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Acute and long-term outcome of transvenous cryothermal catheter ablation of supraventricular arrhythmias involving the perinodal region.
J Cardiovasc Med (Hagerstown). 2006 Nov; 7(11):785-92.JC

Abstract

OBJECTIVE

Cryoenergy is a new valuable treatment option to perform ablation close to the atrioventricular (AV) node in the cure of supraventricular tachycardias because of its favourable properties, such as the possibility of creating reversible lesions. The aim of this study was to report our experience on the effectiveness and safety of catheter cryoablation performed in "critical areas" to treat a large cohort of patients with supraventricular arrhythmias.

METHODS

One hundred and thirty-one patients suffering from supraventricular tachycardias underwent catheter cryoablation using a 7F catheter. Eighty-seven patients presented with AV nodal re-entrant tachycardia (AVNRT), 39 had accessory pathways (APs) either manifest or concealed (15 midseptal, 24 parahissian), three had ectopic right atrial tachycardia (AT), and two patients had a permanent junctional reciprocating tachycardia (PJRT). When the optimal parameters were recorded, ice mapping at -30 degrees C was performed for 80 s to validate the ablation site. If the expected result occurred, cryoablation was carried out by lowering the temperature to -75 degrees C for 4 min.

RESULTS

In two patients cryoablation was not performed because of technical reasons. Cryoablation was acutely successful in 84 out of 85 patients with AVNRT, in 37 of 39 with APs and in all patients with AT and PJRT. No complications occurred in any patient. Transient AV conduction impairment occurred in seven patients with midseptal APs and in two patients with AVNRT. In particular, in these patients no late permanent AV block was observed at follow-up. At a mean follow-up of 27 +/- 12.9 months, clinical success rate was 87%.

CONCLUSIONS

Cryoablation is a safe and effective technique with a high success rate in the long term. It may be particularly useful when performing ablation close to the AV node or His bundle owing to the possibility of validating the ablation site with ice mapping, which creates only a reversible lesion, mainly in the midseptal APs.

Authors+Show Affiliations

Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy. gaitaf@libero.itNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

17060803

Citation

Gaita, Fiorenzo, et al. "Acute and Long-term Outcome of Transvenous Cryothermal Catheter Ablation of Supraventricular Arrhythmias Involving the Perinodal Region." Journal of Cardiovascular Medicine (Hagerstown, Md.), vol. 7, no. 11, 2006, pp. 785-92.
Gaita F, Montefusco A, Riccardi R, et al. Acute and long-term outcome of transvenous cryothermal catheter ablation of supraventricular arrhythmias involving the perinodal region. J Cardiovasc Med (Hagerstown). 2006;7(11):785-92.
Gaita, F., Montefusco, A., Riccardi, R., Scaglione, M., Grossi, S., Caponi, D., Caruzzo, E., Giustetto, C., Bocchiardo, M., & Di Donna, P. (2006). Acute and long-term outcome of transvenous cryothermal catheter ablation of supraventricular arrhythmias involving the perinodal region. Journal of Cardiovascular Medicine (Hagerstown, Md.), 7(11), 785-92.
Gaita F, et al. Acute and Long-term Outcome of Transvenous Cryothermal Catheter Ablation of Supraventricular Arrhythmias Involving the Perinodal Region. J Cardiovasc Med (Hagerstown). 2006;7(11):785-92. PubMed PMID: 17060803.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute and long-term outcome of transvenous cryothermal catheter ablation of supraventricular arrhythmias involving the perinodal region. AU - Gaita,Fiorenzo, AU - Montefusco,Antonio, AU - Riccardi,Riccardo, AU - Scaglione,Marco, AU - Grossi,Stefano, AU - Caponi,Domenico, AU - Caruzzo,Enrico, AU - Giustetto,Carla, AU - Bocchiardo,Mario, AU - Di Donna,Paolo, PY - 2006/10/25/pubmed PY - 2007/1/27/medline PY - 2006/10/25/entrez SP - 785 EP - 92 JF - Journal of cardiovascular medicine (Hagerstown, Md.) JO - J Cardiovasc Med (Hagerstown) VL - 7 IS - 11 N2 - OBJECTIVE: Cryoenergy is a new valuable treatment option to perform ablation close to the atrioventricular (AV) node in the cure of supraventricular tachycardias because of its favourable properties, such as the possibility of creating reversible lesions. The aim of this study was to report our experience on the effectiveness and safety of catheter cryoablation performed in "critical areas" to treat a large cohort of patients with supraventricular arrhythmias. METHODS: One hundred and thirty-one patients suffering from supraventricular tachycardias underwent catheter cryoablation using a 7F catheter. Eighty-seven patients presented with AV nodal re-entrant tachycardia (AVNRT), 39 had accessory pathways (APs) either manifest or concealed (15 midseptal, 24 parahissian), three had ectopic right atrial tachycardia (AT), and two patients had a permanent junctional reciprocating tachycardia (PJRT). When the optimal parameters were recorded, ice mapping at -30 degrees C was performed for 80 s to validate the ablation site. If the expected result occurred, cryoablation was carried out by lowering the temperature to -75 degrees C for 4 min. RESULTS: In two patients cryoablation was not performed because of technical reasons. Cryoablation was acutely successful in 84 out of 85 patients with AVNRT, in 37 of 39 with APs and in all patients with AT and PJRT. No complications occurred in any patient. Transient AV conduction impairment occurred in seven patients with midseptal APs and in two patients with AVNRT. In particular, in these patients no late permanent AV block was observed at follow-up. At a mean follow-up of 27 +/- 12.9 months, clinical success rate was 87%. CONCLUSIONS: Cryoablation is a safe and effective technique with a high success rate in the long term. It may be particularly useful when performing ablation close to the AV node or His bundle owing to the possibility of validating the ablation site with ice mapping, which creates only a reversible lesion, mainly in the midseptal APs. SN - 1558-2027 UR - https://www.unboundmedicine.com/medline/citation/17060803/Acute_and_long_term_outcome_of_transvenous_cryothermal_catheter_ablation_of_supraventricular_arrhythmias_involving_the_perinodal_region_ L2 - http://dx.doi.org/10.2459/01.JCM.0000250865.25413.44 DB - PRIME DP - Unbound Medicine ER -