Cryoablation versus Radiofrequency Ablation for Atrioventricular Nodal Reentrant Tachycardia: Patient Pain Perception and Operator Stress

Chan, Ngai Yin; Choy, Chi Chung; Lau, Chun Leung; Lo, Ying Keung; Chu, Pui S; Yuen, Ho Chuen; Choi, Yuen Choi; Lau, Suet Ting

doi:10.1111/j.1540-8159.2010.02858.x

Cited by 31 publications

(36 citation statements)

References 19 publications

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“…In both studies, pain perception was significantly less among patients treated with cryoablation than among those treated with RF ablation (VAS 0–10: 2.3 ± 2.8 vs 5.4 ± 3.4, P = 0.024; Ref. , and VAS 0–100: 7.3 ± 13.9 vs 20.3 ± 22.0, P < 0.001; Ref. ).…”

Section: Resultsmentioning

confidence: 86%

“…Two RCTs measured patient pain perception using different visual analog scales (VAS), one ranging from 0 to 10 and the other ranging from 0 to 100 . In both studies, pain perception was significantly less among patients treated with cryoablation than among those treated with RF ablation (VAS 0–10: 2.3 ± 2.8 vs 5.4 ± 3.4, P = 0.024; Ref.…”

Section: Resultsmentioning

confidence: 99%

“…1,2 Cryoablation has been used as an alternative to RF ablation and is increasingly being adopted as a first line energy source in children and young adults, [3][4][5] with a reported rate of acute success ranging from 83% to 98% and an up to 15% chance of tachycardia recurrence at follow-up. 5 Reported advantages of this technique include a lower risk of AV block in many, [6][7][8][9] but not all, 3,4,[10][11][12][13][14] published studies. Despite an intrinsically longer lesion application time, some authors have reported comparable procedure times [6][7][8][9][10]12,15 and reduced fluoroscopy times 6,7,9,10,12 due to cryoadhesion (which ensures catheter stability during lesion formation), although others have reported similar or longer fluoroscopy time [3][4][5]14,16 and longer total procedure time 4,5,11,13,14 with cryoablation.…”

Section: Introductionmentioning

confidence: 99%

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Cryoablation Versus RF Ablation for AVNRT: A Meta‐Analysis and Systematic Review

Hanninen

Yeung-Lai-Wah

Massel

et al. 2013

Cardiovasc electrophysiol

113

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Section: Resultsmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cryoablation Versus RF Ablation for AVNRT: A Meta‐Analysis and Systematic Review

Hanninen

Yeung-Lai-Wah

Massel

et al. 2013

Cardiovasc electrophysiol

113

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“…Other benefits include cryoadhesion and catheter stability, clearly demarcated lesion edge, and lower incidence of thromboembolism and coronary artery damage . A recent study also showed that cryoablation produces less pain in patients and is less stressful for the operators in the treatment of AVNRT . Acute procedural success rates of cryoablation have been reported to be between 85–96.8% .…”

Section: Introductionmentioning

confidence: 99%

Low Recurrence Rate in Treating Atrioventricular Nodal Reentrant Tachycardia with Triple Freeze‐Thaw Cycles

Qureshi

Ratnasamy

Sokoloski

et al. 2012

Pacing Clinical Electrophis

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“…In this issue of PACE , 1 Chan and colleagues compare radiofrequency (RF) and cryo ablation for atrioventricular nodal reentry tachycardia (AVNRT) ablation. The authors draw attention to the stresses on both the patient and on the operator.…”

mentioning

confidence: 99%

AVNRT Ablation: Aiming for 100/0, and for Comfort!

Fisher

2010

Pacing Clinical Electrophis

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In this issue of PACE, 1 Chan and colleagues compare radiofrequency (RF) and cryo ablation for atrioventricular nodal reentry tachycardia (AVNRT) ablation. The authors draw attention to the stresses on both the patient and on the operator. They conclude that operator stress is higher with RF than cryo, probably because of the need for intensive and continuous and simultaneous monitoring of catheter position, electrograms, electrocardiograms, and ablation settings. As the authors point out, it is difficult to achieve 100% "cure" of AVNRT or 0% atrioventricular block (AVB).Some of the challenges are anatomical. Patients with "short septums" (between the His area and the coronary sinus os) may offer little room for error in catheter position, and sudden deep breath or other cause for catheter movement can have serious consequences. One of the advantages here of cryo is that the lead tends to become stuck in place at lower temperatures (-60 • C-80 • C) so that inadvertent movement is less of a problem. It is also known that a small percentage of patients will have both the fast and slow pathways well posterior to the His position; hence, the suggestion by some that anterograde and retrograde septal Address for reprints: mapping should be done prior to delivering RF 2,3 and presumably cryo as well.The findings regarding greater patient discomfort with RF may be context related. It is now fairly routine to use sedation during electrophysiology study, and few sedated patients have much memory of their procedures. Chan et al. did not use sedation, and thus were able to query patients on their perception of procedural pain. The authors did not indicate why they did not use sedation: (1) their routine practice? (2) to permit comparison of RF-cryo discomfort levels? (3) to ensure that patients could be told not to take deep breaths or move during delivery of RF or cryo?The reduced operator stress using cryo is also interesting. The reduction in catheter movement when the tip freezes is reassuring. Cryo has the reputation of causing less irreversible AV block than cryo, but all things are relative. This editor is aware of documented but unpublished instances of AVB using cryo, and one wonders whether operator overconfidence may have played a role. Although the cryo technique is more forgiving, operators should avoid a false sense of security, and maybe aim for just a little higher stress than reported by Chan and colleagues. References1. Chan NY, Choy CC, Lau CL, Lo YK, Chu PS, Yuen HC, Choi YC, et al. Cryoablation versus radiofrequency ablation for atrioventricular nodal reentrant tachycardia: Patient pain perception and operator stress. Pacing Clin Electrophysiol 2011; 34: 2-7. 2. Engelstein ED, Stein KM, Markowitz SM, Lerman BB. Posterior fast atrioventricular node pathway: Implications for radiofrequency catheter ablation of atrioventricular node reentry tachycardia. J Am Col Cardiol 1996; 27:1098-1105. 3. Delise P, Bonso A, Coro L, Fantinel M, Gasparini G, Themistoclakis S, Mantovan R. Pacemapping of the triangle of koc...

show abstract

Cryoablation versus Radiofrequency Ablation for Atrioventricular Nodal Reentrant Tachycardia: Patient Pain Perception and Operator Stress

Abstract: CRYO, as compared with RF, produces less pain in patients and less stress in operator in the treatment of AVNRT.

Cited by 31 publications

References 19 publications

Cryoablation Versus RF Ablation for AVNRT: A Meta‐Analysis and Systematic Review

Cryoablation Versus RF Ablation for AVNRT: A Meta‐Analysis and Systematic Review

Low Recurrence Rate in Treating Atrioventricular Nodal Reentrant Tachycardia with Triple Freeze‐Thaw Cycles

AVNRT Ablation: Aiming for 100/0, and for Comfort!

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