Single cryothermia applications of less than five minutes produce permanent cavotricuspid isthmus block in humans

Manusama, Randy; Timmermans, Carl; Philippens, Suzanne; Crijns, Harry J.G.M.; Ayers, Gregory M.; Rodriguez, Luz‐Maria

doi:10.1016/j.hrthm.2004.07.008

Cited by 16 publications

(8 citation statements)

References 32 publications

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“…Using a 9Fr, 8 mm tip increased success rates to100% with symptomatic recurrence of 0% to 10% and recurrent conduction at 1 to 3 months in 19% to 32% [ 32 – 34 ]. There is some discussion as to whether 3, 4 or 8 min of ablation are needed for adequate lesion formation [ 33 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters

Thornton

Janse

Alings

et al. 2008

J Interv Card Electrophysiol

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ObjectivesTo compare the acute success and short-term follow-up of ablation of atrial flutter using 8 mm tip radiofrequency (RF) and cryocatheters.MethodsSixty-two patients with atrial flutter were randomized to RF or cryocatheter (cryo) ablation. Right atrial angiography was performed to assess the isthmus. End point was bidirectional isthmus block on multiple criteria. A pain score was used and the analgesics were recorded. Patients were followed for at least 3 months.ResultsThe acute success rate for RF was 83% vs 69% for cryo (NS). Procedure times were similar (mean 144 ± 48 min for RF, vs 158 ± 49 min for cryo). More applications were given with RF than with cryo (26 ± 17 vs. 18 ± 10, p < 0.05). Fluoroscopy time was longer with RF (29 ± 15 vs. 19 ± 12 min, p < 0.02). Peak CK, CK-MB and CK-MB mass were higher, also after 24 h in the cryo group. Troponin T did not differ. Repeated transient block during application (usually with cryoablation) seemed to predict failure. Cryothermy required significantly less analgesia (p < 0.01), and no use of long sheaths (p < 0.005).The isthmus tended to be longer in the failed procedures (p = 0.117). This was similar for both groups, as was the distribution of anatomic variations. Recurrences and complaints in the successful patients were similar for both groups, with a very low recurrence of atrial flutter after initial success.ConclusionsIn this randomized study there was no statistical difference but a trend to less favorable outcome with 8 mm tip cryocatheters compared to RF catheters for atrial flutter ablation. Cryoablation was associated with less discomfort, fewer applications, shorter fluoroscopy times and similar procedure times. The recurrence rate was very low. Cryotherapy can be considered for atrial flutter ablation under certain circumstances especially when it has been used previously in the same patient, such as in an AF ablation.

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Section: Discussionmentioning

confidence: 99%

Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters

Thornton

Janse

Alings

et al. 2008

J Interv Card Electrophysiol

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“…Entrainment to confirm the isthmus dependence of the AFL circuit was performed in every patient in whom AFL was present or could be induced at the start of the procedure, according to previously published techniques [ 2 , 10 , 15 , 16 , 20 , 21 ]. If AF, requiring cardioversion, was present or developed during stimulation or if we were unable, even under isoproterenol infusion, to induce AFL, CTI ablation was performed during sinus rhythm.…”

Section: Methodsmentioning

confidence: 99%

Long term outcome of cavotricuspid isthmus cryoablation for the treatment of common atrial flutter in 180 patients: A single center experience

Moreira

Timmermans

Wellens

et al. 2008

J Interv Card Electrophysiol

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Objective Recent literature has shown that common type atrial flutter (AFL) can recur late after cavotricuspid isthmus (CTI) catheter ablation using radiofrequency energy (RF). We report the long term outcome of a large group of patients undergoing CTI ablation using cryothermy for AFL in a single center. Methods Patients with AFL referred for CTI ablation were recruited prospectively from July 2001 to July 2006. Cryoablation was performed using a deflectable, 10.5 F, 6.5 mm tip catheter. CTI block was reassessed 30 min after the last application during isoproterenol infusion. Recurrences were evaluated by 12-lead ECG and 24 h Holter recording every clinic visit (1/3/6/9 and 12 months after the procedure and yearly thereafter) or if symptoms developed. Results The 180 enrolled patients had the following characteristics: 39 women (22%), mean age 58 years, no structural heart disease in 86 patients (48%), mean left atrium diameter 44±7 mm and mean left ventricular ejection fraction 57±7%. The average number of applications per patient was 7 (3 to 20) with a mean temperature and duration of −88°C and 3 min, respectively. Acute success was achieved in 95% (171) of the patients. There were no complications. After a mean follow-up of 27±17 (from 12 to 60) months, the chronic success rate was 91%. The majority of the recurrences occurred within the first year post ablation. One hundred and twenty three patients had a history of atrial fibrillation (AF) prior to CTI ablation and 85 (69%) of those remained having AF after cryoablation. In 20 of 57 (35%) patients without a history of AF prior to CTI ablation, AF occurred during follow-up. Conclusions This prospective study showed a 91% chronic success rate (range 12 to 60 months) for cryoablation of the CTI in patients with common type AFL and ratified the frequent association of AF with AFL.

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“…Compared to the standard 4 mm electrode, irrigated/cooled electrodes decrease the number of lesions required for block and decrease fluoroscopy time. 27,28,50,51 Coole 8-mm tip delivers more power and produces deeper lesions.…”

Section: Ablation Catheter Choicementioning

confidence: 99%

Handbook of Cardiac Electrophysiology

2007

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Single cryothermia applications of less than five minutes produce permanent cavotricuspid isthmus block in humans

Cited by 16 publications

References 32 publications

Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters

Acute success and short-term follow-up of catheter ablation of isthmus-dependent atrial flutter; a comparison of 8 mm tip radiofrequency and cryothermy catheters

Long term outcome of cavotricuspid isthmus cryoablation for the treatment of common atrial flutter in 180 patients: A single center experience

Handbook of Cardiac Electrophysiology

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