Cryothermal Energy Ablation Of Cardiac Arrhythmias 2005: State Of The Art



Roberto De Ponti, “Cryothermal Energy Ablation Of Cardiac Arrhythmias 2005:
State Of The Art”

19


Table 1. Review of cryoablation of anteroseptal or midseptal accessory pathways

Author

Year

No.pts

AntS eρt⅛lιdS eρt

Success

Complications

Recurrences

Kitnman(24)

2001

І

1/0

100%

-

-

Lanzottif25f

2002

~T~

4/3

ιoo%-

-

-

Ali(26)

2002

1

1/0

100°∕Γ

-

-

Lovzefl T)

2003

4

4∕0-

75%

-

-

Gaita(27)

2003

20

11/9

ιoo%Γ

-

20%

Wong(28)-

2004

-2-

2/0

І 00%“

-

-

Atιenza(29)

2004

22

10∕12-

1ST

03"

15%

Frostyfl 9)

2004

7

6/1

86%

-

n.r.

Abbreviations: No.pts: number of patients; AntSept: number of patients with
anteroseptal accessory pathways; MidSept: number of patients with midseptal
accessory pathways; RBBB: right bundle branch block; n.r.: not reported

Focal atrial tachycardia and isthmus-dependent atrial flutter. Occasionally, successful
cryoablation of focal atrial tachycardia has been reported and its safety has been confirmed also
for ablation of atrial foci located close to the atrioventricular node
32.

Several papers have reported cryoablation of the cavotricuspid isthmus for typical atrial
flutter with an acute and long-term success comparable to the one of radiofrequency
ablation
33,34,35,36. The use of larger catheter and longer electrode for ablation in this area is
associated with a lower number of applications and a shorter procedural time. As for
radiofrequency ablation, a case of transient ST segment elevation in the inferior leads was
observed during cryo application at the septal isthmus, with wall irregularities in the right
coronary artery without significant stenosis
35. The major advantage of using cryothermal energy
to produce bidirectional conduction block of the cavo-tricuspid isthmus is the absence of pain
perception related to energy application. In a prospective randomized trial in which a visual
analogue scale to evaluate pain was used, pain perception was by far lower if not existent in the
cryothermal as compared to radiofrequency energy group
34.

Pulmonary vein ablation for atrial fibrillation. When radiofrequency energy is applied at the os
of the pulmonary veins to prevent atrial fibrillation recurrences, a heat-induced contraction of the
pulmonary vein wall can be observed early or during the follow-up, which results in a variable
degree of lumen reduction and a wide spectrum of clinical presentations
37. This reaction is
typical of hyperthermic injury and results from a combination of edema, endothelial disruption
and collagen denaturation and shrinkage
38. The occurrence and the degree of stenosis correlate
with the amount of energy delivered
39 and lesion extension40. As mentioned above, cryothermal
energy ablation causes less or minimal endothelial disruption, maintenance of extracellular
collagen matrix and no collagen contracture related to thermal effects. Moreover, lower
incidence of thrombus formation is reported with cryoenergy as compared to radiofrequency
energy ablation. For these characteristics, cryothermal energy ablation can be considered an ideal
and safer energy source also for pulmonary vein ablation and the incidence of both pulmonary

Indian Pacing and Electrophysiology Journal (ISSN 0972-6292), 5(1): 12-24 (2005)



More intriguing information

1. NEW DEVELOPMENTS IN FARM PRICE AND INCOME POLICY PROGRAMS: PART I. SITUATION AND PROBLEM
2. The name is absent
3. Smith and Rawls Share a Room
4. The name is absent
5. Endogenous Determination of FDI Growth and Economic Growth:The OECD Case
6. A Consistent Nonparametric Test for Causality in Quantile
7. Evidence-Based Professional Development of Science Teachers in Two Countries
8. DISCRIMINATORY APPROACH TO AUDITORY STIMULI IN GUINEA FOWL (NUMIDA MELEAGRIS) AFTER HYPERSTRIATAL∕HIPPOCAMP- AL BRAIN DAMAGE
9. EU enlargement and environmental policy
10. Multiple Arrhythmogenic Substrate for Tachycardia in a