Radiofrequency catheter ablation of common atrial flutter: Comparison of electrophysiologically guided focal ablation technique and linear ablation technique

Objectives. The purpose of this study was to study electrophysiologic characteristics and compare the electrophysiologically guided focal ablation technique and linear ablation technique in patients with common atrial flutter in prospective randomized fashion. Background. Catheter ablation of the common atrial flutter circuit can be performed with different techniques. To date, these two techniques have not been compared prospectively in randomized study. Methods. Sixty patients with drug-refractory common atrial flutter were randomly assigned to undergo radiofrequency catheter ablation performed with the electrophysiologically guided focal ablation (Group I) or linear ablation technique (Group II). In Group I, radiofrequency energy was delivered to the site characterized by concealed entrainment with short stimulus-P wave interval (<40 ms) and postpacing interval equal to the atrial flutter cycle length. In Group II, continuous migratory application of radiofrequency energy was used to create two linear lesions in or around the inferior ven cava-tricuspid ring isthmus. Serial 24-h ambulatory electrocardiographic (Holter) and follow-up electrophysiologic studies were performed to assess recurrence of tachycardi and possible atrial arrhythmogenic effects. Results. Successful elimination of the flutter circuit was achieved in 28 of 30 patients in Group I and 29 of 30 patients in Group II. More atrial premature beats and episodes of short run atrial tachyarrhythmias in the early period (within 2 weeks) after ablation were found in Group II. Recurrence rate (2 of 28 vs. 3 of 29) and incidence of new sustained atrial tachyarrhythmias (3 of 28 vs. 3 of 29) was similar in the two groups. Occurrence of recurrent atrial flutter and new sustained atrial tachyarrhythmias was related to associated cardiovascular disease and atrial enlargement in both groups. However, in Group II, the procedure time (104 ± 17 vs. 181 ± 29 min, p < 0.01) and radiation time (22 ± 8 vs. 42 ± 13 min, p < 0.01) were significantly shorter than those in Group I. Conclusions. Radiofrequency ablation of the common atrial flutter circuit was safe and effective with either the electrophysiologically guided focal ablation or linear ablation technique. However, the linear ablation technique was time-saving.