1
|
Okishige K, Tachibana S, Shigeta T, Yamauchi Y, Tanno K, Hirao K, Sasano T. Novel method to avoid serious injurious effects on the atrioventricular nodal (AVN) conduction during catheter ablation of the AVN slow pathway utilizing cryofreezing energy. J Cardiol 2024; 83:371-376. [PMID: 37714263 DOI: 10.1016/j.jjcc.2023.09.005] [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: 04/17/2023] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Slow pathway elimination of the atrioventricular node (AVN) is essential to treat AVN reentrant tachycardia (AVNRT). However, injury to the AVN conduction (IAVN) is one of the serious complications. Cryofreezing energy is expected to reduce the incidence of IAVN. This study aimed to investigate the usefulness of a novel method to avoid IAVN during cryoablation of AVNRT. METHODS A total of 157 patients (average age, 65.8 years; male, 71) suffering from AVNRT were included. Once the AVNRT terminated during cryo-ablation, then rapid atrial constant pacing (RACP) was performed during freezing at a rate lower 10 bpm than that inducing Wenchebach AV block in 74 (47.1 %) patients (Group A). The RACP rate was decreasingly reduced by 10 bpm in case of the occurrence of IAVN. When the RACP reached 100 bpm, the cryoablation was prematurely terminated. Group B patients (83 = 52.9 %) underwent cryoablation during sinus rhythm. All patients were allocated in a randomized fashion. We compared the severity of the IAVN between Groups A and B. RESULTS There were no significant differences at 12 months regarding the freedom from the AVNRT between Groups A and B. However, the duration of the IAVN was significantly longer in Group B than A (p = 0.02). There were no significant differences regarding the distance between the His recording sites and successful ablation sites between Groups A and B. No permanent IAVN requiring pacemaker implantation was provoked in either group. CONCLUSION RACP was useful to avoid sustained and serious IAVN during cryoablation of AVNRT.
Collapse
Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.
| | - Shinichi Tachibana
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Takatoshi Shigeta
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Kaoru Tanno
- Cardiology, Showa University, School of Medicine, Tokyo, Japan
| | - Kenzo Hirao
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tetsuo Sasano
- Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
2
|
Siranart N, Keawkanha P, Pajareya P, Chokesuwattanaskul R, Ayudhya CTN, Prasitlumkum N, Chung EH, Jongnarangsin K, Tokavanich N. Efficacy and safety between radiofrequency ablation and types of cryoablation catheters for atrioventricular nodal reentrant tachycardia: A Network Meta-analysis and Systematic Review. Pacing Clin Electrophysiol 2024; 47:353-364. [PMID: 38212906 DOI: 10.1111/pace.14915] [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: 10/28/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation. METHOD A literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8-mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random-effects model of network meta-analysis, along with p-scores, was employed. RESULTS A total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4-mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202-2.087) when compared to nonirrigated RFA. Similarly, 6-mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307-2.905), 8-mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089-8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058-3.121) compared to nonirrigated RFA. CONCLUSION Our study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile.
Collapse
Affiliation(s)
- Noppachai Siranart
- Chulalongkorn University, Division of Cardiology, Department of Medicine, Bangkok, Thailand
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Ponthakorn Keawkanha
- Chulalongkorn University, Division of Cardiology, Department of Medicine, Bangkok, Thailand
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Patavee Pajareya
- Chulalongkorn University, Division of Cardiology, Department of Medicine, Bangkok, Thailand
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Ronpichai Chokesuwattanaskul
- Chulalongkorn University, Division of Cardiology, Department of Medicine, Bangkok, Thailand
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Choutchung Tinakorn Na Ayudhya
- Chulalongkorn University, Division of Cardiology, Department of Medicine, Bangkok, Thailand
- Division of Cardiovascular Medicine, Center of Excellence in Arrhythmia Research, Cardiac Center, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Narut Prasitlumkum
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eugene H Chung
- Division of Cardiovascular Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Krit Jongnarangsin
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, Michigan, USA
| | - Nithi Tokavanich
- Division of Cardiovascular Medicine, Frankel Cardiovascular Center, University of Michigan Health, Ann Arbor, Michigan, USA
| |
Collapse
|
3
|
Zeng R, Li F, Jiang J, Cui K, Yang Q, Gao J, Zhu X, Shi T, Li W, Tong Y, Zhang Q, Hu H, Fu H. The Safety and Feasibility of Pulsed-Field Ablation in Atrioventricular Nodal Re-Entrant Tachycardia: First-in-Human Pilot Trial. JACC Clin Electrophysiol 2024; 10:82-92. [PMID: 37831032 DOI: 10.1016/j.jacep.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 08/18/2023] [Accepted: 08/22/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND The incidence of atrioventricular conduction system damage during the catheter ablation procedure has long been a safety concern in patients with atrioventricular nodal re-entrant tachycardia (AVNRT). Pulsed-field ablation (PFA) with high tissue selectivity is a promising technique to address this problem in patients with AVNRT. OBJECTIVES This study aimed to evaluate the safety and feasibility of PFA in patients with AVNRT. METHODS This was an investigator-initiated, single-center, single-arm, prospective study performed in West China Hospital, Sichuan University. Patients diagnosed with AVNRT by electrophysiological examination were included and treated using PFA. The primary outcome was the ability to achieve acute ablation success. The secondary outcomes were ablation success after 6 months and safety incidents reported. RESULTS A total of 30 patients with AVNRT with a mean age of 47.9 ± 13.9 years were included and underwent PFA. Acute ablation success was achieved in all patients. The skin-to-skin procedure time was 109.1 ± 32.1 minutes, and fluoroscopy time was 4.1 ± 0.9 minutes. A median of 8 (range: 6.5 to 11.0) PFA applications were delivered. The average distance of the closest ablation site to the His bundle was 6.5 ± 2.5 mm, with a minimum distance of 2.0 mm. All patients maintained sinus rhythm after 6 months. No adverse events occurred in any patient during the ablation or the 6-month follow-up. CONCLUSIONS PFA showed favorable feasibility and safety in patients with AVNRT in this pilot study. Further study with larger population and longer follow-up time is warranted to verify the results.
Collapse
Affiliation(s)
- Rui Zeng
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Fanghui Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jian Jiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaijun Cui
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Yang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinnian Gao
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Xiaolin Zhu
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Tiancai Shi
- Sichuan Jinjiang Electronic Science and Technology Co, Ltd, Chengdu, China
| | - Wentao Li
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Yao Tong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qing Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongde Hu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| | - Hua Fu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
| |
Collapse
|
4
|
Lázaro Rivera C, Marco Del Castillo Á, Rodríguez Muñoz D. Atrioventricular block following prolonged focal cryoablation for parahisian premature ventricular complexes. Indian Pacing Electrophysiol J 2022; 22:286-290. [PMID: 35988904 DOI: 10.1016/j.ipej.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 08/01/2022] [Accepted: 08/14/2022] [Indexed: 11/25/2022] Open
Abstract
A 54-year-old woman with symptomatic premature ventricular contractions (PVC) was referred for electrophysiological study. The earliest activation was located at the parahisian area, so it was decided to ablate using cryoenergy. No AV conduction impairment was observed during cryomapping. PVCs were abolished after the first 15 seconds of cryoablation, without recurrence. However, after 354 seconds of cryoablation, a mild PR prolongation was followed by first degree and 2-to-1 AV block. Termination of cryoablation led to complete recovery without definitive damage and with elimination of the PVC. This case illustrates how lesion formation using cryoenergy can continue to evolve even after several minutes, highlighting the need of monitoring throughout the whole target duration.
Collapse
|
5
|
Identifying an appropriate endpoint for cryoablation in children with atrioventricular nodal reentrant tachycardia: Is residual slow pathway conduction associated with recurrence? Heart Rhythm 2021; 19:262-269. [PMID: 34601128 DOI: 10.1016/j.hrthm.2021.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 09/14/2021] [Accepted: 09/24/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Cryoablation is increasingly used to treat atrioventricular nodal reentrant tachycardia (AVNRT) due to its safety profile. However, cryoablation may have higher recurrence than radiofrequency ablation (RFA), and the optimal procedural endpoint remains undefined. OBJECTIVE The purpose of this study was to identify the association of cryoablation procedural endpoints with postprocedural AVNRT recurrence. METHODS We performed a single-center, retrospective analysis of pediatric patients following successful first-time cryoablation for AVNRT between January 1, 2011, and December 31, 2019. Preablation inducibility of AVNRT was recorded. Procedural endpoints, including slow pathway (SP) conduction (presence of jump or echo beats) with and without isoproterenol, were identified. Recurrence was established from clinical notes and/or direct patient contact. RESULTS Of 256 patients, 147 (57%) were assessed on isoproterenol precryoablation, and 171 (47%) were assessed on isoproterenol postcryoablation. Mean cryolesion time was 2586 ± 1434 seconds. Following ablation, 104 (41%) had some evidence of residual SP conduction. With median follow-up time of 1.9 [0.7-3.7] years, recurrence occurred in 14 patients (5%). Complete elimination of SP conduction (with and without isoproterenol) had a hazard ratio for recurrence of 1.26 (95% confidence interval [CI] 0.42-3.8; P = .68) on univariate analysis and 1.39 (95% CI 0.36-5.4; P = .63) on multivariate analysis (including demographics, ablation time, 8-mm cryocatheter, and baseline inducibility). CONCLUSION The observed AVNRT recurrence rate after cryoablation was comparable to that of RFA. The presence of residual SP conduction was not associated with recurrence. This suggests that jump or single echo beat may be an acceptable endpoint in AVNRT cryoablation.
Collapse
|
6
|
Bastani H, Bourke T, Braunschweig F, Drca N, Gudmundsson K, Insulander P, Jemtren A, Kennebäck G, Ljungström E, Sadigh B, Saluveer O, Scheel S, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation as standard treatment of atrial flutter: a prospective, 2-center study (CASTAF). Acta Cardiol 2021; 76:267-271. [PMID: 32208915 DOI: 10.1080/00015385.2020.1721717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cryoablation (CRYO) of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL) has been shown to be non-inferior to radiofrequency ablation (RF) in terms of ablation success and is associated with less pain. However, procedural time has been significantly longer with CRYO compared to RF. A possible explanation for this could be that operators had less experience with CRYO than with RF. The purpose of this study was to test the hypothesis that in the hands of experienced operators, cryoablation of CTI-dependent AFL is effective with procedure-time similar to what is reported for RF. METHODS This prospective 2-center study included 184 patients with CTI-dependent AFL - median age 66 years (range 28-83), 159 men (86%). Cryoablation was performed using a 9 F, 8 mm tip catheter (Freezor MAX, Medtronic, Inc, MN, USA). Ablation endpoint was bidirectional CTI-block. Pain was evaluated with a visual analogue scale (VAS 0-10). All operators had experience of at least 25 previous CTI-ablations with CRYO. RESULTS The acute success rate was 89%. Procedural time including an observation period of 30 min, was 115 ± 36 min which is similar to procedural times for RF in previous studies. Fluoroscopy time was 11 ± 9 min. Cryoablation was perceived as almost pain- free by the patients, VAS (mean) 1.8 ± 1.2. Success rate at 12-month follow-up (FU) was 88% in patients with primary success. No major adverse events occurred. CONCLUSIONS Cryoablation of CTI-dependent AFL is effective, with a low level of procedure-related pain. In experienced hands, the procedure time in this prospective non-randomised trial seems to be in the level of reported procedure times for RF. The long-term relapse rate appears to be higher than for RF.
Collapse
Affiliation(s)
- H. Bastani
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - T. Bourke
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - F. Braunschweig
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - N. Drca
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - K. Gudmundsson
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - P. Insulander
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - A. Jemtren
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - G. Kennebäck
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - E. Ljungström
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - B. Sadigh
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - O. Saluveer
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - S. Scheel
- Department of Cardiology, Blekinge County Hospital, Karlskrona, Sweden
| | - J. Schwieler
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - J. Tapanainen
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M. Jensen-Urstad
- Department of Medicine, Patient Area Arrhythmia, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
7
|
Okishige K, Yamauchi Y, Nagase S, Kusano K, Miyamoto K, Ozawa T, Sawayama Y, Takeda H, Manita M, Asahi T, Miwa Y, Soejima K, Sasano T. Transcatheter cryo-ablation of septal accessory pathways, multicenter observational study in Japan. J Cardiol 2020; 77:380-387. [PMID: 33342639 DOI: 10.1016/j.jjcc.2020.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/16/2020] [Accepted: 09/26/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Ablation using radiofrequency energy has to be carefully performed when the arrhythmia substrate is located in close proximity to the atrioventricular (AV) node due to the risk of inadvertent permanent AV block. The aim of this study was to evaluate the efficacy and safety of catheter-based cryo-therapy for septal accessory pathways (APs). METHODS A total of eleven patients (median = 56.3 years, range 13-74 years) with septal APs underwent cryoablation. Ice-mapping was performed during sinus rhythm and an AV reciprocating tachycardia utilizing the APs as a requisite limb with cooling of the catheter tip temperature to a maximum of -30℃ for less than 45 s. Cryo-ablation was performed for 4 min at a temperature of -80℃ only if ice-mapping abolished the pre-excitation or retrograde conduction over the AP without injury to the AV nodal conduction. RESULTS Cryo-ablation was acutely successful in all eleven patients. No permanent cryo-related complications or adverse outcomes were reported. During the follow-up (range 14-26 months), no patients experienced any arrhythmia recurrences. CONCLUSION Ice-mapping was a feasible and reliable method to determine the exact location of the APs owing to the possibility of validating the ablation site. Cryo-ablation of APs located near the AV junction is a safe and efficacious technique with a high success rate over the long term. IRB INFORMATION Ethical Committee of Japan Red Cross Yokohama City Bay Hospital #2018-19.
Collapse
Affiliation(s)
- Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Satoshi Nagase
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Tomoya Ozawa
- Cardiovascular Department, Shiga University, School of Medicine, Ohtsu, Japan
| | - Yuichi Sawayama
- Cardiovascular Department, Shiga University, School of Medicine, Ohtsu, Japan
| | - Hiroto Takeda
- Cardiovascular Center, Ohta-Nishinouchi Hospital, Kouriyama, Japan
| | - Mamoru Manita
- Cardiology Department, Naha Municipal Hospital, Naha, Japan
| | - Tomohiro Asahi
- Cardiology Department, Naha Municipal Hospital, Naha, Japan
| | - Yosuke Miwa
- Cardiovascular Department, Kyorin University, School of Medicine, Mitaka, Japan
| | - Kyoko Soejima
- Cardiovascular Department, Kyorin University, School of Medicine, Mitaka, Japan
| | - Tetsuo Sasano
- Cardiovascular Department, Tokyo Medical and Dental University, Tokyo, Japan
| |
Collapse
|
8
|
Kafalı HC, Özgür S, Şahin GT, Akay EÖ, Güzeltaş A, Ergül Y. Cryoablation with an 8-mm tip catheter for typical AVNRT in children: a single center 5-year experience. J Interv Card Electrophysiol 2020; 62:113-122. [PMID: 32968865 DOI: 10.1007/s10840-020-00868-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND In children with typical atrioventricular nodal reentrant tachycardia (tAVNRT), cryoablation is preferred over radiofrequency ablation (RFA) because of its safety profile and acceptable long-term success rates. In this study, we have assessed the utility of 8-mm tip cryocatheters for tAVNRT ablation in our center. METHODS All pediatric AVNRT patients who underwent cryoablation with an 8-mm tip cryocatheter in our center between 2013 and 2018 were included. EnSite™ (St. Jude Medical Inc., St. Paul, MN, USA) was used in all patients. RESULTS A total of 120 patients (64 females, 53%) were included in this study, and the mean age was 13.9 years with a standard deviation of 2.5 years. Eleven patients (9.1%) had structural heart disease, and 12 patients (10%) had additional arrhythmia substrate. The mean number of effective cryolesions was 8 with a standard deviation of 2.3. Fluoroscopy was used in three patients (2.5%). There were minor complications in only four patients (3.3%)-transient first-degree atrioventricular block or transient incomplete right bundle branch block. Acute success rate of cryoablation was 108/120 (90%). In twelve patients, cryoablation was suboptimal, or it failed. The procedure was completed successfully with RFA in the same session in ten patients. Overall acute success rate of ablation (Cryo ± RFA) was 98.5%. During a mean follow-up period of 24.6 months with a standard deviation of 11.3 months, three patients had recurrence (2.5%). Time between the beginning of the effective cryolesion and termination of AVNRT was found associated with acute success of cryoablation (p = 0.013). CONCLUSIONS Cryoablation of AVNRT with an 8-mm tip catheter in children appears to be safe, with an acceptable acute success rate and a low recurrence rate. A faster termination of AVNRT during the cryolesion, slowing down before ending with atrioventricular block, is a good indicator for acute success.
Collapse
Affiliation(s)
- Hasan Candaş Kafalı
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey. .,Istanbul Sağlık Bilimleri Universitesi Mehmet Akif Ersoy Eğitim Araştırma Hastanesi, Istasyon Mahallesi İstanbul Caddesi Bezirganbahçe Mevki, 34303, Küçükçekmece/İstanbul, Turkey.
| | - Senem Özgür
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Gülhan Tunca Şahin
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Elif Özkilitçi Akay
- Department of Anesthesiology and Reanimation, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Alper Güzeltaş
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| | - Yakup Ergül
- Department of Pediatric Cardiology, University of Health Sciences, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Education and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Miyamoto K, Kapa S, Mulpuru SK, Deshmukh AJ, Asirvatham SJ, Munger TM, Friedman PA, Packer DL. Outcome of combined cryo‐ and radiofrequency‐catheter ablation in patients with supraventricular tachycardias. J Cardiovasc Electrophysiol 2019; 30:1960-1966. [DOI: 10.1111/jce.14068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/24/2019] [Accepted: 07/05/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Koji Miyamoto
- Department of Cardiovascular MedicineMayo ClinicRochester Minnesota
| | - Suraj Kapa
- Department of Cardiovascular MedicineMayo ClinicRochester Minnesota
| | - Siva K. Mulpuru
- Department of Cardiovascular MedicineMayo ClinicRochester Minnesota
| | | | | | - Thomas M. Munger
- Department of Cardiovascular MedicineMayo ClinicRochester Minnesota
| | - Paul A. Friedman
- Department of Cardiovascular MedicineMayo ClinicRochester Minnesota
| | | |
Collapse
|
10
|
Suzuki G, Yotsukura A, Nanbu T, Sakurai M. Successful catheter cryoablation for premature ventricular contractions originating from the para-Hisian region. Clin Case Rep 2019; 7:1508-1513. [PMID: 31428377 PMCID: PMC6693052 DOI: 10.1002/ccr3.2246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 04/24/2019] [Accepted: 05/05/2019] [Indexed: 11/09/2022] Open
Abstract
We achieved successful catheter cryoablation in a patient with para-Hisian premature ventricular contractions (PVCs) without conduction disturbance using the freeze-thaw-freeze method while observing the atrial-His bundle interval. Cryoablation could be considered an alternative to radiofrequency ablation for patients with para-Hisian PVCs.
Collapse
Affiliation(s)
- George Suzuki
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Akihiko Yotsukura
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Tadafumi Nanbu
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| | - Masayuki Sakurai
- Division of Arrhythmias and Cardiac Electrophysiology, Department of Cardiovascular MedicineHokko Memorial HospitalSapporoJapan
| |
Collapse
|
11
|
Evaluation of myocardial injury induced by different ablation approaches (radiofrequency ablation versus cryoablation) in atrial flutter patients: a meta-analysis. Biosci Rep 2019; 39:BSR20182251. [PMID: 31076543 PMCID: PMC6533206 DOI: 10.1042/bsr20182251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 04/12/2019] [Accepted: 05/08/2019] [Indexed: 11/28/2022] Open
Abstract
Background: To evaluate myocardial injury in Atrial flutter (AFL) patients undergoing Radiofrequency ablation (RF) and cryoablation (CRYO) treatments. Methods: We conducted a systematic search on PubMed, Embase, Cochrane Library, and CBM databases. All relevant clinical trials (up to October 2018) on myocardial injury in AFL patients were retrieved and subsequent results analyzed with a random-effects model or a fixed-effects model. Results: A total of eight clinical trials with a sample size of 644 patients, were identified and incorporated in the present study. The results indicated no significant differences in creatine kinase (CK) levels (mean difference (MD) = 62.74, P=0.46; 4–6 h and MD = 30.73, P=0.49; 12–24 h after ablation), creatine kinase MB(CK-MB) levels (MD = 17.32, P=0.25; 12–24 h post-ablation), troponinI (TnI) levels (MD = 0.12, P=0.08; 6 h after ablation), and troponin T (TnT) levels (MD = 0.30, P=0.08; 4–6 h post-ablation) between the two treatment approaches. However, patients receiving CRYO xhibited higher levels of CK (MD = 179.54, P=0.04; tested immediately after the procedure), CK-MB (MD = 10.08, P=0.004) 4–6 h after ablation, and TnT (MD = 0.19, P=0.002) tested the next morning. Moreover, those patients had a significantly reduced pain perception (odds ratio (OR) = 0.05, P=0.04) compared with those in the RF group. Conclusion: These results indicate that CRYO in comparison with RF significantly increases myocardial injury in AFL patients. Additionally, it decreases pain perception during the procedure. Further large-sampled studies are needed to support these findings.
Collapse
|
12
|
Safety and Efficacy of Cryoablation in Patients With Ventricular Arrhythmias Originating From the Para-Hisian Region. JACC Clin Electrophysiol 2018; 4:366-373. [DOI: 10.1016/j.jacep.2017.12.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/24/2022]
|
13
|
Karacan M, Çelik N, Akdeniz C, Tuzcu V. Long-term outcomes following cryoablation of atrioventricular nodal reentrant tachycardia in children. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:255-260. [DOI: 10.1111/pace.13277] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 10/21/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Mehmet Karacan
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
| | - Nida Çelik
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
| | - Celal Akdeniz
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
| | - Volkan Tuzcu
- Department of Pediatrics, Pediatric and Genetic Arrhythmia, Center, Faculty of Medicine; Istanbul Medipol University; Istanbul Turkey
| |
Collapse
|
14
|
Wells P, Dubuc M, Klein GJ, Dan D, Roux JF, Lockwood E, Sturmer M, Dunbar D, Novak P, Rao A, Peterson BJ, Kueffer F, Ellenbogen KA. Intracardiac ablation for atrioventricular nodal reentry tachycardia using a 6 mm distal electrode cryoablation catheter: Prospective, multicenter, North American study (ICY-AVNRT STUDY). J Cardiovasc Electrophysiol 2017; 29:167-176. [DOI: 10.1111/jce.13367] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Peter Wells
- Baylor Heart and Vascular Institute; Dallas TX USA
| | - Marc Dubuc
- Montreal Heart Institute; Montreal Quebec Canada
| | | | - Dan Dan
- Intermountain Healthcare; Ogden UT USA
| | | | | | | | | | - Paul Novak
- University of British Columbia; Vancouver British Columbia Canada
| | - Arun Rao
- Wellmont CVA Heart Institute; Kingsport TN USA
| | | | | | | | | |
Collapse
|
15
|
Berman AE, Rivner H, Chalkley R, Heboyan V. A comparative analysis of clinical outcomes and disposable costs of different catheter ablation methods for the treatment of atrioventricular nodal reentrant tachycardia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2017; 9:677-683. [PMID: 29138585 PMCID: PMC5680894 DOI: 10.2147/ceor.s139861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT. Methods We performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56). Results Baseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group (p<0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN (p=0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure. Conclusion AVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy.
Collapse
Affiliation(s)
- Adam E Berman
- Department of Medicine, Medical College of Georgia.,Department of Clinical and Digital Health Sciences, College of Allied Health Sciences.,Division of Cardiology.,Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | | | - Vahé Heboyan
- Department of Clinical and Digital Health Sciences, College of Allied Health Sciences
| |
Collapse
|
16
|
Tuzcu V, Gul EE, Karacan M, Kamali H, Celik N, Akdeniz C. Comparison of 6-mm Versus 8-mm-Tip Cryoablation Catheter for the Treatment of Atrioventricular Nodal Reentrant Tachycardia in Children: A Prospective Study. Pediatr Cardiol 2017; 38:1220-1225. [PMID: 28612086 DOI: 10.1007/s00246-017-1648-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Accepted: 06/02/2017] [Indexed: 11/29/2022]
Abstract
Due to its safety profile, cryoablation (Cryo) for atrioventricular nodal reentrant tachycardia (AVNRT) is more commonly preferred over radiofrequency (RF) ablation in children in recent years. Recent studies demonstrated high long-term success rates comparable to radiofrequency ablation. The aim of this prospective study was to compare the efficacy and safety of an 8-mm-tip versus 6-mm-tip Cryo catheter in the treatment of AVNRT in children. A total of 125 consecutive patients over 10 years of age with AVNRT were included. EnSite system (St. JudeMedical, St Paul, MN, USA) was used to reduce or eliminate fluoroscopy. The acute procedural success was 100% in both groups. The prodecure duration for the 8-mm-tip group was shorter (151.6 ± 63.2 vs. 126.6 ± 36.7 min, p < 0.01, respectively). Fluoroscopy was used in only 7 patients. The mean follow-up duration was 14.6 ± 8.4 months (median 13.5 months, min. 3 months and max. 27 months). The recurrence rate for AVNRT was also comparable between the two groups (6-mm tip: 9.6 vs. 8-mm tip: 8%). Cryo of AVNRT is a safe and effective procedure with comparable acute and mid-term follow-up success rates using 6-mm and 8-mm-tip catheters in children. In addition, procedure duration is shorter with an 8-mm-tip Cryo catheter.
Collapse
Affiliation(s)
- Volkan Tuzcu
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Enes Elvin Gul
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey.
| | - Mehmet Karacan
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Hacer Kamali
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Nida Celik
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| | - Celal Akdeniz
- Pediatric and Genetic Arrhythmia Center, Istanbul Medipol University, TEM Avrupa Otoyolu Goztepe Cikisi, No 1, Bagcilar, 14, Istanbul, Turkey
| |
Collapse
|
17
|
Jordaens L. Should all-comers with atrioventricular nodal re-entrant tachycardia or selected patients only be treated with cryoablation? Europace 2017; 19:887-888. [PMID: 27738064 DOI: 10.1093/europace/euw290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
18
|
Chan NY. Catheter ablation of peri-nodal and pulmonary veno-atrial substrates: should it be cool? Europace 2016; 17 Suppl 2:ii19-30. [DOI: 10.1093/europace/euv230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
|
19
|
Gonzalez J, Levinstein M, Brugada P. [Cryoablation: Clinical applications in cardiac electrophysiology from their biophysical bases]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2015; 86:41-50. [PMID: 26556222 DOI: 10.1016/j.acmx.2015.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 09/14/2015] [Accepted: 09/29/2015] [Indexed: 10/22/2022] Open
Abstract
Cryoablation is an energy alternative to radiofrequency for ablation of various arrhythmias, where its unique biophysical properties offer a greater safety profile. Since its first use for the surgical treatment of different arrhythmias until its conceptualization in the current technical transcatheter, cryoablation has proven not to be only a safe source of energy, but also an effective source in the long-term. While the radiofrequency has been the energy most used for isolation of pulmonary veins in atrial fibrillation ablation, technological advances in cryoballon have managed to simplify the procedure without sacrificing its effectiveness. Cryoablation has been widely used for arrhythmias located in high-risk locations, such as the ablation of the atrioventricular nodal reentrant tachycardia and septal accessory pathways, due to its theoretical null risk of complete AV block. This review intends to give the clinical applications of the cryothermy through a thorough understanding of their biophysical basis.
Collapse
Affiliation(s)
- Jorge Gonzalez
- Centro Especializado en Terapia Endovascular, Jardines Hospital de Especialidad, Guadalajara, Jalisco, México.
| | | | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Bruselas, Bélgica
| |
Collapse
|
20
|
Santangeli P, Proietti R, Di Biase L, Bai R, Natale A. Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 2013; 39:111-9. [PMID: 24293174 DOI: 10.1007/s10840-013-9842-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 09/10/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ablation of the slow pathway is an established cure for atrioventricular nodal reentrant tachycardia (AVNRT). Periprocedural damage to the conduction system is a major concern during AVNRT ablation, and cryoablation (CRYO) has been suggested to improve the procedural safety compared to standard radiofrequency (RF) ablation, without reducing the procedural success. OBJECTIVE We performed a systematic review and meta-analysis of studies comparing CRYO with RF ablation of AVNRT. METHODS We searched PubMed, CENTRAL, the BioMed Central, EMBASE, CardioSource, clinicaltrials.gov, and ISI Web of Science (January 1980 to July 2013). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify studies that compared the procedural outcomes of AVNRT ablation with either CRYO or RF energy. Two independent reviewers assessed the risk of bias according to the Cochrane Collaboration, and extracted patient, study characteristics, and procedural outcome data. Results are expressed as odds ratio (OR) or as weighted mean difference (WMD) with their 95 % confidence interval (CI). RESULTS Fourteen studies (5 prospective randomized and 9 observational) with 2,340 patients (mean age range 13 to 53 years, 1,522 (65 %) females) were included in the analysis. RF ablation was performed in 1,262 (54 %) patients, while CRYO in 1,078 (46 %) patients. Acute success (abolition of dual atrioventricular node physiology or single echo beats) was achieved in 88 % of patients treated with RF versus 83 % of those treated with CRYO (OR = 0.72, 95 % CI 0.46 to 1.13; P = 0.157). RF ablation was associated with shorter total procedure time (WMD = -13.7 min, 95 % CI -23 to -4.3 min; P = 0.004), but slightly longer fluoroscopy time (WMD = +4.6 min 95 % CI +1.7 to +7.6 min; P = 0.002). Permanent atrioventricular block occurred in 0.87 % RF cases and in no CRYO case (OR = 3.60, 95 % CI 1.09 to 11.81; P = 0.035). Over a median follow-up of 10.5 months (range 6 to 12 months), freedom from recurrent AVNRT was 96.5 % in the RF group versus 90.9 % in the CRYO group (OR = 0.40, 95 % CI 0.28 to 0.58; P < 0.001). At meta-regression analysis, no clinical or procedural variable had a significant interaction with the results above. CONCLUSIONS In patients undergoing AVNRT ablation, RF significantly reduces the risk of long-term arrhythmia recurrence compared to CRYO, but is associated with a higher risk of permanent atrioventricular block.
Collapse
Affiliation(s)
- Pasquale Santangeli
- Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA,
| | | | | | | | | |
Collapse
|
21
|
HANNINEN MIKAEL, YEUNG-LAI-WAH NICOLE, MASSEL DAVID, GULA LORNEJ, SKANES ALLANC, YEE RAYMOND, KLEIN GEORGEJ, MANLUCU JAIMIE, LEONG-SIT PETER. Cryoablation Versus RF Ablation for AVNRT: A Meta-Analysis and Systematic Review. J Cardiovasc Electrophysiol 2013; 24:1354-60. [DOI: 10.1111/jce.12247] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/09/2013] [Accepted: 07/15/2013] [Indexed: 11/29/2022]
Affiliation(s)
- MIKAEL HANNINEN
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| | | | - DAVID MASSEL
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| | - LORNE J. GULA
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| | - ALLAN C. SKANES
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| | - RAYMOND YEE
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| | - GEORGE J. KLEIN
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| | - JAIMIE MANLUCU
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| | - PETER LEONG-SIT
- Arrhythmia Service, London Health Science Center; London Ontario Canada
| |
Collapse
|
22
|
El Arid JM, Sénage T, Toquet C, Al Habash O, Mugniot A, Baron O, Roussel JC. Human comparative experimental study of surgical treatment of atrial fibrillation by epicardial techniques. J Cardiothorac Surg 2013; 8:140. [PMID: 23725512 PMCID: PMC3679832 DOI: 10.1186/1749-8090-8-140] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 05/22/2013] [Indexed: 11/10/2022] Open
Abstract
Background To set up an experimental model of cadaveric heart in order to evaluate and compare histologic transmurality of lesions immediately caused by different energy sources of anti-arrhythmic epicardial devices. Methods Procedures were performed on a cadaveric human heart in orthotopic position with an ischemic time of 48 h at 37° and supported through the use of cardiopulmonary bypass. Three anti-arrhythmic epicardial devices were studied: the bipolar forceps Cardioblate BP (Medtronic) for the radiofrequency, the Epicor Ultracinch LP Ablation device (St. Jude) for ultrasound and the Cardioblate CryoFlex (Medtronic) device for cryoablation. Histological features of lesions made at the pulmonary venous confluence assessed the effectiveness of different energy sources. Results Over 45 experimentations performed, only 28 were considered correct and retained for histological analysis. Three distinct groups were studied according to the type of procedure performed: group 1 (Radiofrequency, n = 12), group 2 (ultrasound, n = 4), group 3 (cryoablation, n = 10) and controls (n = 2). All analysed samples showed histological changes with a success rates of transmurality of 33% for radiofrequency, 25% for ultrasound and 90% for cryotherapy (p <0.001). The average length of transmurality, when it was reached and the proportion of transmurality over the total length of the lesion were respectively 12 ± 6 mm and 37 ± 18% for group 1, 10 mm and 33% for group 2 and 11.1 ± 1.1 mm and 35 ± 5% for group 3. Conclusion Immediate detectable histological transmural lesions after epicardial procedure are discontinuous whatever the kind of energy source tested in this work and it strongly encourages the repetition of radiofrequency procedures. Nevertheless, our experimental model seems inadequate to assess ultrasound energy efficacy.
Collapse
|
23
|
Scaglione M, Ebrille E, Caponi D, Blandino A, DI Donna P, Siboldi A, Bertero G, Anselmino M, Raimondo C, Sardi D, Gabbarini F, Marasini M, Gaita F. Single center experience of fluoroless AVNRT ablation guided by electroanatomic reconstruction in children and adolescents. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2013; 36:1460-7. [PMID: 23713835 DOI: 10.1111/pace.12183] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/26/2013] [Accepted: 04/02/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anatomical considerations and risks related to x-ray exposure make atrioventricular nodal reentrant tachycardia (AVNRT) ablation in pediatric patients a concerning procedure. We aimed to evaluate the feasibility, safety, and efficacy of performing fluoroless slow-pathway cryoablation guided by the electroanatomic (EA) mapping in children and adolescents. METHODS Twenty-one consecutive patients (mean age 13.5 ± 2.4 years) symptomatic for AVNRT were prospectively enrolled to right atrium EA mapping and electrophysiological study prior to cryoablation. Cryoablation was guided by slow-pathway potential and performed using a 4-mm-tip catheter. RESULTS Sustained slow-fast AVNRT was inducible in all the patients with a dual AV nodal physiology in 95%. Acute success was achieved in 100% of the patients with a median of two cryo-applications. Fluoroless ablation was feasible in 19 patients, while in two subjects 50 seconds and 45 seconds of x-ray were needed due to difficult progression of the catheters along the venous system. After a mean follow-up of 25 months, AVNRT recurred in five patients. All the recurrences were successfully treated with a second procedure. In three patients, a fluoroless cryoablation with a 6-mm-tip catheter was successfully performed, while in the remaining two patients, a single pulse of 60 seconds of radiofrequency energy was applied under fluoroscopic monitoring. No complications occurred. CONCLUSIONS Combination of EA mapping systems and cryoablation may allow to perform fluoroless slow-pathway ablation for AVNRT in children and adolescents in the majority of patients. Fluoroless slow-pathway cryoablation showed a high efficacy and safety comparable to conventional fluoroscopy guided procedures.
Collapse
Affiliation(s)
- Marco Scaglione
- Cardiology Department, Cardinal Massaia Hospital, Asti, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Affiliation(s)
- Jason G Andrade
- Electrophysiology Service, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | | |
Collapse
|
25
|
Rodriguez-Entem FJ, Expósito V, Gonzalez-Enriquez S, Olalla-Antolin JJ. Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study. J Interv Card Electrophysiol 2012; 36:41-5; discussion 45. [DOI: 10.1007/s10840-012-9732-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 09/13/2012] [Indexed: 12/01/2022]
|
26
|
Das S, Law IH, Von Bergen NH, Bradley DJ, Dick M, Etheridge SP, Saarel EV, Frias PA, Strieper MJ, Fischbach PS. Cryoablation therapy for atrioventricular nodal reentrant tachycardia in children: a multicenter experience of efficacy. Pediatr Cardiol 2012; 33:1147-53. [PMID: 22430375 DOI: 10.1007/s00246-012-0273-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 02/27/2012] [Indexed: 10/28/2022]
Abstract
Atrioventricular nodal reentrant tachycardia (AVNRT), a common tachycardia in children, is routinely treated by catheter ablation using radiofrequency or cryothermal energy. Acute success rates of 95-97 % are reported for cryoablation, similar to those achieved with radiofrequency ablation (RFA). However, early studies reported higher recurrence rates after cryoablation for treatment of AVNRT than those reported for RFA. This study evaluated the success and recurrence rates for cryoablation in a current cohort of pediatric patients across several institutions. Patients 21 years old or younger with AVNRT who underwent cryoablation at five participating centers between 2004 and 2009 were retrospectively reviewed. Patient demographics and procedural data were extracted from patient records and analyzed. A total of 434 patients with AVNRT who underwent cryoablation were identified. Cryoablation was used as the exclusive ablation method for 379 patients. For 97 % (368/379) of these patients, cryoablation was acutely successful. A higher acute success rate was found with the 6-mm-tip catheter (99 %) than with the 4-mm-tip catheter (91 %) (p < 0.01). Recurrence was experienced by 7.3 % of the patients. Recurrence was more likely for those treated with the 4-mm-tip catheter (6/42, 14 %) than for those who had the larger catheters (12/204, 6 %) No patient experienced permanent heart block. Success and recurrence rates for this cohort of patients were similar to those reported for RFA used to treat AVNRT in pediatric patients. The findings show a higher success rate and a lower recurrence rate after cryoablation with a 6-mm-tip catheter than after use of the 4-mm-tip catheter, with an associated excellent safety profile.
Collapse
Affiliation(s)
- Srikant Das
- Sibley Heart Center, Children's Healthcare of Atlanta, Emory University, 2835 Brandywine Road, Ste. 300, Atlanta, GA 30341, USA
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Tonet J, De Sisti A, Pardo Restrepo N, Raguin D, Amara W, Márquez MF, Aouate P, Waintraub X, Touil F, Hidden-Lucet F. Post-ablation prolongation of atrioventricular nodal refractory period is correlated with long-term success of cryoablation for atrioventricular nodal reentrant tachycardia in the case of the persistence of a residual jump. J Interv Card Electrophysiol 2012; 35:63-9. [PMID: 22562357 PMCID: PMC3435514 DOI: 10.1007/s10840-012-9680-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 02/28/2012] [Indexed: 11/30/2022]
Abstract
PURPOSE A residual slow pathway after successful cryoablation for atrioventricular nodal reentrant tachycardia (AVNRT) is correlated with a higher recurrence rate. We described determinants of recurrence in subjects with a residual jump. METHODS We analyzed the data of subjects with acute successful slow pathway cryoablation for AVNRT using a 6-mm-tip cryocatheter. Success was defined as AVNRT non-inducibility. Patients with no baseline elicitable jump, no inducible AVNRT, and transient first atrioventricular (AV) block at the last site were excluded. RESULTS From 371 patients who underwent cryoablation from May 2002 to March 2011, 303 fulfilled the entry criteria (mean age, 41 ± 16; 222 women). Baseline AV nodal effective refractory period (ERP) was 272 ± 57 ms, postprocedural 331 ± 64 (P < 0.001), and the mean of the difference (Δ ERP) 60 ± 41. At the end of the procedure, 64 patients (21 %) had a residual jump, of whom 22 with a single echo. At 12 months follow-up, the actuarial recurrence-free rate was 70.3 % in patients with a residual jump and 86 % in those without (P = 0.01). In patients with a jump, only Δ AV nodal ERP was correlated with recurrence (37 ± 41 vs. 68 ± 47 ms; P < 0.04) while a single echo was not. The actuarial rate of recurrence was 60.8 % in patients with a Δ AV nodal ERP ≤ 30 ms and 18.8 % in those with a Δ AV nodal ERP >30 ms (P < 0.01). CONCLUSIONS Suppression of slow pathway conduction is the optimal endpoint for AVNRT cryoablation. A residual jump can be tolerated if AV nodal ERP postcryoablation is prolonged >30 ms.
Collapse
Affiliation(s)
- Joelci Tonet
- Cardiology Institute, Rhythmology Unit, Pitié-Salpêtrière Hospital, 47-83, boulevard de l'Hôpital, 75651 Paris, France.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
VILLASENOR MARIO, SCHAFFER MICHAELS, COLLINS KATHRYNK. Cryoablation for Presumed Atrioventricular Nodal Reentrant Tachycardia in Pediatric Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1319-25. [DOI: 10.1111/j.1540-8159.2012.03507.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
29
|
Bastani H, Drca N, Insulander P, Schwieler J, Braunschweig F, Kennebäck G, Sadigh B, Tapanainen J, Jensen-Urstad M. Cryothermal vs. radiofrequency ablation as atrial flutter therapy: a randomized comparison. ACTA ACUST UNITED AC 2012; 15:420-8. [DOI: 10.1093/europace/eus261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
30
|
|
31
|
Chan NY, Mok NS, Choy CC, Lau CL, Chu PS, Yuen HC, Lau ST. Treatment of atrioventricular nodal re-entrant tachycardia by cryoablation with an 8-mm-tip catheter versus radiofrequency ablation. J Interv Card Electrophysiol 2012; 34:295-301. [DOI: 10.1007/s10840-012-9670-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 01/23/2012] [Indexed: 11/28/2022]
|
32
|
Park KM, Rhee KS, Jin ES, Nam GB, Choi KJ, Kim YH. Effects of slow pathway ablation on fast pathway function in patients with atrioventricular nodal reentrant tachycardia: cryo- vs. radiofrequency ablation. Circ J 2012; 76:1091-6. [PMID: 22333216 DOI: 10.1253/circj.cj-11-1325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In typical atrioventricular nodal reentrant tachycardia, radiofrequency (RF) ablation of the slow pathway (SP) is known to change the effective refractory period of the fast pathway (ERP(FP)) after successful RF ablation of the SP. The purpose of this study was to ascertain the mechanism of the ERP(FP) changes after SP ablation by comparing the results of both cryo- and RF ablation. METHODS AND RESULTS A total of 112 patients were enrolled prospectively and their electrophysiological properties analyzed before and after successful SP ablation. Patients were grouped into cryoablation (n=54) and RF ablation (n=58) groups and each group was subdivided into complete ablation (CG) and modification (MG) based on the presence of the SP after successful ablation. CG was performed in 64 patients: 30 by cryoablation and 34 by RF ablation. In patients who underwent complete SP ablation, the ERP(FP) was shortened significantly after cryoablation (375 ± 74 vs. 281 ± 39 ms, P<0.01), without significant change in the atrio-His (AH) or sinus cycle length (SCL) interval. Similarly, the ERP(FP) was shortened significantly (358 ± 106 vs. 289 ± 84 ms, P=0.01) also after RF ablation without change in AH or SCL interval. CONCLUSIONS ERP(FP) shortening was observed after complete SP ablation with both cryo- and RF ablation without significant changes in indices of autonomic activity.
Collapse
Affiliation(s)
- Kyoung-Min Park
- Sanggye Paik Hospital, Department of Internal Medicine, University of Inje College of Medicine, Seoul, Korea
| | | | | | | | | | | |
Collapse
|
33
|
|
34
|
DE SISTI ANTONIO, TONET JOELCI. Cryoablation of Atrioventricular Nodal Reentrant Tachycardia: A Clinical Review. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2011; 35:233-40. [DOI: 10.1111/j.1540-8159.2011.03244.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
35
|
Successful cryothermal ablation for Atrioventricular nodal reentry tachycardia after radiofrequency ablation failure. J Interv Card Electrophysiol 2011; 34:89-92. [DOI: 10.1007/s10840-011-9628-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 09/19/2011] [Indexed: 10/14/2022]
|
36
|
De Sisti A, Tonet J, Amara W, Raguin D, Aouate P, Gueffaf F, Touil F, Hidden-Lucet F. Correlations between long-term results after cryoablation for atrioventricular nodal reentry tachycardia and a residual jump associated or not with a single echo. Europace 2011; 14:261-6. [DOI: 10.1093/europace/eur297] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
37
|
Ozcan C, Ruskin J, Mansour M. Cryoballoon catheter ablation in atrial fibrillation. Cardiol Res Pract 2011; 2011:256347. [PMID: 21747987 PMCID: PMC3130969 DOI: 10.4061/2011/256347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 03/05/2011] [Accepted: 04/25/2011] [Indexed: 12/02/2022] Open
Abstract
Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.
Collapse
Affiliation(s)
- Cevher Ozcan
- Cardiac Arrhythmia Service, Heart Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | | |
Collapse
|
38
|
Andrew P, Hamad Y, Jerat S, Montenero A, O’Connor S. Approaching a decade of cryo catheter ablation for type 1 atrial flutter—a meta-analysis and systematic review. J Interv Card Electrophysiol 2011; 32:17-27. [DOI: 10.1007/s10840-011-9582-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 04/18/2011] [Indexed: 11/27/2022]
|
39
|
Long-term follow-up after catheter ablation for atrioventricular nodal reentrant tachycardia: a comparison of cryothermal and radiofrequency energy in a large series of patients. J Interv Card Electrophysiol 2010; 30:55-61. [PMID: 21153914 PMCID: PMC3034882 DOI: 10.1007/s10840-010-9530-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 11/08/2010] [Indexed: 11/30/2022]
Abstract
Background Radiofrequency (RF) catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) is highly successful but carries a risk for inadvertent atrioventricular block. Cryoablation (cryo) has the potential to assess the safety of a site before the energy is applied. Purpose The aim of this study was to evaluate the long-term efficacy and safety of cryothermal ablation in a large series of patients and compare it to RF. Methods All consecutive routinely performed AVNRT ablations from our centre between 1999 and 2007 were retrospectively analysed. Results In total, 274 patients were elegible: 150 cryoablations and 124 RF. Overall procedural success was 96% (262/274), and equal in both groups, but nine patients were crossed to another arm. Mean fluoroscopy time was longer in the group treated with RF (27 ± 22 min vs. cryo 19 ± 15 min; p = 0.002). Mean procedure time was not different (RF 138 ± 71 min vs. cryo 146 ± 60 min). A permanent pacemaker was necessary in two RF patients. The questionnaire revealed a high incidence of late arrhythmia related symptoms (48%), similar in both groups, with improved perceived quality of life. The number of redo procedures for AVNRT over 4.3 ± 2.5-years follow-up was not statistically different (11% after cryo and 5% after RF). Conclusions Our data confirm that cryo and RF ablation with 4-mm tip catheters for AVNRT are equally effective, even after long-term follow-up.
Collapse
|
40
|
STERN JOSHUAD, ROLNITZKY LINDA, GOLDBERG JUDITHD, CHINITZ LARRYA, HOLMES DOUGLASS, BERNSTEIN NEILE, BERNSTEIN SCOTTA, KHAIRY PAUL, AIZER ANTHONY. Meta-Analysis to Assess the Appropriate Endpoint for Slow Pathway Ablation of Atrioventricular Nodal Reentrant Tachycardia. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:269-77. [DOI: 10.1111/j.1540-8159.2010.02948.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
41
|
Schwagten B, Van Belle Y, Jordaens L. Cryoablation: how to improve results in atrioventricular nodal reentrant tachycardia ablation? Europace 2010; 12:1522-5. [PMID: 20719780 PMCID: PMC2963480 DOI: 10.1093/europace/euq294] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Ablation for atrioventricular nodal reentry tachycardia is very effective, with a potential for damage to the normal conduction system. Cryoablation is an alternative, as it allows cryomapping, which permits assessment of slow pathway elimination at innocent freezing temperatures, avoiding permanent damage to the normal conduction system. It is associated with shorter radiation times and the absence of heart block in all published data. We discuss in this overview different approaches of cryoenergy delivery (focusing on spot catheter ablation), and how lesion formation is influenced by catheter tip size, application duration, and freezing rate. Some advantages of cryoenergy are explained. Whether these features also apply for an approach with a cryoballoon, e.g. for atrial fibrillation is unclear.
Collapse
Affiliation(s)
| | | | - Luc Jordaens
- Corresponding author. Tel: +31 10 463 2699; Fax: +31 10 463 2701, E-mail:
| |
Collapse
|
42
|
CHAN NGAIYIN, CHOY CHICHUNG, LAU CHUNLEUNG, LO YINGKEUNG, CHU PUISHAN, YUEN HOCHUEN, CHOI YUENCHOI, LAU SUETTING. Cryoablation versus Radiofrequency Ablation for Atrioventricular Nodal Reentrant Tachycardia: Patient Pain Perception and Operator Stress. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 34:2-7. [DOI: 10.1111/j.1540-8159.2010.02858.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
43
|
Bastani H. Cryoablation versus radiofrequency ablation for treatment of atrioventricular nodal reentrant tachycardia. Heart Rhythm 2010; 7:S1547-5271(10)00571-0. [PMID: 20685622 DOI: 10.1016/j.hrthm.2010.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Indexed: 11/21/2022]
|
44
|
CZOSEK RICHARDJ, ANDERSON JEFFERY, MARINO BRADLEYS, CONNOR CHAD, KNILANS TIMOTHYK. Linear Lesion Cryoablation for the Treatment of Atrioventricular Nodal Re-entry Tachycardia in Pediatrics and Young Adults. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2010; 33:1304-11. [DOI: 10.1111/j.1540-8159.2010.02811.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
45
|
Cryoablation versus radiofrequency ablation for treatment of atrioventricular nodal reentrant tachycardia: Cryoablation with 6-mm-tip catheters is still less effective than radiofrequency ablation. Heart Rhythm 2010; 7:340-3. [DOI: 10.1016/j.hrthm.2009.11.029] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 11/28/2009] [Indexed: 11/18/2022]
|
46
|
Makhoul M, Von Bergen NH, Rabi F, Gingerich J, Evans WN, Law IH. Successful transcatheter cryoablation in infants with drug-resistant supraventricular tachycardia: a case series. J Interv Card Electrophysiol 2010; 29:209-15. [DOI: 10.1007/s10840-009-9456-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Accepted: 10/25/2009] [Indexed: 10/20/2022]
|
47
|
Atienza F, Almendral J, Sánchez-Quintana D, Zaballos M, Murillo M, Jimeno C, Parra V, Fernández-Avilés F. Cryoablation time-dependent dose-response effect at minimal temperatures (-80 degrees C): an experimental study. Europace 2009; 11:1538-45. [PMID: 19846431 PMCID: PMC2770697 DOI: 10.1093/europace/eup310] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS To establish a temporal safety window for cryoablation at minimal temperatures and to assess the electrophysiological and histological changes as a function of the application duration. METHODS AND RESULTS Twenty mini-pigs underwent AV nodal cryoablation at -80 degrees C without prior cryomapping. The duration of the cryoapplication following atrioventricular block (AVB) was randomized to 0, 10, 20, 40, or 60 s. Atrioventricular block was obtained in all animals after a median of 3 (1-8 interquartile range) applications. One week later, AV nodal conduction fully recovered in animals with application duration <10 s, whereas persistent AVB incidence increased as a function of time in animals with longer applications duration. Cryoablation application duration following AVB was the only independent predictor of persistent AVB (OR, 1.116; 95% CI, 1.013-1.229; P = 0.026). There was no difference in lesion location or size between animals with vs. those without persistent AVB at 1 week. However, animals randomized to longer application duration demonstrated higher degree of cell destruction and fibrotic content. CONCLUSION In this closed-chest pig model, there was a relation between cryoapplication duration following AVB at -80 degrees C and recovery of conduction. A safety window of at least 10 s was observed in all cases.
Collapse
Affiliation(s)
- Felipe Atienza
- Cardiology Department, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Amara W, De Sisti A, Tonet J. [AV nodal reentrant tachycardias: what is the place of cryoablation?]. Ann Cardiol Angeiol (Paris) 2009; 58:299-303. [PMID: 19819422 DOI: 10.1016/j.ancard.2009.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2009] [Accepted: 08/28/2009] [Indexed: 11/18/2022]
Abstract
Radiofrequency ablation is the reference method for the interventional treatment of AV nodal reentrant tachycardias. Even if risks are low, one of the complications of radiofrequency ablation is auriculoventricular block. Cryoablation is an alternative to radiofrequency ablation. The most important advantage of this technique is a lack of permanent AV-block. This article reviews principles of cryotherapy, its main results in ablation of AV nodal reentrant tachycardias, its advantages and disadvantages. A proposal is made about its indications.
Collapse
Affiliation(s)
- W Amara
- Unité de Rythmologie, GHI Le Raincy-Montfermeil, Montfermeil, France.
| | | | | |
Collapse
|
49
|
Bastani H, Schwieler J, Insulander P, Tabrizi F, Braunschweig F, Kenneback G, Drca N, Sadigh B, Jensen-Urstad M. Acute and long-term outcome of cryoablation therapy of typical atrioventricular nodal reentrant tachycardia. Europace 2009; 11:1077-82. [DOI: 10.1093/europace/eup177] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
50
|
Chan NY, Mok NS, Lau CL, Lo YK, Choy CC, Lau ST, Choi YC. Treatment of atrioventricular nodal re-entrant tachycardia by cryoablation with a 6 mm-tip catheter vs. radiofrequency ablation. Europace 2009; 11:1065-70. [DOI: 10.1093/europace/eup121] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|