Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study)

Deisenhofer, Isabel; Zrenner, Bernhard; Yin, Yuehui; Pitschner, Heinz-Friedrich; Kuniss, Malte; Großmann, Georg; Stiller, S.; Luik, Armin; Veltmann, Christian; Frank, Julia K.; Linner, Julia; Estner, Heidi; Pflaumer, Andreas; Wu, Jinjin; Bary, Christian von; Ücer, Ekrem; Reents, Tilko; Tzeis, Stylianos; Fichtner, Stephanie; Kathan, Susanne; Karch, Martin R.; Jilek, Clemens; Ammar, Sonia; Kolb, Christof; Liu, Zeng-Chang; Haller, Bernhard; Schmitt, Claus; Hessling, Gabriele

doi:10.1161/circulationaha.110.970350

Cited by 148 publications

(131 citation statements)

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“…Considering long-term outcome, the incidence of recurrences (11.7%) is higher compared to that reported by RFCA, ranging from 2 to 4% [4,7,9,10]. Interestingly, a cooling dynamic pattern characterized by longer cooling time during ablation and the presence of residual dual AV node physiology appear to be strong predictors of long term AVNRT recurrence.…”

Section: Discussionmentioning

confidence: 92%

“…Incidence of AV block following AVNRT RFCA has been reported to occur in a percentage of patients of about 0.5-2% [7,22,23], and a large meta-analysis reporting an incidence of 1.7% [10].…”

Section: Discussionmentioning

confidence: 99%

“…Transcatheter cryoablation of the slow pathway has been demonstrated to be a feasible and safe alternative to RFCA, with no permanent AV block reported and a comparable acute success rate [5][6][7]. In fact, reversible cryomapping permits to evaluate the safety of the site targeted for ablation, leading to a return to integrity in case of AV block development [8].…”

Section: Introductionmentioning

confidence: 99%

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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

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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

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Section: Discussionmentioning

confidence: 92%

“…Incidence of AV block following AVNRT RFCA has been reported to occur in a percentage of patients of about 0.5-2% [7,22,23], and a large meta-analysis reporting an incidence of 1.7% [10].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

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“…The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate. 20 …”

Section: Discussionmentioning

confidence: 99%

Circulation Editors' Picks

2012

Circulation

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Summary: This article describes the frequent (30% of patients) presence of sizable mobile thrombus on pacemaker and defibrillator leads identified with careful intracardiac echocardiographic assessment during ablation procedures for atrial fibrillation and ventricular tachycardia. These thrombi were more frequently seen on the atrial portion of the leads. Prior use of oral anticoagulants or antiplatelet agents, the number and age of leads, and presence of a superior vena cava coil were not specifically associated with lead thrombi during the procedure. The group with thrombus had a higher pulmonary artery pressure, suggesting the possibility that patients with lead thrombi may have subclinical pulmonary emboli elevating the pressure and/or that higher pulmonary artery pressure predisposes to thrombus formation in right-sided cardiac chambers. Further study is warranted to identify hematologic or other clinical factors that may increase patients' risk of forming device lead thrombi and to assess the potential clinical impact of these thrombi. Conclusion:Mobile thrombi on cardiovascular implantable electronic device leads are present in 30% of patients undergoing ablation and are readily identified with intracardiac echocardiography despite being underrecognized with transthoracic echocardiography. Further study is warranted to determine whether lead thrombi are a clinically relevant source of pulmonary emboli in some patients with cardiovascular implantable electronic devices. 1 Reversal of Severe Heart Failure With a Continuous-Flow Left Ventricular Assist Device and Pharmacological Therapy: A Prospective StudySummary: Myocardial recovery sufficient to allow pump removal is thought to be rare after left ventricular assist device support. We have previously shown that a specific combination of drug therapy and left ventricular assist device unloading results in recovery in two thirds of patients with dilated cardiomyopathy receiving a pulsatile device. However, there has been a transition to rotary devices, and this protocol has not been previously used with nonpulsatile devices. We report the results of a prospective study of 20 Heartmate II bridge to transplantation patients receiving a specific drug regimen consisting of a combination of angiotensin-converting enzymes, ␤-blockers, angiotensin II inhibitors, and aldosterone antagonists to maximize reverse remodeling, followed by the ␤2-agonist clenbuterol to promote "physiological hypertrophy" to maximize the incidence and durability of recovery. Patients were regularly tested (echocardiograms, exercise tests, catheterizations) with the pump at low speed. One patient was lost to follow-up and died. Of the remaining 19, 12 (63.2%) were explanted. Before explantation at low flow, echocardiographic, exercise test, and hemodynamic data were excellent. Actuarial survival without recurrence of heart failure was 83.3% at 1 and 3 years. Hence, a high rate of reversal of end-stage heart failure secondary to nonischemic cardiomyopathy can be achieved with nonpulsatile fl...

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“…66 The preexistence of first-degree heart block may carry a higher risk for late AV block and slow pathway modification, as opposed to complete elimination, is probably preferable in this setting. 67 Cryoablation may carry a lower risk of AV block, but it is negligible and this mode of therapy is associated with a significantly higher recurrence rate.…”

Section: Ablationmentioning

confidence: 99%

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

Katritsis

Josephson

2016

Arrhythmia &Amp; Electrophysiology Review

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Atrioventricular nodal reentrant tachycardia (AVNRT) denotes re-entry in the area of the AV node, and represents the most common regular arrhythmia in the human.1 Although several models have been proposed to explain the mechanism of the arrhythmia in the context of the complex anatomy and the anisotropic properties of the atrioventricular (AV) node and its atrial extensions (see Figure 1), 2 the actual circuit of AVNRT still remains elusive. Recent studies suggest a three-dimensional AV node with greater variability in the space constant of tissue and poor gap junction connectivity due to differential expression of connexin isoforms, that provide an explanation of dual conduction and nodal reentrant arrhythmogenesis. 3,4 AV junctional arrhythmias are presented in Table 1. Classification schemes for AVNRT have been mainly based on the conventional concept of longitudinally dissociated dual AV nodal pathways that conduct around a central obstacle (see Table 2).In typical slow-fast AVNRT the onset of atrial activation appears prior to, at the onset, or just after the QRS complex, thus maintaining an atrial-His/His-atrial ratio, AH/HA >1. The HA interval is usually <70 ms, measured from earliest deflection of the His bundle activation to the earliest rapid deflection of the atrial activation in the His bundle electrogram, and the VA interval, measured from the onset of ventricular activation on surface ECG to the earliest rapid deflection of the atrial activation on the His bundle electrogram, is <60 ms. 1,5,6 In atypical, fast-slow form of atypical AVNRT, the retrograde atrial electrogram begins after ventricular activation with an AH/HA ratio <1. The HA interval is prolonged, ≥70 msec, and the VA interval is ≥60 msec. 5,6 The atypical, slow-slow form, represents, by definition, an arrhythmia utilising two slow pathways. The AH/HA ratio is ≥1 but the HA interval is ≥70 msec, and the AH interval exceeds 200 ms. [7][8][9] There are several inherent limitations of this classification. The distinction between fast-slow and slow-slow atypical AVNRT is often arbitrary in view of the lack of a unanimously accepted definition. In order to establish the diagnosis of a truly fast-slow form, it has been proposed that the AH interval should be less than 185 ms 10 or 200 ms. 6 This criterion, however, has not been adopted by other investigators. 11-13Thus, tachycardias with a relatively prolonged AH interval but an AH/ HA ratio <1 cannot be reliably classified as either fast-slow or slow-slow (see Figure 2). Furthermore, the term 'fast-slow' implies that the fast component of slow-fast AVNRT is the same as the fast in the fast-slow type. There is now evidence that this is not the case in patients who present with both types of tachycardia.14,15 Typical slow-fast and atypical fast-slow AVNRT appear to utilise different anatomical pathways for fast conduction. In addition, electrophysiological behaviour compatible with multiple pathways may also be seen, and in some patients, several forms of AVNRT may be inducible at electrophy...

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Cryoablation Versus Radiofrequency Energy for the Ablation of Atrioventricular Nodal Reentrant Tachycardia (the CYRANO Study)

Cited by 148 publications

References 24 publications

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

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

Circulation Editors' Picks

Classification, Electrophysiological Features and Therapy of Atrioventricular Nodal Reentrant Tachycardia

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