Cryothermal slow pathway modification for atrioventricular nodal reentrant tachycardia

Abstract

As a cryoablation procedural outcome for AVNRT, persistent dual AV nodal physiology with or without echo beats is not associated with higher recurrence rates than complete elimination of dual AV nodal physiology if AVNRT remains non-inducible on and off isoproterenol.

Role of Isoproterenol in Predicting the Success of Catheter Ablation in Patients with Reproducibly Inducible Atrioventricular Nodal Reentrant Tachycardia

“…The proportion of women (72.5%) in the current study was consistent with those of other series (62%-79%), [3][4][5][6][7][8][9][10][11]13 and there was no statistically significant difference between our 2 study groups in that regard (Table I). Female sex has been associated with higher recurrence rates.…”

“…1,2 Routinely after slow-pathway ablation, attempts at reinduction of arrhythmia are performed, with or without isoproterenol or other provocative medications. Some physicians use isoproterenol after ablation regardless of its use before ablation (strategy 1), [3][4][5][6][7] whereas others use isoproterenol after ablation of AVNRT only when it had been necessary for arrhythmia induction before ablation (strategy 2). [8][9][10][11][12] However, the published data available for the comparison of these 2 strategies are inadequate.…”

“…Some physicians consider the slow pathway to be successfully ablated only if AVNRT is not inducible both in the basal state and during isoproterenol infusion, regardless of how it was induced before ablation (strategy 1). [3][4][5][6][7] Others assume that the infusion of catecholamines is unnecessary after ablation, in cases wherein AVNRT is inducible in the basal state before ablation (strategy 2). [8][9][10][11][12] Neither group, however, has sufficiently examined the reproducibility of the arrhythmia, and both ignore the potential effect of reproducibility on the acute or longterm results of AVNRT ablation.…”

“…[8][9][10][11][12] Neither group, however, has sufficiently examined the reproducibility of the arrhythmia, and both ignore the potential effect of reproducibility on the acute or longterm results of AVNRT ablation. [3][4][5][6][7][8][9][10][11][12] Weismuller and colleagues 13 studied reinduction of AVNRT after ablation in the basal state in comparison with reinduction during the infusion of orciprenaline as a β-adrenergic stimulator. Of 121 patients with AVNRT who underwent successful ablation without sequela, 95 had inducible arrhythmia in the basal state.…”

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

“…Previous studies focused on identifying factors that could affect acute and long-term efficacy, such as catheter tip size [11], electrophysiological markers of residual dual AV node physiology [11,12], duration and number of cryoenergy applications [13], but data are limited and sometimes controversial, and no strong predictor of cryoablation long-term efficacy has been identified [14][15][16]. The aim of this study is to evaluate the safety, acute and long-term efficacy of AVNRT cryoablation and to identify intra-procedural predictors of long-term efficacy, focusing on both electrophysiological parameters and cooling dynamics.…”