Comparison between a 7 French 6 mm tip cryothermal catheter and a 9 French 8 mm tip cryothermal catheter for cryoablation treatment of common atrial flutter.

Background: Larger tipped cryothermal catheters may deliver efficacy and procedure benefits in the treatment of patients with atrial flutter.

Objective: To compare 7 French 6 mm and 9 French 8 mm tip cryothermal catheters (Freezor, Xtra or Freezor, MAX, CryoCath Technologies Inc., Kirkland, Canada) in terms of acute and chronic efficacy, and procedure characteristics in the treatment of atrial flutter.

Methods: This non-randomized clinical investigation determined bi-directional isthmus block at intervention, procedure characteristics, and symptom and conduction recurrence rates post procedure in consecutive patients with symptomatic atrial flutter ablated either with the 7 French 6 mm tip cryothermal catheter (n = 43) at -75 degrees C for 4 minutes or the 9 French 8 mm tip cryothermal catheter (n = 51) at -75 degrees C for 8 minutes.

Results: Clinical data showed a higher acute success rate for the larger tipped catheter (100% vs. 88%). Symptom recurrence rates were 0% for both catheters at 3, 6, and 9 month follow-up. Conduction recurrence rates were similar for both catheters on repeat electrophysiological study at 3 months post procedure (35% vs. 32%). Procedure benefits were fewer cryotests (20 +/- 17 vs. 26 +/- 21) and ablations (4 +/- 4 vs. 12 +/- 18), and shorter procedure (80 +/- 61 min vs. 87 +/- 48 min), fluoroscopy (14 +/- 9 min vs. 24 +/- 10 min), and cryoapplication times (37 +/- 18 min vs. 44 +/- 23 min) with the larger tipped catheter. There were no adverse events reported.

Conclusions: Clinical results showed differences in catheter performance that favoured the larger tipped catheter. However, increased acute success rate did not translate into reduced conduction recurrence rate post ablation, although clinical recurrence was completely absent long-term.