparison of effectiveness of implantable cardioverter defibrillator in patients with idiopathic dilated cardiomyopathy versus those with proved coronary heart disease.

This study analyzes the effectiveness of the implantable cardioverter defibrillator in a group of 40 consecutive patients with idiopathic dilated cardiomyopathy and sustained ventricular arrhythmia; these patients were compared with a control group of 80 consecutive patients with proved coronary artery disease. There were no differences in the type and probability of recurrences at follow-up. Most recurrences were due to sustained monomorphic ventricular tachycardia, and the efficacy of the defibrillator in treating the arrhythmia was the same in both groups.