Successful catheter cryoablation for premature ventricular contractions originating from the para‐Hisian region

Abstract

We achieved successful catheter cryoablation in a patient with para‐Hisian premature ventricular contractions (PVCs) without conduction disturbance using the freeze‐thaw‐freeze method while observing the atrial‐His bundle interval. Cryoablation could be considered an alternative to radiofrequency ablation for patients with para‐Hisian PVCs.

Safety and efficacy of first‐line cryoablation for para‐hisian ventricular arrhythmias using a cryomapping protocol approach: A case series

“…6,11 However, to date, little has been reported on the safety and efficacy of cryoablation for para-Hisian VAs. 5,8,9 Miyamoto et al 8 reported that cryoablation was performed in 10 patients with VAs arising from the para-Hisian region and clinical success was obtained in 4 patients. In their study, only 2 patients (20%) underwent cryoablation as first-line treatment, while 8 patients underwent cryoablation secondary to the failure of previous RF ablation.…”

“…The radiofrequency (RF) catheter ablation near the electrical conduction system has the risk of AV block, whereas the cryothermal system has an advantage of avoiding AV conduction disturbance 6,11 . However, to date, little has been reported on the safety and efficacy of cryoablation for para‐Hisian VAs 5,8,9 . Miyamoto et al 8 reported that cryoablation was performed in 10 patients with VAs arising from the para‐Hisian region and clinical success was obtained in 4 patients.…”

“…However, catheter ablation for VAs arising from the para‐Hisian region was reported to be challenging due to the risk of atrioventricular (AV) conduction disturbance 3,4 . A cryoablation system has been recently developed as an alternative approach to treat arrhythmia, and the system is considered as a feasible approach to avoid the risk of injury to conduction systems, such as the His bundle 5‐9 . Nevertheless, there is no guarantee that AV conduction disturbances will not occur even while using cryoenergy.…”

“…3,4 A cryoablation system has been recently developed as an alternative approach to treat arrhythmia, and the system is considered as a feasible approach to avoid the risk of injury to conduction systems, such as the His bundle. [5][6][7][8][9] Nevertheless, there is no guarantee that AV conduction disturbances will not occur even while using cryoenergy. Previous study reported a permanent AV block that occurred during cryoablation for para-Hisian VAs.…”

Ablación exitosa con radiofrecuencia a través de la cúspide coronariana derecha de un complejo ventricular prematuro parahisiano

“…Los complejos ventriculares prematuros cuyo origen se encuentra en la región parahisiana son poco frecuentes en la práctica clínica, lo cual hace que su manejo a través de terapias de ablación con catéter de radiofrecuencia o crioablación sea un reto, pues su localización supone un alto riesgo para el desarrollo de bloqueo aurículo-ventricular [6][7][8] . Las características en el electrocardiograma de superficie de las CVP parahisianas son un QRS con morfología de bloqueo completo de rama izquierda, eje inferior, onda R en DI o aVL, QS en aVR, transición del QRS temprana en V2 y QRS estrecho, usualmente < 143 ms 2,9,10 .…”