Cryothermy has potential advantages over RF energy for catheter ablation, including reversibility of lesion formation, catheter stability, and less procedural discomfort. Cryoablation procedures were performed in 14 patients with atrioventricular reentrant tachycardias (AVNRTs), 13 patients with accessory pathway (AP)-mediated tachycardias, and 5 patients with atrial fibrillation. The numbers of energy applications, pain scores, procedural times, and outcomes were recorded and compared with age- and sex-matched patients undergoing similar RF procedures. Cryoablation was successful in 26 of 32 patients (11/14 AVNRT, 10/13 AP, 5/5 AF) compared with 30 of 32 undergoing RF procedures, with similar numbers of energy applications and procedural times. Cryothermy was painless in all patients, and the overall procedural discomfort was significantly less than in patients treated with RF (1.3 +/- 2.2 vs 6.1 +/- 3.5). In patients with anteroseptal pathways, cryomapping successfully identified safe sites to target the delivery of energy. Cryothermy is a painless and safe alternative to RF. It may be particularly useful for catheter ablation of patients with pathways close to the atrioventricular node.

An APB induces HRT but the response is substantially attenuated and is not influenced by the APB coupling interval. In contrast to a VPB, TO is positive after an APB. Lack of correlation between HRT after a VPB and the VBP coupling interval indicates blunted baroreflex response in patients with left ventricular dysfunction.

Objective-To assess the changes in quality of life, arrhythmia symptoms, and hospital resource utilisation following catheter ablation of typical atrial flutter. Design-Patient questionnaire to compare the time interval following ablation with a similar time interval before ablation. Setting-Tertiary referral centre. Patients-63 consecutive patients were studied. Four patients subsequently underwent an ablate and pace procedure, two died of co-morbid illnesses, and two were lost to follow up. The remaining 55 patients form the basis of the report. Results-Patients were followed for a mean (SD) of 12 (9.5) months. Atrial flutter ablation resulted in an improvement in quality of life (3.8 v 2.5, p < 0.001) and reductions in symptom frequency score (2.0 v 3.5, p < 0.001) and symptom severity score (2.0 v 3.8, p < 0.001) compared with preablation values. There was a reduction in the number of patients visiting accident and emergency departments (11% v 53%, p < 0.001), requiring cardioversion (7% v 51%, p < 0.001), or being admitted to hospital for a rhythm problem (11% v 56%, p < 0.001). Subgroup analysis confirmed that patients with atrial flutter and concomitant atrial fibrillation before ablation and those with atrial flutter alone both derived significant benefit from atrial flutter ablation. Patients with concomitant atrial fibrillation had an improvement in quality of life (3.5 v 2.5, p < 0.001) and reductions in symptom frequency score (2.3 v 3.5, p < 0.001) and symptom severity score (2.2 v 3.7, p < 0.001) compared with preablation values. Conclusions-Ablation of atrial flutter is recommended both in patients with atrial flutter alone and in those with concomitant atrial fibrillation. (Heart 2001;86:167-171)