Europace Advance Access published online on April 7, 2007
Europace, doi:10.1093/europace/eum031
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Transvenous cryo-ablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia: a single-centre initial experience study
Rhythmology Unit, Cardiology Institute, Pitie-Salpetriere Hospital, Paris 75015, France
Aims Within the last several years, transvenous cryo-ablation has become an alternative method to perform ablation of the slow-pathway. This study evaluated the acute and long-term safety and effectiveness of atrio-ventricular nodal re-entrant tachycardia (AVNRT) cryo-ablation.
Methods and results The first 69 consecutive patients with AVNRT (60 slow–fast, 4 fast–slow, and 5 slow–slow) who underwent slow-pathway cryo-ablation were included. Mean age was 37 ± 15, body weight 68 ± 14 kg, symptom duration 125 ± 104 months, and number of ineffective antiarrhythmic (AA) drugs 1.8 ± 1.4. A 7 Fr cryo-catheter (Cryocath®) was used, with initially 4-mm-tip and later with 6-mm-tip electrode. Cryo-mapping (n = 7.9 ± 8.4 per pt) was performed at the temperature of –30°C to test the effect on the target ablation site. Successful cryo-mapping was defined as abolition of nodal conduction jump or AV nodal refractory period prolongation. Cryo-ablation (n = 5.1 ± 4.9 per pt) was then applied by freezing to –75°C for 4 min in duration if no AV-block occurred. Acute procedural success (defined as AVNRT non-inducibility) after the first cryo-ablation attempt was achieved in 60/69 patients (87%). During cryo-ablation, inadvertent transient AV-block was encountered in 14 patients (five I AV-block and nine II–III AV-block). A mid-septal target site was the only variable correlated with inadvertent AV-block occurrence during cryo-ablation (P < 0.02). Long-term clinical success after cryo-ablation was globally achieved in 56/66 (85%) with a mean follow-up of 18 ± 9 months (3 pts dropped-out). After the first procedure, 41/66 (62%) had no relapse, eight had a dramatic reduction in AVNRT duration-frequency and considered themselves cured, and five needed previously ineffective AA (with no relapse in three, drastic reduction in AVNRT duration-frequency in two). The five last patients needed one or more procedures, after which one had no recurrence and one had reduction in duration-frequency. Absence of recurrence after the first procedure was positively correlated with 6-mm-tip cryo-catheter use (<0.001) and negatively with acute procedural success (<0.001). At multivariate analysis, both were independently significant (<0.04 and <0.008, respectively). Long-term clinical success was correlated only with 6-mm-tip cryo-catheter use (<0.001).
Conclusions Slow pathway cryo-ablation is associated with an acute success but a higher recurrence rate. A 6-mm-tip cryo-catheter seems to assure during cryo-ablation a large acute and long-term success. AV-block seems non-guaranteed by a negative cryo-mapping, stressing on need of a careful surveillance. Nevertheless, the theoretical advantage of avoiding the risk of permanent AV-block when compared with radiofrequency needs larger series to be demonstrated.
Key Words: Atrioventricular node, Tachycardia, Mapping, Catheter ablation
* Corresponding author. Tel: +33 145409530; fax: +33 323243118. E-mail address: antoniodesisti{at}yahoo.fr
Manuscript submitted 28 December 2006. Accepted after revision 7 February 2007.
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