Comparison of Two High‐Power Ablation Strategies for Typical Atrial Flutter: Acute and Long‐Term Outcome

ABSTRACT Background Ablation of the cavo‐tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High‐power strategies have been described to improve lesion efficacy and durability. Objective To compare the acute success, safety, and long‐term outcomes of two strategies of high...

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Bibliographic Details
Main Authors: Wael Zaher, Lorenzo Marcon, Klaus‐Richard Ebinger, Antonio Sorgente
Format: Article
Language:English
Published: Wiley 2025-07-01
Series:Annals of Noninvasive Electrocardiology
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Online Access:https://doi.org/10.1111/anec.70089
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Summary:ABSTRACT Background Ablation of the cavo‐tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High‐power strategies have been described to improve lesion efficacy and durability. Objective To compare the acute success, safety, and long‐term outcomes of two strategies of high‐power CTI ablation using 8‐mm gold‐tip nonirrigated and 4‐mm irrigated‐tip catheters. Methods This single‐center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8‐mm gold‐tip nonirrigated catheter (60 W, ≥ 30 s) or a 4‐mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long‐term follow‐up data were assessed. Results Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4‐mm group and 97.8% of the 8‐mm group (p = 1.000). No major complications were reported. During a median follow‐up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank p value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups. Conclusion High‐power CTI ablation with both 8‐mm gold‐tip nonirrigated and 4‐mm irrigated catheters is highly effective and safe, providing durable outcomes over long‐term follow‐up.
ISSN:1082-720X
1542-474X