Mario Matta1, Matteo Anselmino2, Marco Scaglione3, Marco Vitolo2, Federico Ferraris2, Paolo Di Donna3, Domenico Caponi3, Davide Castagno2, Fiorenzo Gaita2. 1. Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy. m.matta26@gmail.com. 2. Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, University of Turin, Corso Bramante 88, 10126, Turin, Italy. 3. Division of Cardiology, Cardinal Massaia Hospital, Asti, Italy.
Abstract
PURPOSE: Catheter ablation of the slow pathway is the most effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). Cryoenergy, compared to radiofrequency, relates to lower heart block risk but higher incidence of AVNRT recurrences. The aims of this study are to confirm the safety and efficacy of AVNRT cryoablation and to identify predictors of long-term recurrences. METHODS: Among 241 patients undergoing AVNRT cryoablation, 239 (99.2%) experienced acute effective cryoablation of the slow pathway, and no procedure-related complications were reported. RESULTS: After a follow-up of 44.9 ± 31.7 months, 28 (11.7%) patients presented AVNRT recurrences. A shorter preablation (p = 0.05) and postablation anterograde Wenckebach cycle length (p < 0.01), a shorter postablation atrioventricular node refractory period (p = 0.04), and persistence of the crossover sign (p = 0.03) were associated with higher incidence of long-term recurrences. Considering cooling dynamics, a longer time to reach temperature ≤-70 °C (p = 0.03) and a higher minimal temperature during ablation (p = 0.04) were related to recurrences. Patients without residual markers of dual AV node physiology (AH jump, single atrial echo beat, crossover) reported a lower recurrence rate (p = 0.05) compared to those without. At multivariate analysis, a longer time to -70 °C was the strongest independent predictor of long-term recurrence (OR 1.75, 95% CI 1.01-3.03, p = 0.04). CONCLUSIONS: AVNRT cryoablation is safe and effective. Long-term recurrence rate was 11.7%. An ablation approach directed to the complete elimination of dual AV node physiology, along with assessment of the tissue's cooling dynamics, holds the potential to improve long-term AVNRT cryoablation efficacy.
PURPOSE: Catheter ablation of the slow pathway is the most effective treatment for atrioventricular nodal reentrant tachycardia (AVNRT). Cryoenergy, compared to radiofrequency, relates to lower heart block risk but higher incidence of AVNRT recurrences. The aims of this study are to confirm the safety and efficacy of AVNRT cryoablation and to identify predictors of long-term recurrences. METHODS: Among 241 patients undergoing AVNRT cryoablation, 239 (99.2%) experienced acute effective cryoablation of the slow pathway, and no procedure-related complications were reported. RESULTS: After a follow-up of 44.9 ± 31.7 months, 28 (11.7%) patients presented AVNRT recurrences. A shorter preablation (p = 0.05) and postablation anterograde Wenckebach cycle length (p < 0.01), a shorter postablation atrioventricular node refractory period (p = 0.04), and persistence of the crossover sign (p = 0.03) were associated with higher incidence of long-term recurrences. Considering cooling dynamics, a longer time to reach temperature ≤-70 °C (p = 0.03) and a higher minimal temperature during ablation (p = 0.04) were related to recurrences. Patients without residual markers of dual AV node physiology (AH jump, single atrial echo beat, crossover) reported a lower recurrence rate (p = 0.05) compared to those without. At multivariate analysis, a longer time to -70 °C was the strongest independent predictor of long-term recurrence (OR 1.75, 95% CI 1.01-3.03, p = 0.04). CONCLUSIONS: AVNRT cryoablation is safe and effective. Long-term recurrence rate was 11.7%. An ablation approach directed to the complete elimination of dual AV node physiology, along with assessment of the tissue's cooling dynamics, holds the potential to improve long-term AVNRT cryoablation efficacy.
Authors: Paul Khairy; Paul G Novak; Peter G Guerra; Isabelle Greiss; Laurent Macle; Denis Roy; Mario Talajic; Bernard Thibault; Marc Dubuc Journal: Europace Date: 2007-08-04 Impact factor: 5.214
Authors: Hung-Fat Tse; Kenneth L Ripley; Kathy L F Lee; Chung-Wah Siu; John F Van Vleet; William L Pelkey; Chu-Pak Lau Journal: J Cardiovasc Electrophysiol Date: 2005-02
Authors: Valter Giaretto; Andrea Ballatore; Claudio Passerone; Paolo Desalvo; Mario Matta; Andrea Saglietto; Mario De Salve; Fiorenzo Gaita; Bruno Panella; Matteo Anselmino Journal: J R Soc Interface Date: 2019-09-18 Impact factor: 4.118