Catheter cryoablation of supraventricular tachycardia: results of the multicenter prospective “frosty” trial

Friedman, Peter L.; Dubuc, Marc; Green, Martin S.; Jackman, Warren M.; Keane, David; Marinchak, Roger A.; Nazari, Jose; Packer, Douglas L.; Skanes, Allan C.; Steinberg, Jonathan S.; Stevenson, William G.; Tchou, Patrick; Wilber, David J.; Worley, Seth J.

doi:10.1016/j.hrthm.2004.02.022

Cited by 159 publications

(145 citation statements)

References 13 publications

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“…However, the high rate of recurrence is a limitation in clinical practice. 4,14 In our study, 18 of 20 patients with PH-AP superior to the HB, mapping with the ablation catheter in reverse-C curve was stably achieved in 18 patients. The APs were http://circep.ahajournals.org/ Downloaded from Para-Hisian Ablation rapidly blocked with power of 20 W at the beginning and was achieved after single radiofrequency application in 9 patients, 2 radiofrequency applications in 7 patients, and 3 radiofrequency applications in 4 patients.…”

Section: Mapping and Ablation Of Ph-apsupporting

confidence: 49%

Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans

Xue

Zhan

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background— Ablation of para-Hisian accessory pathway (AP) poses high risks of atrioventricular block. We developed a pacing technique to differentiate the near-field (NF) from far-field His activations to avoid the complication. Methods and Results— Three-dimensional mapping of the right ventricle was performed in 15 mongrel dogs and 23 patients with para-Hisian AP. Using different pacing outputs, the NF- and far-field His activation was identified on the ventricular aspect. Radiofrequency application was delivered at the NF His site in 8 (group 1) and the far-field His site in 7 dogs (group 2), followed by pathologic examination after 14 days. NF His activation was captured with 5 mA/1 ms in 10 and 10 mA/1 ms in 5 dogs. In group 1, radiofrequency delivery resulted in complete atrioventricular block in 3, right bundle branch block with HV (His-to-ventricular) interval prolongation in 1, and only right bundle branch block in 2 dogs, whereas no changes occurred in group 2. Pathologic examination in group-1 dogs showed complete or partial necrosis of the His bundle in 4 and complete necrosis of the right bundle branch in 5 dogs. In group 2, partial necrosis in the right bundle branch was found only in 1 dog. Using this pacing technique, the APs were 5.7±1.2 mm away from the His bundle located superiorly in 20 or inferiorly in 3 patients. All APs were successfully eliminated with 1 to 3 radiofrequency applications. No complications and recurrence occurred during a follow-up of 11.8±1.4 months. Conclusions— Differentiating the NF His from far-field His activations led to a high ablation success without atrioventricular block in para-Hisian AP patients.

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Section: Mapping and Ablation Of Ph-apsupporting

confidence: 49%

Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans

Xue

Zhan

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…5 Overall, cryoenergy might offer a less aggressive and more titrated way to alter tissue with a better safety profile than RFCA and a comparable success rate. [7][8][9] The use of 6-mm-tip cryoablation catheters seems to enhance short-term success rates. 10,11 The present study was designed as a multicenter prospective randomized trial to test the hypothesis that cryoablation for AVNRT is as effective (both short term and long term) as RFCA with a lower risk of permanent AV block.…”

Section: Clinical Perspective On P 2245mentioning

confidence: 99%

Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study)

et al. 2010

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Background-Cryoablation has emerged as an alternative to radiofrequency catheter ablation (RFCA) for the treatment of atrioventricular (AV) nodal reentrant tachycardia (AVNRT). The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up with a lower risk of permanent AV block. Methods and Results-A total of 509 patients underwent slow pathway cryoablation (nϭ251) or RFCA (nϭ258). The primary end point was immediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-month follow-up. Secondary end points included procedural parameters, device functionality, and pain perception. Significantly more patients in the cryoablation group than the RFCA group reached the primary end point (12.6% versus 6.3%; Pϭ0.018). Whereas immediate ablation success (96.8% versus 98.4%) and occurrence of permanent AV block (0% versus 0.4%) did not differ, AVNRT recurrence was significantly more frequent in the cryoablation group (9.4% versus 4.4%; Pϭ0.029). In the cryoablation group, procedure duration was longer (138Ϯ54 versus 123Ϯ48 minutes; Pϭ0.0012) and more device problems occurred (13 versus 2 patients; Pϭ0.033). Pain perception was lower in the cryoablation group (PϽ0.001). Conclusions-Cryoablation for AVNRT is as effective as RFCA over the short term but is associated with a higher recurrence rate at the 6-month follow-up. The risk of permanent AV block does not differ significantly between cryoablation and RFCA. The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate. Clinical Trial Registration-URL: http://www.clinicaltrials.gov.

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“…Thirdly, complications such as a prolonged PR interval as well as AV blocks during cryo-mapping are completely reversible and are not permanent (2,3), compared to radiofrequency ablation of antero--septal accessory pathways, in which the risk of permanent AV block is reported to be up to 2.7 % (4). Although the acute procedural success rate of cryo-ablation is lower than that of radiofrequency ablation (69 % vs. 93 %), it is preferable to use cryo-ablation when the possibility of permanent AV block is more probable (5). In the case of para-Hisian accessory pathway ablation, cryo-ablation was demonstrated to be safe with no long-term complications (6,7).…”

Section: Discussionmentioning

confidence: 99%

Fluoroless cryo-ablation of para-Hisian accessory pathway

et al. 2017

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We present a case of para-Hisian accessory pathway ablation in a patient with Wolff-Parkinson-White syndrome, which was performed with cryoablation to reduce the possibility of collateral damage to the conduction system of the heart. We also used fluoroless approach to exclude possible harm from radiation exposure, using only intracardial electrograms and three-dimensional (3D) electro--anatomic mapping system to navigate the catheters in the heart. IzvlečekPredstavljamo primer ablacije parahisarne akcesorne poti, ki smo jo opravili pri bolniku s sindromom Wolff-Parkinson-White. Opravili smo krioablacijo, da bi čim bolj zmanjšali možnost poškodbe prevodnega sistema srca med ablacijo. Za usmerjanje katetrov na ustrezna mesta v srcu smo uporabili le znotrajsrčne elektrokardiograme in sistem za tridimenzionalno (3D) mapiranje. Rentgenske diaskopije nismo uporabili, s čimer smo izključili možnost škodljivih vplivov rentgenskega sevanja.

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Catheter cryoablation of supraventricular tachycardia: results of the multicenter prospective “frosty” trial

Cited by 159 publications

References 13 publications

Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans

Experimental, Pathologic, and Clinical Findings of Radiofrequency Catheter Ablation of Para-Hisian Region From the Right Ventricle in Dogs and Humans

Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study)

Fluoroless cryo-ablation of para-Hisian accessory pathway

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