Abstract
OBJECTIVE: To compare the acute and long-term outcomes of high-power ablation for typical atrial flutter using a 4-mm irrigated catheter (4-IC) versus an 8-mm non-irrigated catheter (8-NIC). METHODS: We conducted a retrospective cohort study of 215 patients who underwent cavotricuspid isthmus (CTI) ablation between January 2019 and December 2024. Patients were divided into two groups based on the catheter used: 4-IC (n = 113) and 8-NIC (n = 102). Baseline, procedural, and follow-up data were analyzed. RESULTS: Both groups achieved 100% acute procedural success with no significant difference in CTI block rates. The 8-NIC group had significantly shorter procedure duration (68.4 ± 15.2 vs. 77.4 ± 18.5 min, p < 0.001), reduced fluoroscopy time, and fewer lesions with shorter total RF delivery time. Periprocedural complications were rare and similar between groups. Over a mean follow-up of 15.7 ± 7.2 months, atrial flutter recurrence occurred in 12.6% of patients, with no significant difference between groups (14.2% vs. 10.8%, p = 0.442). Rates of atrial fibrillation, pacemaker implantation, and continued anticoagulation were also comparable. CONCLUSION: Both ablation strategies are safe and effective, with the 8-mm catheter offering greater procedural efficiency without compromising long-term outcomes.