Cryoablation of typical AVNRT: Younger age and administration of bonus ablation favor long-term success

Pieragnoli, Paolo; Perini, Alessandro Paoletti; Checchi, Luca; Carrassa, Gianmarco; Giomi, Andrea; Carrai, Paolo; Michelucci, Antonio; Padeletti, Luigi; Ricciardi, Giuseppe

doi:10.1016/j.hrthm.2015.05.035

Cited by 16 publications

(9 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This may have influenced the AVNRT recurrence rate as younger age was an independent predictor of recurrence in other studies investigating CA 17 or RF ablation 26 techniques. However, it is worth noting the opposite results from another CA study in which younger age was an independent predictor of success at a 12‐month follow‐up and age as a continuous variable was statistically associated with recurrences 22 . Moreover, the risk of AVNRT recurrence in our study remained significantly higher in the CA group after adjusting for age and sex (adjusted HR = 3.1; 95% CI, 1.1–9.8).…”

Section: Discussioncontrasting

confidence: 98%

“…Another option would be to perform bonus CA application. However, the expected benefit is still unclear as in some studies, bonus CA was only realized in the absence of complicating factors such as a small Koch's triangle or occurrence of PR lenghtening during the procedure 22 . An alternate approach to our CA technique would have been to perform a double freezing cycle (freezing–thawing–freezing) to improve tissue lesion formation.…”

Section: Discussionmentioning

confidence: 99%

“…Interestingly, AH lenghtening and/or transient AV block during CA procedure was associated with AVNRT recurrence in univariate analysis while it did not reach significance in multivariate analysis. 22 An alternate approach to our CA technique would have been to perform a double freezing cycle (freezing-thawing-freezing) to improve tissue lesion formation. However, there are no cardiovascular data yet supporting the routine use of this technique as this concept is based solely on results of research on hepatic tissue.…”

Section: Long-term Efficacy and Predictors Of Recurrences After Avnmentioning

confidence: 99%

See 2 more Smart Citations

Very long‐term outcomes after catheter ablation of atrioventricular nodal reentrant tachycardia: How does cryoenergy differ from radiofrequency?

Chaumont

Mirolo

Savouré

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

Introduction: Either cryoenergy or radiofrequency can be used during atrioventricular nodal reentrant tachycardia (AVNRT) ablation. There are still limited data comparing their respective long-term efficacy (>1 year). This study sought to compare the very long-term outcomes of AVNRT ablation using radiofrequency or cryotherapy. Methods: We retrospectively included all patients who had undergone a first AVNRT ablation in our institution between January 2010 and December 2017. The primary endpoint was recurrence of documented AVNRT. Results: The study population consisted of 409 patients (274 females; mean age, 49.9 years). Ablation was performed using cryoenergy in 260 patients and radiofrequency in 149. High acute procedural success rate (>98%) was obtained and no permanent AV block was observed using both techniques. During a mean follow-up of 3.3 ± 2.3 years, documented AVNRT recurrence occurred in 24 (9.2%) and 4 patients (2.7%) in the cryoablation (CA) and radiofrequency (RF) group, respectively. The risk of AVNRT recurrence was significantly higher in the CA group as compared with the RF group (hazard ratio [HR] = 3.7; 95% confidence interval [CI], 1.3-5.9). Most of the recurrences after CA occurred between 1-and 6-year follow-up (14/24; 58.3%), with one-third of late recurrences after 3-year follow-up. In multivariable analysis, only Koch's triangle anatomical variant was associated with AVNRT recurrence after CA (HR = 6.7; 95% CI, 2.7-16.3). Conclusion: While AVNRT recurrence rates were similar at 1 year of follow-up regardless of the energy used, long-term efficacy appeared higher after radiofrequency ablation. Strikingly, recurrences occured much later after cryotherapy compared with radiofrequency ablation.

show abstract

Section: Discussioncontrasting

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Long-term Efficacy and Predictors Of Recurrences After Avnmentioning

confidence: 99%

See 1 more Smart Citation

Very long‐term outcomes after catheter ablation of atrioventricular nodal reentrant tachycardia: How does cryoenergy differ from radiofrequency?

Chaumont

Mirolo

Savouré

et al. 2020

Cardiovasc electrophysiol

View full text Add to dashboard Cite

show abstract

“…Previous studies investigated the impact of the number and duration of cryoenergy applications on cryoablation efficacy, in particular addressing the higher incidence of recurrence compared to RFCA [24]. This difference is due to the mechanisms of lesion formation of the two energy sources.…”

Section: Cooling Dynamicsmentioning

confidence: 99%

Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation

Matta

Anselmino

Scaglione

et al. 2016

J Interv Card Electrophysiol

View full text Add to dashboard Cite

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 aim of this study is to confirm safety and efficacy of AVNRT cryoablation and to identify predictors of long-term recurrences. 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 tissue's cooling dynamics, hold the potential to improve long-term AVNRT cryoablation efficacy. Methods andAbstract word count: 244 2

show abstract

“…[35][36][37] Its favourable safety profile and higher long-term success rate in younger people make it especially attractive in children. 38 There is no procedure-related mortality in most published studies, although in the Latin American Catheter Ablation Registry there was one death (corresponding to 0.02 % mortality) following tamponade. 39 I believe that there is no such risk associated with AVNRT ablation in experienced centres today.…”

mentioning

confidence: 97%

Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia: Facts and Fiction

Katritsis

2018

Arrhythmia &Amp; Electrophysiology Review

View full text Add to dashboard Cite

Although the exact circuit of atrioventricular nodal re-entrant tachycardia (AVNRT) still eludes us, AVNRT is the most common regular arrhythmia in humans, and therefore the most commonly encountered during ablation attempts for regular tachycardias. [1][2][3][4] Catheter ablation for AVNRT is the current treatment of choice in symptomatic patients. It reduces arrhythmia-related hospitalisations and costs, and substantially improves quality of life. [5][6][7][8][9][10][11][12][13][14][15][16] Catheter ablation approaches aimed at the fast pathway have been abandoned; slow pathway ablation, using a combined anatomical and mapping approach, is now the method of choice. This approach offers a success rate of 95 %, has a recurrence rate of approximately 1.3-4.0 %, and has been associated with a low risk of atrioventricular (AV) block that in most, but not all, studies is <1 %. 9,10,15,17 How true are these assumptions, however, in the current era of catheter ablation? Recent reports have provided useful insights into the technique and complications associated with catheter ablation,and several myths have been refuted, outlined below. 5,[18][19][20] We know now that the inferior nodal extensions represent the anatomical substrate of the slow pathway in all forms of AVNRT. 4,[21][22][23] The only legitimate question that still remains unanswered is the relative importance of the right and left extensions. Connexin staining and genotyping studies have identified the left inferior extension and the AV node itself as areas of low connexin 43 (Cx43) expression, and consequently slow conduction, thus suggesting that this is the main substrate of the slow pathway (Figure 1). 24 The inferior nodal extensions at the inferior (posterior) part of the triangle of Koch and below the coronary sinus ostium, as depicted in the right anterior oblique projection, are the appropriate targets for KeywordsAtrioventricular nodal re-entrant tachycardia, catheter ablation Disclosure: The author has no conflicts of interest to declare.A. Proposed circuits of AVNRT based on the role of the inferior nodal extensions. During typical AVNRT (slow-fast) right-or left-sided circuits may occur with antegrade conduction through the inferior inputs and retrograde conduction through the superior inputs or the anisotropic atrionodal transitional area. In atypical AVNRT, conduction occurs anterogradely through the left or right inferior inputs, and retrogradely through the other. Depending on the orientation of the circuit, we may record the so-called fast-slow, slow-slow, or indeterminate types. B. Hypothetical circuits of AVNRT based on connexin genotyping data. Areas in blue have a high expression of Cx43 and therefore display characteristics of fast conduction. These are the right inferior extension, and the lower nodal bundle. There is also a smooth transition in Cx43 at the interface of the transitional cells and the node. Areas in yellow, such as the compact node and the left inferior extension, have very low Cx43 expression and are capable of slow...

show abstract

Cryoablation of typical AVNRT: Younger age and administration of bonus ablation favor long-term success

Cited by 16 publications

References 22 publications

Very long‐term outcomes after catheter ablation of atrioventricular nodal reentrant tachycardia: How does cryoenergy differ from radiofrequency?

Very long‐term outcomes after catheter ablation of atrioventricular nodal reentrant tachycardia: How does cryoenergy differ from radiofrequency?

Cooling dynamics: a new predictor of long-term efficacy of atrioventricular nodal reentrant tachycardia cryoablation

Catheter Ablation of Atrioventricular Nodal Re-entrant Tachycardia: Facts and Fiction

Contact Info

Product

Resources

About