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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.
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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
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2
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Devecchi C, Matta M, Magnano M, Dell'Era G, Galiffa VA, Renaudo D, Negro A, Occhetta E, Patti G, Rametta F. Voltage and propagation mapping: New tools to improve successful ablation of atrioventricular nodal reentry tachycardia. J Cardiovasc Electrophysiol 2024; 35:942-949. [PMID: 38462681 DOI: 10.1111/jce.16234] [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: 10/14/2023] [Revised: 01/25/2024] [Accepted: 02/19/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Mapping system is useful in ablation of atrioventricular nodal reentry tachycardia (AVNRT) and localization of anatomic variances. Voltage mapping identifies a low voltage area in the Koch triangle called low-voltage-bridge (LVB); propagation mapping identifies the collision point (CP) of atrial wavefront convergence. We conducted a prospective study to evaluate the relationship between LVB and CP with successful site of ablation and identify standard value for LVB. MATERIALS AND METHODS Three-dimensional (3D) maps of the right atria were constructed from intracardiac recordings using the ablation catheter. Cut-off values on voltage map were adjusted until LVB was observed. On propagation map, atrial wavefronts during sinus rhythm collide in the site representing CP, indicating the area of slow pathway conduction. Ablation site was selected targeting LVB and CP site, confirmed by anatomic position on fluoroscopy and atrioventricular ratio. RESULTS Twenty-seven consecutive patients were included. LVB and CP were present in all patients. Postprocedural evaluation identified standard cut-off of 0.3-1 mV useful for LVB identification. An overlap between LVB and CP was observed in 23 (85%) patients. Procedure success was achieved in all patient with effective site at first application in 22 (81%) patients. There was a significant correlation between LVB, CP, and the site of effective ablation (p = .001). CONCLUSION We found correlation between LVB and CP with the site of effective ablation, identifying a voltage range useful for standardized LVB identification. These techniques could be useful to identify ablation site and minimize radiation exposure.
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Affiliation(s)
- Chiara Devecchi
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
| | - Mario Matta
- Division of Cardiology, AOU Città della Salute e della Scienza, Torino, Italy
| | - Massimo Magnano
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
| | | | | | | | | | - Eraldo Occhetta
- Division of Cardiology, Ospedale Sant'Andrea, Vercelli, Italy
| | - Giuseppe Patti
- Division of Cardiology, AOU Maggiore della Carità, Novara, Italy
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
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Leung LW, Evranos B, Gonna H, Harding I, Domenichini G, Gallagher MM. Multi-catheter cryotherapy for the treatment of resistant accessory pathways. Indian Pacing Electrophysiol J 2024; 24:1-5. [PMID: 37977548 PMCID: PMC10927982 DOI: 10.1016/j.ipej.2023.11.002] [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: 08/27/2023] [Revised: 10/25/2023] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation. BACKGROUND Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods. METHODS Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA). RESULTS Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation. CONCLUSION Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
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Affiliation(s)
- Lisa Wm Leung
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Banu Evranos
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Hanney Gonna
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Idris Harding
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Giulia Domenichini
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK
| | - Mark M Gallagher
- Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK.
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Fukuda R, Nakahara S, Wakamatsu Y, Hori Y, Nishiyama N, Sato H, Aoki H, Mizutani Y, Kobayashi S, Ishikawa T, Taguchi I. Cryofreezing for slow-pathway modification in patients with slow-fast AVNRT: Efficacy, safety, and electroanatomical relation between sites of transient AV block and sites of successful cryoablation. J Cardiovasc Electrophysiol 2021; 32:3135-3142. [PMID: 34582058 DOI: 10.1111/jce.15257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 08/11/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Cryoablation has emerged as an alternative to radiofrequency ablation for treating atrioventricular nodal reentrant tachycardia (AVNRT). The aim of this prospective study was to evaluate the efficacy and safety of cryoapplication at sites within the mid/high septal region of Koch's triangle and the relation between sites of transient AV block (AVB) and sites of successful cryoablation. METHODS AND RESULTS Included were 45 consecutive patients undergoing slow-fast AVNRT cryoablation. Initial delivery of cryoenergy was to the mid-septal to high septal region of Koch's triangle. Transient AVB occurred during cryoenergy delivery in 62% (28/45) of patients. Median distance between sites at which cryofreezing successfully eliminated slow pathway conduction and sites of AVB was 4.0 (3.25-5.0) mm. Sites of successful cryoablation tended to be to the left and inferior to the AVB sites. The atrial/ventricular electrogram ratio was significantly lower at sites of successful cryoablation than at AVB sites (0.25 [0.17-0.56] vs. 0.80 [0.36-1.25], p < .001). Delayed discrete or fractionated atrial electrograms were recorded more frequently at sites of successful cryoablation than at AVB sites (78% vs. 20%, p < .001). No persistent AV conduction disturbance occurred, and 96% (43/45) of patients showed absence of recurrence at a median follow-up time of 25.0 months. CONCLUSION Cryoablation of slow-fast AVNRT and targeting the mid/high septal region of Koch's triangle was highly successful. AVB frequently emerged near the site at which the slow pathway was eliminated but always resolved by regulating the energy delivery under careful monitoring, and it may be distinguishable by its local electrogram features.
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Affiliation(s)
- Reiko Fukuda
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Shiro Nakahara
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Yuichi Hori
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Naoki Nishiyama
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hirotsugu Sato
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Hideyuki Aoki
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Yukiko Mizutani
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Sayuki Kobayashi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Tetsuya Ishikawa
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
| | - Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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von Olshausen G, Jemtrén A, Schwieler J, Tapanainen J, Bourke T, Paul-Nordin A, Benson L, Saluveer O, Kennebäck G, Braunschweig F, Drca N. Cryoablation of atypical atrioventricular nodal reentry tachycardia. J Cardiovasc Electrophysiol 2021; 32:2971-2978. [PMID: 34535930 DOI: 10.1111/jce.15244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/13/2021] [Accepted: 09/06/2021] [Indexed: 12/29/2022]
Abstract
AIM Data on ablation for atypical recurrent atrioventricular nodal reentry tachycardia (AVNRT) and long-term follow-up are generally sparse. Furthermore, the rate of recurrence and safety of cryoablation for atypical AVNRT has not been established. We compared patients cryoablated for atypical AVNRT and typical AVNRT during long-term follow-up. METHODS All patients (n = 2612) who underwent catheter ablation for AVNRT at the Karolinska University Hospital between January 2009 and August 2019 were analyzed. A total of 91 patients undergoing first-time cryoablation for atypical AVNRT were included. A control group with first-time cryoablation for typical AVNRT was matched in a 1:1 ratio. Patients were followed-up for recurrences for a median of 5.0 years (interquartile range: 3.1-7.5 years). RESULTS After 5 years, AVNRT recurrence occurred in 10 patients (11.0%) in the atypical AVNRT group and in 8 patients (8.8%) in the typical AVNRT group (hazard ratio: 1.31 [95% confidence interval: 0.52-3.32]; p = 0.568). The duration of the index procedure was significantly longer for atypical compared to typical AVNRT ablation (132.1 ± 49.2 min vs. 110.1 ± 38.8 min; p = 0.001). Transient AV blocks occurred in a similar fashion in the atypical compared to typical group (11 [12.1%] vs. 4 [4.9%]; p = 0.103). However, no ablation induced persistent AV block developed in either group. CONCLUSION Cryoablation for atypical AVNRT showed similar rate of recurrences and safety compared to typical AVNRT during long-term follow-up.
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Affiliation(s)
- Gesa von Olshausen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anette Jemtrén
- Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, St. Göran's Hospital, Stockholm, Sweden
| | - Jonas Schwieler
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jari Tapanainen
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Tara Bourke
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Astrid Paul-Nordin
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
| | - Lina Benson
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Ott Saluveer
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Göran Kennebäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Frieder Braunschweig
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Nikola Drca
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
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6
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Zweerink A, Bakelants E, Stettler C, Burri H. Cryoablation vs. radiofrequency ablation of the atrioventricular node in patients with His-bundle pacing. Europace 2021; 23:421-430. [PMID: 33241283 DOI: 10.1093/europace/euaa344] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Radiofrequency ablation (RFA) of the atrioventricular node (AVN) with His-bundle pacing (HBP) can cause rise in capture thresholds. Cryoablation (CRYO) may offer reversibility in case of threshold rise but has never been tested for AVN ablation in this setting. Our aim was to compare procedural characteristics and outcome of CRYO compared with RFA for AVN ablation in patients with HBP. METHODS AND RESULTS Forty-four patients with HBP underwent AVN ablation for an 'ablate and pace' indication. Cryoablation was performed in the first 22 patients and RFA in the following 22 patients. Procedural characteristics, success rates, and change in His capture thresholds were compared between groups. Distance from the ablation site to the His lead was measured using biplane fluoroscopy. Acute success was 100% with both strategies. Median procedural duration was significantly longer for CRYO {50 [interquartile range (IQR) 38-63] min} compared with RFA [36 (IQR, 30-41) min; P = 0.027]. An acute threshold rise of ≥1 V was observed in four CRYO (one complete loss of capture) and three RFA patients (P = 0.38), with all of the applications being within 6 mm of the His lead tip. During follow-up, nine patients had AVN re-conduction (six CRYO vs. three RFA; P = 0.58), but only four patients required a redo procedure (all CRYO; P = 0.09). CONCLUSION Cryoablation does not offer any advantage over RFA for AVN ablation in patients with HBP and tended to require more redo procedures. If possible, a distance of ≥6 mm should be maintained from the His lead tip to avoid a rise in capture thresholds.
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Affiliation(s)
- Alwin Zweerink
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Elise Bakelants
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Carine Stettler
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
| | - Haran Burri
- Department of Cardiology, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211 Geneva, Switzerland
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Catheter ablation via the left atrium for atrioventricular nodal reentrant tachycardia: A narrative review. Heart Rhythm O2 2021; 2:187-200. [PMID: 34113921 PMCID: PMC8183875 DOI: 10.1016/j.hroo.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Since 1996, it has been recognized that catheter ablation for atrioventricular nodal reentrant tachycardia (AVNRT) may require an approach through the left atrium. Objective The purposes are to present a case report and to provide a comprehensive narrative review on this topic. Methods A literature review of all articles that provided detailed information on patients who underwent catheter ablation via the left atrium for AVNRT was performed. The primary search queried PubMed using Medical Subject Headings (MeSH) terms "atrioventricular nodal reentrant tachycardia" and "left." The secondary search was performed by manual review of reference lists and Google Scholar citations of manuscripts retrieved by the primary search. The review was limited to the English language. Results The searches yielded 30 articles that described 79 patients. A case report was added. Therefore, the final review consisted of 80 patients. The prevalence of left atrial ablation for patients with AVNRT undergoing catheter ablation at tertiary care centers was approximately 1%. Failed right atrial ablation, with or without coronary sinus ablation, was the most common indication for left atrial ablation. Pooled data from 3 cohort studies estimated the acute success rate for radiofrequency ablation of the slow pathway at the septal or inferoparaseptal segments of the mitral valve annulus after failed right-sided ablation to be 90%. There were no reports of atrioventricular block requiring permanent pacemaker implantation. Conclusion Catheter ablation of the slow pathway via the left atrium is an important technique for AVNRT cases that are refractory to conventional ablation.
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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.
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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
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Supple GE. Cryoablation: A useful tool in selected cases. J Arrhythm 2020; 36:522-523. [PMID: 32528581 PMCID: PMC7279997 DOI: 10.1002/joa3.12323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gregory E. Supple
- University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
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10
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Technological Advances in Arrhythmia Management Applied to Adults With Congenital Heart Disease. Can J Cardiol 2019; 35:1708-1722. [DOI: 10.1016/j.cjca.2019.06.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 11/21/2022] Open
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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
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Okishige K, Okumura K, Tsurugi T, Yotsukura A, Nanbu T, Sugiura H, Sanada A, Kondo Y, Takano M, Keida T, Fujita M, Kamiya H, Tsuchiya K, Adachi K, Katoh Y, Hiroshima K, Yamamoto K, Ashikaga K, Hoshiyama T, Sasano T, Hirao K. Japan ablation registry: cryoablation in atrioventricular nodal reentrant tachycardia (“JARCANRET study”): results from large multicenter retrospective investigation. J Interv Card Electrophysiol 2019; 58:289-297. [DOI: 10.1007/s10840-019-00585-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 06/18/2019] [Indexed: 11/28/2022]
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13
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Efficacy and safety of cryoablation of para-Hisian and mid-septal accessory pathways using a specific protocol: single-center experience in consecutive patients. J Interv Card Electrophysiol 2019; 55:47-54. [DOI: 10.1007/s10840-018-0498-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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14
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Gordon JP, Liang JJ, Pathak RK, Zado ES, Garcia FC, Hutchinson MD, Santangeli P, Schaller RD, Frankel DS, Marchlinski FE, Supple GE. Percutaneous cryoablation for papillary muscle ventricular arrhythmias after failed radiofrequency catheter ablation. J Cardiovasc Electrophysiol 2018; 29:1654-1663. [DOI: 10.1111/jce.13716] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 08/06/2018] [Accepted: 08/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Jeffrey P. Gordon
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Jackson J. Liang
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Rajeev K. Pathak
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Erica S. Zado
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Fermin C. Garcia
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Mathew D. Hutchinson
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Pasquale Santangeli
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Robert D. Schaller
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - David S. Frankel
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Francis E. Marchlinski
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
| | - Gregory E. Supple
- Electrophysiology Section, Division of CardiologyHospital of the University of Pennsylvania, Perelman School of Medicine, University of PennsylvaniaPhiladelphia Pennsylvania
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15
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Ávila P, Bessière F, Mondésert B, Abadir S, Dore A, Mongeon FP, Dubuc M, Khairy P. Cryoablation for Perinodal Arrhythmia Substrates in Patients With Congenital Heart Disease and Displaced Atrioventricular Conduction Systems. JACC Clin Electrophysiol 2018; 4:1328-1337. [DOI: 10.1016/j.jacep.2018.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 05/22/2018] [Accepted: 05/29/2018] [Indexed: 11/26/2022]
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16
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Carnlöf C, Iwarzon M, Jensen-Urstad M, Gadler F, Insulander P. Women with PSVT are often misdiagnosed, referred later than men, and have more symptoms after ablation. SCAND CARDIOVASC J 2017; 51:299-307. [DOI: 10.1080/14017431.2017.1385837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Carina Carnlöf
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Iwarzon
- Karolinska Institute of Medicine, Department of Neurobiology, Care Sciences and Society, Huddinge, Sweden
| | - Mats Jensen-Urstad
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Gadler
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Per Insulander
- Karolinska Institute of Medicine, C1-82, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden
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17
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Dechert BE, Dick M, Bradley DJ, LaPage MJ. Variation in Pediatric Post-Ablation Care: A Survey of the Pediatric and Congenital Electrophysiology Society (PACES). Pediatr Cardiol 2017. [PMID: 28620754 DOI: 10.1007/s00246-017-1654-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Although catheter ablation is a standard treatment for pediatric arrhythmias, there are no consensus guidelines for follow-up care. This study describes the variation in post-ablation practices identified through a survey of the pediatric and congenital electrophysiology society (PACES). Pediatric and congenital electrophysiology society members were invited to participate in an online survey of post-ablation practices in September 2014. Survey questions targeted routine post-ablation practices for three common arrhythmia substrates: atrioventricular nodal reentry tachycardia, concealed accessory pathways (AP), and manifest APs. Significant practice variation was defined as <90% concordance among respondents. There were 70 respondents from 67 centers, 29 (41%) in practice for <10 years. Uniform practices included aspirin after left side ablation by 65 (93%), immediate post-procedure ECG by 63 (90%), and performance of outpatient follow-up in 69 (99%) including ECG in 97-100% depending on substrate. The majority, 57 (81%), have standardized follow-up independent of substrate. Post-procedural observation is highly variable, with 25 (36%) discharging patients on the day of ablation, 22 (33%) observing patients in hospital overnight, and 21 (30%) basing hospitalization on pre-defined criteria. Immediate post-procedure echo is performed after all ablations in only 16 (23%). Discharge from outpatient care occurs at a median time of 12 months for each arrhythmia substrate. Common post-ablation practices are evident among pediatric electrophysiologists. However, they report significant variation in post-procedure monitoring practices and testing. The rationale for these variances, and their impact on costs and outcomes, should be defined.
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Affiliation(s)
- Brynn E Dechert
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA.
| | - Macdonald Dick
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA
| | - David J Bradley
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA
| | - Martin J LaPage
- Division of Pediatric Cardiology, Department of Pediatrics and Communicable Disease, C.S. Mott Children's Hospital, University of Michigan, 11th Floor Pediatric Cardiology, 1540 E. Hospital Dr, Ann Arbor, MI, 48109, USA
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18
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Insulander P, Bastani H, Braunschweig F, Drca N, Kennebäck G, Schwieler J, Tapanainen J, Jensen-Urstad M. Cryoablation of atrioventricular nodal re-entrant tachycardia: 7-year follow-up in 515 patients-confirmed safety but very late recurrences occur. Europace 2017; 19:1038-1042. [PMID: 27738058 DOI: 10.1093/europace/euw145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/27/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Cryoablation is an alternative method to radiofrequency ablation for treatment of atrioventricular nodal re-entrant tachycardia (AVNRT). This study investigates the long-term safety and efficacy of cryoablation in AVNRT. Methods and results We studied 515 consecutive patients (317 women, mean age 50 years, range 13-89 years) undergoing a first cryoablation for AVNRT between 2003 and 2008. Ablations were performed with a 6-mm Freezor Xtra catheter. Six patients were acute failures; 494 out of 509 (97%) primarily successfully ablated patients were followed up for a mean of 7.1 years (range 2-12 years). About 11% (54/494 patients) of patients had recurrences of the index arrhythmia. Time to recurrence varied from days to 9 years; 14 patients (3%) had recurrences later than 2 years, 8 patients (2%) later than 3 years, and 6 patients (2%) later than 4 years. Recurrence rate was higher in patients with slow-slow or fast-slow AVNRT (n = 24) compared with the common slow-fast variant (25 vs. 10%; P = 0.04). Recurrence rate was not higher in patients with residual slow pathway conduction (jump with or without echo beat, n = 199, 39%). Transient atrioventricular (AV) block of the first-, second-, or third-degree during ablation was observed in 45 patients but had no impact on the risk of AVNRT recurrence. No late AV block occurred. Single vs. multiple applications or total amount of cryoenergy delivered did not differ between patients with and without recurrences. Conclusion Cryoablation in AVNRT is safe with a long-term efficacy of 88%; however, very late recurrences occur.
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19
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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
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20
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Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation. J Interv Card Electrophysiol 2016; 48:333-341. [DOI: 10.1007/s10840-016-0208-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/30/2016] [Indexed: 10/20/2022]
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21
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Backhoff D, Klehs S, Müller MJ, Schneider HE, Kriebel T, Paul T, Krause U. Long-Term Follow-Up After Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Children. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.116.004264. [DOI: 10.1161/circep.116.004264] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 08/29/2016] [Indexed: 11/16/2022]
Abstract
Background—
Catheter ablation of the slow conducting pathway (SP) is treatment of choice for atrioventricular nodal reentrant tachycardia (AVNRT). Although there are abundant data on AVNRT ablation in adult patients, little is known about the long-term results ≥3 years after AVNRT ablation in pediatric patients.
Methods and Results—
Follow-up data from 241 patients aged ≤18 years who had undergone successful AVNRT ablation were analyzed. Median age at ablation had been 12.5 years, and median follow-up was 5.9 years. Radiofrequency current had been used in 168 patients (70%), whereas cryoenergy had been used in 73 patients (30%). Procedural end point of AVNRT ablation had been either SP ablation (no residual dual atrioventricular nodal physiology) or SP modulation (residual SP conduction allowing for a maximum of one atrial echo beat). After the initial AVNRT ablation, calculated freedom from AVNRT was 96% at 1 year, 94% at 3 years, 93% at 5 years, and 89% at 8 years. Age, sex, body weight, the choice of ablation energy, and the procedural end point of AVNRT ablation did not impact freedom from AVNRT. Six of 22 AVNRT recurrences (27%) occurred ≥5 years after ablation. No late complications including atrioventricular block were noted.
Conclusions—
Cumulatively, catheter ablation of AVNRT continued to be effective in >90% of our pediatric patients during the long-term course. A significant part of recurrences occurred >5 years post ablation. Body weight, energy source, and the end point of ablation had no impact on long-term results. No adverse sequelae were noted.
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Affiliation(s)
- David Backhoff
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Sophia Klehs
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Matthias J. Müller
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Heike E. Schneider
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Thomas Kriebel
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Thomas Paul
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
| | - Ulrich Krause
- From the Department of Pediatric Cardiology and Intensive Care Medicine, Georg August University Medical Center, Göttingen, Germany
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22
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Philip Saul J, Kanter RJ, Abrams D, Asirvatham S, Bar-Cohen Y, Blaufox AD, Cannon B, Clark J, Dick M, Freter A, Kertesz NJ, Kirsh JA, Kugler J, LaPage M, McGowan FX, Miyake CY, Nathan A, Papagiannis J, Paul T, Pflaumer A, Skanes AC, Stevenson WG, Von Bergen N, Zimmerman F. PACES/HRS expert consensus statement on the use of catheter ablation in children and patients with congenital heart disease. Heart Rhythm 2016; 13:e251-89. [DOI: 10.1016/j.hrthm.2016.02.009] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Indexed: 11/15/2022]
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23
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Peiker C, Pott C, Eckardt L, Kelm M, Shin DI, Willems S, Meyer C. Dual atrioventricular nodal non-re-entrant tachycardia. Europace 2015; 18:332-9. [DOI: 10.1093/europace/euv056] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/19/2015] [Indexed: 11/14/2022] Open
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24
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A Pilcher Md T, V Saarel Md E. Anatomic Challenges In Pediatric Catheter Ablation. J Atr Fibrillation 2014; 7:1054. [PMID: 27957095 DOI: 10.4022/jafib.1054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 07/02/2014] [Accepted: 07/02/2014] [Indexed: 01/13/2023]
Abstract
Pediatric patients present unique anatomic challenges for catheter ablation. Small patient size requires special adaptation and understanding to perform safe procedures when clinically indicated. The anatomic variations of congenital heart disease also create problems that require pre-procedural preparation for each case in addition to a specialized understanding of a vast anatomic variation and surgical repairs. This understanding coupled with the knowledge of the pathophysiology of arrhythmia disorders and the biophysics of catheter ablation technology are required to perform successful and safe ablation procedures in this special population.
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Affiliation(s)
- Thomas A Pilcher Md
- University of Utah Division of Pediatric Cardiology Located at Primary Children's Hospital Salt Lake City Utah
| | - Elizabeth V Saarel Md
- University of Utah Division of Pediatric Cardiology Located at Primary Children's Hospital Salt Lake City Utah
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25
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Defaye P. How 'cool' is cryoablation in the vicinity of the atrioventricular node? Europace 2013; 16:159-61. [PMID: 24068447 DOI: 10.1093/europace/eut297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pascal Defaye
- Arrhythmia Unit, Cardiology Department, University Hospital, 38043 Grenoble, France
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