Cryothermal atrial linear ablation in patients with atrial fibrillation: An insight from the comparison with radiofrequency atrial linear ablation

Abstract

Background: Atrial linear lesions are generally created with radiofrequency energy.We sought to evaluate the feasibility of cryothermal atrial linear ablation. Methods and Results: Twenty-one atrial fibrillation (AF) patients underwent linear ablation on the left atrial (LA) roof, mitral isthmus (MI), and cavotricuspid isthmus (CTI) with 8-mm-tip cryocatheters following pulmonary vein isolation. The data were compared with those of 31 patients undergoing linear ablation with irrigated-tip radiofrequency catheters. Conduction block was successfully created in 18 of 20 (90%), 9 of 21 (43%), and 20 of 20 (100%) on the LA roof, MI, and CTI by endocardial cryoablation alone with 19.0 (12.0-24.0), 30.0 (23.0-34.0), and 14.0 (14.0-16.0) minute cryo applications, respectively. The presence of either an interposed circumflex artery or pouch at the MI was significantly associated with failed MI block (P = .04). Conduction block was created in 25 of 31 (83.9%), 27 of 31 (87.1%), and 30 of 31 (96.8%) on the roof, MI, and CTI, respectively, by radiofrequency ablation.During the 17.5 (13.0-31.7) months of follow-up, freedom from AF/atrial tachycardia (AT) was significantly higher in the cryo group (P = .05); especially, recurrent AT was more frequent in the RF group (8/31 vs 1/21; P = .03). Conduction block across the roof, MI, and CTI was durable in 6 of 12 (50.0%), 4 of 12 (33.3%), and 9 of 12 (75.0%) patients during second procedures. All nine patients (except one) with recurrent ATs had at least one roof or MI conduction resumption.Conclusions: Cryoablation is effective for creating a roof and CTI linear block, however, creating MI block by endocardial ablation alone was often challenging. Conduction resumption of LA linear block is common and recurrent arrhythmias, especially iatrogenic ATs, are more frequently observed after radiofrequency linear ablation.

Remote vascular interventional surgery robotics: a literature review

“…The operation process does not require a guidewire, but occurs under the guidance of the steerable electrophysiological catheter, itself. The ablation instrument installed on the catheter head tip releases a radiofrequency current to treat the target tissue (6,7).…”

“…Vascular interventional surgery robots are commonly designed for angioplasty, vascular embolization, or radiofrequency ablation. The interventional instruments operated by surgical robots also vary depending on the surgical scenario (5)(6)(7)(8). Related commercial products have been certified and employed for clinical use in various fields.…”

Remote Vascular Interventional Surgery Robotics: A Review

“…The operation process does not require a guidewire, but under the guidance of steerable electrophysiological catheter itself. The ablation instrument installed on the catheter head tip releases radio frequency current to treat the target tissue [6,7]. Interventional surgery robots designed for electrophysiological therapy are mainly to manipulate EP catheters.…”

“…Common vascular interventional surgical robots are designed for angioplasty, vascular embolization, or radiofrequency ablation. The interventional instruments operated by surgical robots are also different in different surgical scenarios [5][6][7][8]. Related commercial products in various fields have been certified and put into clinical use.…”

The Long-Term Results of Three Catheter Ablation Methods in Patients With Paroxysmal Atrial Fibrillation: A 4-Year Follow-Up Study

“…The PV must be treated for a shorter time with cryoablation than with RCA, and there are fewer postoperative complications ( 9 , 10 ). Cryoablation produces a clear boundary, less thrombosis, and a lower incidence of cardiac perforation ( 11 , 12 ).…”