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Penela D, Chauca A, Fernández-Armenta J, Pavón R, Benito B, Acosta J, Lozano JM, Falasconi G, San Antonio R, Soto-Iglesias D, Martí-Almor J, Ordoñez A, Bellido A, Carreño JM, Matiello M, Cano L, Pedrote A, Viveros D, Alderete J, Francia P, Algarra-Cullell M, Silva E, Meca-Santamaria J, Franco P, Cappato R, Berruezo A. Outcomes of cavotricuspid isthmus-dependent flutter ablation: randomized study comparing single vs. multiple catheter procedures-the SIMPLE study. J Interv Card Electrophysiol 2023; 66:1979-1988. [PMID: 36877415 DOI: 10.1007/s10840-023-01511-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/14/2023] [Indexed: 03/07/2023]
Abstract
BACKGROUND Catheter ablation is recommended as first-line therapy for patients with symptomatic typical AFl. Although the conventional multi-catheter approach is the standard of care for cavotricuspid isthmus (CTI) ablation, a single-catheter approach was recently described as a feasible alternative. The present study sought to compare safety, efficacy, and efficiency of single vs. multi-catheter approach for atrial flutter (AFl) ablation. METHODS In this randomized multi-center study, consecutive patients referred for AFl ablation (n = 253) were enrolled and randomized to multiple vs. single-catheter approach for CTI ablation. In the single-catheter arm, PR interval (PRI) on the surface ECG was used to prove CTI block. Procedural and follow-up data were collected and compared between the two arms. RESULTS 128 and 125 patients were assigned to the single-catheter and to the multi-catheter arms, respectively. In the single-catheter arm, procedure time was significantly shorter (37 ± 25 vs. 48 ± 27 minutes, p = 0.002) and required less fluoroscopy time (430 ± 461 vs. 712 ± 628 seconds, p < 0.001) and less radiofrequency time (428 ± 316 vs. 643 ± 519 seconds, p < 0.001), achieving a higher first-pass CTI block rate (55 (45%) vs. 37 (31%), p = 0.044), compared with the multi-catheter arm. After a median follow-up of 12 months, 11 (4%) patients experienced AFl recurrences (5 (4%) in the single-catheter arm and 6 (5%) in the multi-catheter arm, p = 0.99). No differences were found in arrhythmia-free survival between arms (log-rank = 0.71). CONCLUSIONS The single-catheter approach for typical AFl ablation is not inferior to the conventional multiple-catheter approach, reducing procedure, fluoroscopy, and radiofrequency time.
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Affiliation(s)
- Diego Penela
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Alfredo Chauca
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Ricardo Pavón
- Hospital Universitario Virgen de Valme, Sevilla, Spain
| | | | - Juan Acosta
- Virgen del Rocío University Hospital, Sevilla, Spain
| | | | - Giulio Falasconi
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Rodolfo San Antonio
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - David Soto-Iglesias
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Julio Martí-Almor
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Augusto Ordoñez
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | - Aldo Bellido
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Maria Matiello
- Hospital Universitario General de Cataluña, Barcelona, Spain
| | - Lucas Cano
- Puerta del Mar University Hospital, Cádiz, Spain
| | | | - Daniel Viveros
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Jose Alderete
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Campus Clínic, University of Barcelona, Barcelona, Spain
| | - Pietro Francia
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
- Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza, Rome, Italy
| | | | | | | | - Paula Franco
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain
| | | | - Antonio Berruezo
- Heart Institute, Teknon Medical Center, C/ Vilana, 12, Barcelona, 08022, Spain.
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