Randomized Comparison of Multipolar, Duty-Cycled, Bipolar-Unipolar Radiofrequency Versus Conventional Catheter Ablation for Treatment of Common Atrial Flutter

Methods: Patients presenting to our department with symptomatic, typical AFL were enrolled consecutively and randomized to conventional RF ablation with an 8-mm tip catheter (ConvRF) or a duty-cycled, bipolar-unipolar RF generator delivering power to a hexapolar tip-versatile ablation catheter (T-VAC) group. For both groups, the procedural endpoint was bidirectional cavotricuspid isthmus block. Results: Sixty patients were enrolled, 30 patients each assigned to ConvRF and T-VAC groups. Total procedure time (40.2 +/- 15.8 min vs 60.5 +/- 12.7 min), energy delivery time (8.5 +/- 3.7 min vs 14.7 +/- 5.2 min), radiation dose (14.5 +/- 3.5 cGy/cm2 vs 31.7 +/- 12.1 cGy/cm2), and the minimum number of RF applications needed to achieve block (4.2 +/- 2.4 vs 8.9 +/- 7.2) were significantly lower in the T-VAC group. In 7 patients treated with the T-VAC catheter, bidirectional block was achieved with less than 3 RF applications, versus no patients with conventional RF energy delivery. Conclusion: The treatment of typical AFL using a hexapolar catheter with a multipolar, duty-cycled, bipolar-unipolar RF generator offers comparable effectiveness relative to conventional RF while providing improved procedural efficiency. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1109-1113).