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Title: Irrigated-tip vs conventional-tip catheters for primary ablation of posteroseptal and right free-wall accessory pathways: a prospective randomized study
Author(s): N. Mujović , M. Grujić , S. Mrđa , A. Kocijančić , D. Simić , N. Mujović
Journal: Acta Cardiologica
Volume: 66    Issue: 5   Date: 2011   
Pages: 613-618
DOI: 10.2143/AC.66.5.2131087

Abstract :
Background: The use of irrigated-tip catheters enables elimination of almost all accessory pathways (APs) resistant to standard radiofrequency ablation (RFA). However, efficacy of irrigation catheter technology in the initial AP ablation has not been studied systematically yet.
Objectives: We tested whether the externally irrigated-tip catheters are more effective than the conventional-tip catheters for initial RFA of the posteroseptal and right free-wall APs, i.e. where application of the conventional RFA is expected to have a lower success rate.
Methods Fifty consecutive patients (39 ± 12 years, 32 males), who were subjected to primary catheter-ablation of the posteroseptal or right freewall AP were randomly assigned to RFA with an externally irrigated-tip catheter (group I, n = 25; 45°C/40 W outside the coronary sinus (CS) and 45°C/30 W inside the CS) or a conventional-tip catheter (group C, n = 25; 60°C/60 W outside and 55°C/35 W inside the CS).
Results: No significant difference was identified between groups I and C with respect to acute success rate (88% vs 96%), number of radiofrequency applications (6.8 ± 4.7 vs 6.1 ± 4.3), RFA time (373 ± 242 sec vs 365 ± 241 sec), energy (11022 ± 7833 J vs 12870 ± 11414 J), fluoroscopy time (669 ± 443 sec vs 789 ± 578 sec) and recurrence rate (18.2% vs 16.7%). The only complication was encountered in group I, manifested as AV-block I-II° after elimination of the right posteroseptal AP.
Conclusions: Irrigated-tip catheters are not more efficient than conventional catheters in initial RFA of the posteroseptal and right free-wall APs. Therefore, the use of irrigated-tip catheters is justifiable only for ablation of the APs resistant to previously attempted conventional RFA.