Randomized study comparing radiofrequency ablation with cryoablation for the treatment of atrial flutter with emphasis on pain perception.
BACKGROUND
Radiofrequency ablation (RF) of atrial flutter (AFL) has a high procedural efficacy, a low recurrence rate, and reports of procedure-related pain. The aim of the present study was to compare RF with cryoablation (cryo) for the treatment of AFL, with emphasis on pain perception during application of energy.


RESULTS
Fourteen patients (55+/-11 years, 11 males) with AFL were randomized to receive ablation of the cavotricuspid isthmus (CTI) by either RF or cryo. Cryothermia was delivered with the CryoCor Cryoablation System (10F, 6-mm tip), and radiofrequency energy was delivered with the use of an 8-mm-tip catheter. Pain was evaluated according to a visual analogue scale (VAS; 0 to 100). All patients in the cryo group were successfully ablated with a mean of 18 applications (9 sites), and RF was successful in 6 of 7 patients (not significant) with 13 applications (not significant). The mean temperature was -82 degrees C and 55 degrees C for cryo and RF, respectively. One patient in the cryo group perceived pain, versus all 7 patients in the RF group (P<0.05). The proportion of painful applications averaged 75.3% in the RF group and 2.0% in the cryo group (P<0.05), whereas the corresponding VAS for pain was 38.3+/-25.3 and 0.32+/-0.86, respectively (P<0.05). At 6-month follow-up, there were no recurrences of atrial flutter.


CONCLUSIONS
Cryo, as compared with RF, produces significantly less pain during application. Although in the present study there was no significant difference in efficacy, larger studies will be needed to definitively compare efficacy.
Timmermans
Carl
C
Department of Cardiology, Academic Hospital Maastricht, The Netherlands. ccmm.timmermans@cardio.unimaas.nl
Ayers
Gregory M
GM
Crijns
Harry J G M
HJ
Rodriguez
Luz-Maria
LM
D000328:Adult; D000368:Aged; D001282:Atrial Flutter / Q000175:diagnosis / Q000628:therapy*; D017115:Catheter Ablation / Q000009:adverse effects*; D003452:Cryosurgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008214:Lymphocytes; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000523:psychology; D010465:Perception