Contact force-guided ablation for typical atrial flutter does not reduce recurrent atrial arrhythmia

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Contact-force (CF)-guided ablation to treat typical atrial flutter does not reduce recurrent atrial arrhythmia at 12 months follow-up, in comparison to ablation blinded for contact force. This was the main conclusion of a randomised controlled trial (RCT), findings of which were published by a research team at Aarhus University Hospital, Aarhus, Denmark, this month in the Journal of Interventional Cardiac Electrophysiology.

 

Mikkel Giehm-Reese
Mikkel Giehm-Reese

For patients with recurrent atrial arrhythmia, CF-guided catheter ablation (CA) is designed to improve efficacy, while reducing the risk of complications. The research team, comprising Mikkel Giehm-Reese and colleagues (all Aarhus University Hospital, Aarhus, Denmark) note that a previous study, published in EP Europace with the same study population documented that the rate of persistent conduction block was similar with and without using CF while performing CA for typical atrial flutter after three months. Therefore, Giehm-Reese and team aimed to study the recurrent atrial arrhythmia during 12-month follow-up, to investigate whether CF-guided CA for typical atrial flutter is superior to CF-blinded CA.

A total of 156 patients were recruited, however, this was reduced to 150, due to four withdrawals of consent, and two deaths during follow-up. The patients were randomised into one of two groups of CA guided by CF (intervention group) or blinded to CF (control group). At 12 months follow-up, all patients attended a clinical check-up and a five-day ambulatory Holter monitor recording. The authors note that the primary outcome of the study was for any recurrent atrial arrhythmia ≥30 seconds, within 12 months, and documented in 12-lead electrocardiogram or Holter monitor recording.

“When evaluating one treatment over another, the golden standard is an RCT. With that in mind and considering our recent results along others derived from RCT’s, CF-guided CA does not seem to be the answer for improving outcome regarding recurrent arrhythmia following CA. Regarding upcoming technologies or new approaches, carefully evaluating these in ample powered RCT’s will be crucial” Giehm-Resese tells Cardiac Rhythm News. 

Within the final analysis, the authors recall that recurrent arrhythmia was detected in 36 out of 77 (47%) of patients in the intervention group, and in 32 out of 73 patients (44%) in the control group (p=0.51). In addition, it was noted that atrial fibrillation (AF) was detected in 23 (30%) and 29 (40%) patients in the intervention and control group respectively. Lastly, the authors note that typical atrial flutter was detected in 11 (14%) and 5 (7%) patients in the intervention and control groups respectively.


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