Comparison of a 6.5, 10, and 15 mm cryoablation catheter-tip for the treatment of common atrial flutter

Manusama, Randy; Timmermans, Carl; Schoot, Maud van der; Philippens, Suzanne; Rodriguez, Luz‐Maria

doi:10.1093/europace/eus091

Cited by 2 publications

(8 citation statements)

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“…We demonstrated acute efficacy in 30 out of 30 (100%) of patients, without the use of electro‐anatomic navigation, while procedure and fluoroscopy times were reduced compared with those reported in literature. 14 , 17 , 18 A median of 3 + 1 bonus freeze was needed to achieve BCB and 40% of the patients showed BCB after the first freeze. In previous studies, acute success, defined as bidirectional conduction block, is reported in 85‐97% of procedures and in agreement with our findings.…”

Section: Discussionmentioning

confidence: 99%

“… 22 Available cryoablation systems use a focal “point by point” energy delivery, requiring several freeze‐thaw cycles of many minutes. 13 , 14 Ablation using RF requires shorter applications and has no additional thaw time due to the lack of catheter adhesion. Using RF ablation, lines are created using a “drag and burn” method across the CTI followed by selective touch‐up to complete conduction block.…”

Section: Discussionmentioning

confidence: 99%

“…22 Available cryoablation systems use a focal "point by point" energy delivery, requiring several freeze-thaw cycles of many minutes. 13,14 Ablation using RF requires shorter applications and has no additional thaw time due to the lack of catheter adhesion.…”

Section: Acute Success and Procedural Outcomesmentioning

confidence: 99%

“…For both cryoablation and RF ablation, a larger ablation tip is associated with reduced time to achieve conduction block and shorter overall procedure times. 14,20 Consequently, the small number of freezes needed to acquire conduction block further decreased the use of fluoroscopy. (1.44%) as the most frequent, followed by respiratory (0.88%), vascular (0.78%), and neurologic (0.05%) complications.…”

Section: Acute Success and Procedural Outcomesmentioning

confidence: 99%

“…This limits the catheters' overall cooling power, cooling speed, minimum temperature and effective cooling surface, while resulting in a massive gas consumption, mandating multiple applications (freeze‐thaw‐cycles) of several minutes. 12 , 13 , 14 , 15 Although liquid cryogens possess much higher thermal conduction and greater heat capacity than N 2 O, they are difficult to handle in endovascular catheters and considered unreliable and unsafe. Nitrogen near its liquid‐vapor critical point (near‐critical nitrogen) provides a unique solution that can be used in cardiac applications.…”

Section: Introductionmentioning

confidence: 99%

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Ultralow temperature cryoablation using near‐critical nitrogen for cavotricuspid isthmus‐ablation, first‐in‐human results

Klaver

Potter

Iliodromitis

et al. 2021

Cardiovasc electrophysiol

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Introduction: Cryoablation has evolved as a safe alternative to radiofrequency ablation in the treatment of several supraventricular arrhythmias and has potential advantages, yet is limited by the properties of the cryogen used. We investigated a novel ultralow temperature cryoablation (ULTC) system using nitrogen near its liquid-vapor critical point as a freezing source, achieving temperatures as low as -196 degrees Celsius in a long linear catheter with a continuous energy release. Initial safety, procedural and efficacy outcomes of ULTC are described in patients undergoing cavotricuspid isthmus (CTI) ablation. Methods and Results:The Cryocure studies (NCT02355106, NCT02839304) are prospective, single-arm, multi-center, first-in-human clinical studies in 17 patients with atrial flutter (AFL) and 13 patients with atrial fibrillation (AF). A total of 30 patients, mean age 65 ± 8 years old and 67% male, were enrolled and underwent ablation of the CTI. Acute success, defined as the confirmation of stable bidirectional conduction block across the CTI, was achieved in all 30 patients. After 12 months of follow-up, 14 out of 17 AFL patients remained free from any AFL. One (3.3%) procedure-related but not devicerelated serious adverse event was reported, involving transient inferolateral ST-elevation associated with temporary AV conduction block. Conclusion:In this first-in-human clinical study the safety and performance results demonstrate the capabilities of ultralow temperature near-critical nitrogen as an effective energy source for CTI ablation. Ongoing, larger, studies should confirm our findings and evaluate the capabilities to create linear and focal transmural lesions in other arrhythmias.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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Section: Discussionmentioning

confidence: 99%