Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter

Abstract

Background-Cryoablation (cryo) has a high success rate in the short-term treatment of atrial flutter (AFL), but evidence of long-term efficacy is lacking. The present study reports the long-term effect of cryo of the cavotricuspid isthmus (CTI) in patients with common AFL. Methods and Results-Thirty-five consecutive patients (28 men; mean age, 53 years) underwent cryo of the CTI. In 34 patients, the AFL had a counterclockwise rotation (cycle length, 242Ϯ43 ms). Eleven patients had structural heart disease. Cryo was performed with a 10F catheter with a 6-mm-tip electrode (CryoCor). Applications (3 to 5 minutes each) were delivered by use of a point-by-point technique to create the ablation line. The acute end point of the procedure was creation of bidirectional isthmus conduction block and noninducibility of AFL. A median of 14 applications (range, 4 to 30) at 10 sites (range, 4 to 19) was given along the CTI with a mean temperature of Ϫ80.0Ϯ5.0°C. Mean fluoroscopy and procedure times were 40Ϯ26 minutes and 3.2Ϯ1.3 hours, respectively. Of the 35 patients, 34 were acutely successfully ablated (97%). After a mean follow-up of 17.6Ϯ6.2 months (range, 9.6 to 26.1 months), 31 patients (89%) did not have recurrence of AFL. Three of the 4 patients with recurrence had a second successful procedure. One patient had transient ST elevation in the inferior leads during cryoapplication. Conclusions-Cryo produces permanent bidirectional isthmus conduction block of the CTI. Short-and long-term success rates are comparable to those for radiofrequency ablation.

Diagnosis and Management of Typical Atrial Flutter

“…Nonetheless, several clinical and preclinical studies have recently been published on the use of catheter cryoablation and microwave ablation for treatment of atrial flutter and other arrhythmias. [51][52][53][54][55][56][57] Recent studies have been reported demonstrating that catheter cryoablation of type 1 AFL can be achieved with similar results to that achieved with radiofrequency ablation. [51][52][53] The potential advantages of cryoablation include the lack of pain associated with ablation, the ability to produce a large transmural ablation lesion, and the lack of tissue charring or coagulum formation.…”

Mapping of Human Atrial Flutter and Its Variants

“…Several clinical and preclinical studies have recently been published on the use of catheter cryoablation and microwave ablation of AFL [43][44][45][46][47][48]. Recent studies have demonstrated that catheter cryoablation of typical AFL can be achieved with results similar to radio-frequency ablation [43,44]. The potential advantages of cryoablation include less pain associated with ablation, and the lack of tissue charring or coagulum formation.…”

Transvenous radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia and its pitfalls: A rationale for cryoablation?

“…For atrioventricular reentry tachycardia (AVRT) and pulmonary vein isolation the success rates tend to be lower than for RF [33 -37]. However, comparable success rates are achieved in atrial flutter ablation [38,39]. The same conflicting results are obtained for the rates of arrhythmia recurrences and procedure times [19,26,28 -30,33].…”