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

Abstract

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.

Response to letter to the editor: Very late recurrences after ablation of AVNRT

“…As mentioned in article, 1 we cannot provide a definite explanation for these late AVNRT recurrences.…”

“…We gratefully thank the authors for their constructive comments on our article entitled Very long-term outcomes after catheter ablation of AVNRT: How does cryoenergy differ from radiofrequency? 1 In their letter, Insulander et al proposed an alternative explanation to our observation of very late recurrences following AVNRT ablation. In their own experience with cryoablation of AVNRT, they also documented late and very-late recurrences of arrhythmia.…”

Very late recurrences after ablation of AVNRT

“…We read with great interest the recently published article by Chaumont et al (1) regarding late recurrences in AVNRT after cryoablation. The authors found that among 257 patients with AVNRT successfully ablated with cryo energy, recurrences occurred in 24 subjects during a follow-up of 38±27 months.…”

Very late recurrences after ablation of AVNRT

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We read with great interest the recently published article by Chaumont et al 1 regarding late recurrences in atrioventricular reentrant tachycardia (AVNRT) after cryoablation. The authors found This may also be explained by the previously mentioned age-related AV nodal changes.Consequently, the occurrence of AVNRT many years after an ablation procedure may perhaps not always implicate a recurrence but instead an arrhythmia caused by a new substrate.

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“…We read with great interest the recently published article by Chaumont et al 1 regarding late recurrences in atrioventricular reentrant tachycardia (AVNRT) after cryoablation. The authors found This may also be explained by the previously mentioned age-related AV nodal changes.…”