(Circulation. 2000;102:2856.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Cryothermal Ablation of the Slow Pathway for the Elimination of Atrioventricular Nodal Reentrant Tachycardia
From the Arrhythmia Services, University of Western Ontario, and the Institut de Cardiologie de Montreal (M.D., D.R., P.G., M.T.), Montreal, Quebec, Canada.
Correspondence to Allan C. Skanes, Arrhythmia Service, Division of Cardiology, London Health Sciences Centre, University Campus, 339 Windermere Rd, London, Ontario N6A 5A5. E-mail allan.skanes{at}lhsc.on.ca
Background—We report the first successful slow pathway ablation using a novel catheter-based cryothermal technology for the elimination of atrioventricular nodal reentrant tachycardia (AVNRT).
Methods and Results—Eighteen patients with typical AVNRT underwent cryoablation. Reversible loss of slow pathway (SP) conduction during cryothermy (ice mapping) was demonstrated in 11 of 12 patients. Because of time constraints, only 2 sites were ice mapped in 1 patient. Seventeen of 18 patients had successful cryoablation of the SP. One patient had successful ice mapping of the SP, but inability to cool beyond -38°C prevented successful cryoablation. A single radiofrequency lesion at this site eliminated SP conduction. No patient has had recurrent AVNRT over 4.9±1.7 months of follow-up. During cryoablation, accelerated junctional tachycardia was not seen and was therefore not available to guide lesion delivery. Adherence of the catheter tip during cryothermy (cryoadherence) allowed atrial pacing to test for SP conduction. Cryoablation in the anterior septum produced inadvertent transient PR prolongation consistent with loss of fast pathway conduction in 1 patient and transient (6.5 seconds) 2:1 AV block in another. On rewarming, the PR interval returned to normal, and the AV nodal effective refractory period was unchanged in both. Accelerated junctional tachycardia was seen on rewarming in both but not during cryothermy.
Conclusions—Cryothermal ablation of the SP was achieved in patients with this novel technique. Successful ice mapping of both the SP and fast pathway was demonstrated. The ability to test the functionality of specific ablation sites before production of a permanent lesion may eliminate inadvertent AV block.
Key Words: catheter ablation • atrioventricular node • tachycardia • arrhythmia • mapping
This article has been cited by other articles:
 |
|
 |
|
  W. Moreira, R. Manusama, C. Timmermans, B. Ghaye, S. Philippens, H. J.J. Wellens, and L.-M. Rodriguez Long-Term Follow-Up After Cryothermic Ostial Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation J. Am. Coll. Cardiol., February 26, 2008; 51(8): 850 - 855. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. E. Eckart and L. M. Epstein Interventional Therapy for Atrial and Ventricular Arrhythmias Card. Surg. Adult, January 1, 2008; 3(2008): 1357 - 1374. [Full Text]
|
|
|
|
 |
|
 H. Nakagawa and W. M. Jackman Catheter Ablation of Paroxysmal Supraventricular Tachycardia Circulation, November 20, 2007; 116(21): 2465 - 2478. [Full Text] [PDF]
|
|
|
|
 |
|
 E. Gonzalez-Torrecilla, A. Arenal, F. Atienza, and J. Almendral Transient atrioventricular block shortly after uneventful cryoablation of atrioventricular nodal re-entrant tachycardias: report of two cases Europace, October 1, 2007; 9(10): 927 - 930. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Khairy, P. G. Novak, P. G. Guerra, I. Greiss, L. Macle, D. Roy, M. Talajic, B. Thibault, and M. Dubuc Cryothermal slow pathway modification for atrioventricular nodal reentrant tachycardia Europace, October 1, 2007; 9(10): 909 - 914. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. De Sisti, J. Tonet, N. Barakett, J. Lacotte, J.F. Leclercq, and R. Frank Transvenous cryo-ablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia: a single-centre initial experience study Europace, June 1, 2007; 9(6): 401 - 406. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G.-J. P. Kimman, D. A.M.J. Theuns, P. A. Janse, M. Rivero-Ayerza, M. F. Scholten, T. Szili-Torok, and L. J. Jordaens One-year follow-up in a prospective, randomized study comparing radiofrequency and cryoablation of arrhythmias in Koch's triangle: clinical symptoms and event recording Europace, August 1, 2006; 8(8): 592 - 595. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A.S. Thornton, P. Janse, D.A.M.J. Theuns, M.F. Scholten, and L.J. Jordaens Magnetic navigation in AV nodal re-entrant tachycardia study: early results of ablation with one- and three-magnet catheters. Europace, April 1, 2006; 8(4): 225 - 230. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. L. Pasquie, J. Scalzi, J. C. Macia, F. Leclercq, and R. Grolleau-Raoux Long-term safety and efficacy of slow pathway ablation in patients with atrioventricular nodal re-entrant tachycardia and pre-existing prolonged PR interval. Europace, February 1, 2006; 8(2): 129 - 133. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Drago, A. De Santis, G. Grutter, and M. S. Silvetti Transvenous cryothermal catheter ablation of re-entry circuit located near the atrioventricular junction in pediatric patients: Efficacy, safety, and midterm follow-up J. Am. Coll. Cardiol., April 5, 2005; 45(7): 1096 - 1103. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Miyazaki, A. D. Blaufox, D. L. Fairbrother, and J. P. Saul Cryo-ablation for septal tachycardia substrates in pediatric patients: Mid-term results J. Am. Coll. Cardiol., February 15, 2005; 45(4): 581 - 588. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Kirsh, G. J. Gross, S. O'Connor, R. M. Hamilton, and Cryocath International Patient Registry Transcatheter cryoablation of tachyarrhythmias in children: Initial experience from an international registry J. Am. Coll. Cardiol., January 4, 2005; 45(1): 133 - 136. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. Zrenner, J. Dong, J. Schreieck, I. Deisenhofer, H. Estner, B. Luani, M. Karch, and C. Schmitt Transvenous cryoablation versus radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia: a prospective randomized pilot study Eur. Heart J., December 2, 2004; 25(24): 2226 - 2231. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G.P. Kimman, D.A.M.J. Theuns, T. Szili-Torok, M.F. Scholten, J.C. Res, and L.J. Jordaens CRAVT: a prospective, randomized study comparing transvenous cryothermal and radiofrequency ablation in atrioventricular nodal re-entrant tachycardia Eur. Heart J., December 2, 2004; 25(24): 2232 - 2237. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. A.M.J. Theuns, G. P. Kimman, T. Szili-Torok, J. C.J. Res, and L. J. Jordaens Ice mapping during cryothermal ablation of accessory pathways in WPW: the role of the temperature time constant Europace, January 1, 2004; 6(2): 116 - 122. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G P Kimman, T Szili-Torok, D A M J Theuns, J C Res, M F Scholten, and L J Jordaens Comparison of radiofrequency versus cryothermy catheter ablation of septal accessory pathways Heart, September 1, 2003; 89(9): 1091 - 1092. [Full Text] [PDF]
|
|
|
|
|
|
P. Khairy, P. Chauvet, J. Lehmann, J. Lambert, L. Macle, J.-F. Tanguay, M. G. Sirois, D. Santoianni, and M. Dubuc Lower Incidence of Thrombus Formation With Cryoenergy Versus Radiofrequency Catheter Ablation Circulation, April 22, 2003; 107(15): 2045 - 2050. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Timmermans, G. M. Ayers, H. J.G.M. Crijns, and L.-M. Rodriguez Randomized Study Comparing Radiofrequency Ablation With Cryoablation for the Treatment of Atrial Flutter With Emphasis on Pain Perception Circulation, March 11, 2003; 107(9): 1250 - 1252. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Satti and L. M. Epstein Cardiologic Interventional Therapy for Atrial and Ventricular Arrhythmias Card. Surg. Adult, January 1, 2003; 2(2003): 1253 - 1270. [Full Text]
|
|
|
|
|
|
Y. Zhang, S. Bharati, K. A. Mowrey, S. Zhuang, P. J. Tchou, and T. N. Mazgalev His Electrogram Alternans Reveal Dual-Wavefront Inputs Into and Longitudinal Dissociation Within the Bundle of His Circulation, August 14, 2001; 104(7): 832 - 838. [Abstract] [Full Text] [PDF]
|
|