# Comparison of Two High‐Power Ablation Strategies for Typical Atrial Flutter: Acute and Long‐Term Outcome

## TL;DR

This study compares two high-power ablation techniques for treating typical atrial flutter and finds both are equally effective and safe in the long term.

## Contribution

The study introduces a direct comparison of two high-power ablation strategies using different catheter types for cavo-tricuspid isthmus ablation.

## Key findings

- Both 8-mm and 4-mm catheters achieved similar acute success rates in creating a bidirectional block in the cavo-tricuspid isthmus.
- Long-term follow-up showed no significant differences in freedom from atrial arrhythmia or other outcomes between the two catheter types.
- No major complications were observed in either group during the study period.

## Abstract

Ablation of the cavo‐tricuspid isthmus (CTI) is the standard treatment for typical atrial flutter. High‐power strategies have been described to improve lesion efficacy and durability.

To compare the acute success, safety, and long‐term outcomes of two strategies of high‐power CTI ablation using 8‐mm gold‐tip nonirrigated and 4‐mm irrigated‐tip catheters.

This single‐center prospective cohort study included 253 patients who underwent CTI ablation. Patients were treated with either an 8‐mm gold‐tip nonirrigated catheter (60 W, ≥ 30 s) or a 4‐mm irrigated catheter (45 W, ≥ 30 s). Procedural outcomes, safety, and long‐term follow‐up data were assessed.

Using a propensity score matching, 180 patients were yielded with a 1:1 ratio. Acute bidirectional CTI block was achieved in 97.8% of the 4‐mm group and 97.8% of the 8‐mm group (p = 1.000). No major complications were reported. During a median follow‐up of 27.7 ± 20.1 months, freedom from atrial arrhythmia was 93.3% in both groups (log rank p value 0.935). No significant differences were observed in atrial fibrillation incidence, pacemaker implantation, or cardiovascular mortality between the groups.

High‐power CTI ablation with both 8‐mm gold‐tip nonirrigated and 4‐mm irrigated catheters is highly effective and safe, providing durable outcomes over long‐term follow‐up.