Atrial flutter ablation: Efficacy and cost-effectiveness of a single decapolar electrode to demonstrate bidirectional isthmus block

Aims To evaluate whether a single decapolar electrode is a reliable and cos t-effective substitute for the 'Halo' catheter to map the circuit and detec t bidirectional isthmus block during atrial flutter (AFL) ablation. Methods and Results Twenty-four patients underwent AFL ablation by using th e decapolar electrode in the infero-lateral wall of right atrium (group A) while a 'Halo' catheter was used in 11 patients (group B). Both groups had similar clinical characteristics. Anti-clockwise rotation (20 patients), cl ockwise (3 patients) or both forms of AFL (1 patient) were detected in grou p A. All patients in group B had anti-clockwise AFL. Bidirectional isthmus block was completed in 22 patients of group A and in 9 of group B (P = NS) while incomplete isthmus block was detected in 2 patients in each group (P = NS). Mean fluoroscopy and procedure time was 27 +/- 47 min, 107 +/- 36 mi n in group A and 14 +/- 19 min, 114 +/- 65 min in group B (P = NS). AFL rel apsed in 3 patients of group A (follow-up 7 +/- 4 months) and in 2 of group B (4 +/- 2 months). Conclusion A single decapolar electrode is a reliable method to map the cir cuit and demonstrate bidirectional isthmus block during AFL ablation. The c ost of the decapolar electrode is a quarter of that of the 'Halo' catheter. This represents a significant saving particularly for centres with a subst antial number of AFL ablations. (C) 2001 The European Society of Cardiology .