Catheter-based cryoablation permanently cures patients with common atrial flutter.
BACKGROUND
Cryoablation (cryo) has a high success rate in the short-term treatment of atrial flutter (AFL), but evidence of long-term efficacy is lacking. The present study reports the long-term effect of cryo of the cavotricuspid isthmus (CTI) in patients with common AFL.


RESULTS
Thirty-five consecutive patients (28 men; mean age, 53 years) underwent cryo of the CTI. In 34 patients, the AFL had a counterclockwise rotation (cycle length, 242+/-43 ms). Eleven patients had structural heart disease. Cryo was performed with a 10F catheter with a 6-mm-tip electrode (CryoCor). Applications (3 to 5 minutes each) were delivered by use of a point-by-point technique to create the ablation line. The acute end point of the procedure was creation of bidirectional isthmus conduction block and noninducibility of AFL. A median of 14 applications (range, 4 to 30) at 10 sites (range, 4 to 19) was given along the CTI with a mean temperature of -80.0+/-5.0 degrees C. Mean fluoroscopy and procedure times were 40+/-26 minutes and 3.2+/-1.3 hours, respectively. Of the 35 patients, 34 were acutely successfully ablated (97%). After a mean follow-up of 17.6+/-6.2 months (range, 9.6 to 26.1 months), 31 patients (89%) did not have recurrence of AFL. Three of the 4 patients with recurrence had a second successful procedure. One patient had transient ST elevation in the inferior leads during cryoapplication.


CONCLUSIONS
Cryo produces permanent bidirectional isthmus conduction block of the CTI. Short- and long-term success rates are comparable to those for radiofrequency ablation.
Manusama
Randy
R
Department of Cardiology, Academic Hospital Maastricht, Maastricht, The Netherlands.
Timmermans
Carl
C
Limon
Froylan
F
Philippens
Suzanne
S
Crijns
Harry J G M
HJ
Rodriguez
Luz-Maria
LM
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D001282:Atrial Flutter / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D003452:Cryosurgery / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006330:Heart Defects, Congenital / Q000150:complications; D006333:Heart Failure / Q000150:complications; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014261:Tricuspid Valve