title: Cryothermal ablation treatment of atrial flutter--experience with a new 9 French 8 mm tip catheter.
abstract: BACKGROUND
  Cardiac cryoablation has been used to successfully treat a variety of arrhythmias.
  
  
  OBJECTIVE
  This study documents our experience with a new 9 French (FR) 8 mm cryocatheter for ablation treatment of symptomatic atrial flutter.
  
  
  METHODS
  A total of 77 consecutive patients with symptomatic atrial flutter were treated. Electrophysiological studies (EPS) were performed with diagnostic catheters and ablation was performed with a 9FR, 8 mm tip, quadripolar cryocatheter (Freezor MAX catheter, CryoCath Technologies Inc., Kirkland, Canada). Cryoablation at -75 degrees C for 8 minutes was performed, beginning at the inferior rim of the coronary sinus (CS) os and creating a posterior line to the Eustachian ridge. Safety, bidirectional isthmus block at intervention, and recurrence at 3 months post procedure were assessed.
  
  
  RESULTS
  There were no adverse events reported. All patients remained free of discomfort on cryoenergy delivery. The acute success rate at intervention was 96% for all patients and 100% for those with common atrial flutter. Follow-up data from 47 patients showed 33 (70%) patients without conduction recurrence on repeat EPS at 3 months. Although, 1 (2%) patient had both symptom and conduction recurrence. Data available from 53 acutely successful patients at 6 month clinical follow-up showed that 48 (91%) patients were asymptomatic and 5 (9%) patients had recurrence documented by ECG and/or patient diary records.
  
  
  CONCLUSIONS
  Our experience with a new 9FR, 8 mm tip, quadripolar cryocatheter yielded a high success rate at intervention and an excellent safety profile. Although repeat EPS at 3 months post ablation identified conduction recurrence in 30% of patients, at 6 month clinical follow-up only 9% of patients had recurrence. Further monitoring is necessary to assess whether the relatively low recurrence rate observed at 6 month clinical follow-up is maintained over the long term.
authors.affiliation: Cardiology Department and Arrhythmia Center of Policlinico MultiMedica, Sesto S. Giovanni, Milan, Italy. montenero@hotmail.com
authors.forename: Annibale S
authors.initials: AS
authors.lastname: Montenero
authors.forename: Nicola
authors.initials: N
authors.lastname: Bruno
authors.forename: Francesco
authors.initials: F
authors.lastname: Zumbo
authors.forename: Andrea
authors.initials: A
authors.lastname: Antonelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Fiocca
authors.forename: Luca
authors.initials: L
authors.lastname: Barbieri
authors.forename: Francesca
authors.initials: F
authors.lastname: De Bernardi
authors.forename: Peter
authors.initials: P
authors.lastname: Andrew
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Affinito
mesh_terms: D001282:Atrial Flutter / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation*; D003452:Cryosurgery / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
references.citation: Circulation. 1996 Dec 15;94(12):3204-13
references.pmid: 8989130
references.citation: Turk J Pediatr. 2003 Jul-Sep;45(3):209-16
references.pmid: 14696798
references.citation: Card Electrophysiol Rev. 2002 Dec;6(4):383-8
references.pmid: 12438817
references.citation: J Interv Card Electrophysiol. 1998 Sep;2(3):285-92
references.pmid: 9870024
references.citation: Circulation. 1980 Jul;62(1):67-74
references.pmid: 7379286
references.citation: Pacing Clin Electrophysiol. 2003 Jan;26(1 Pt 2):500-3
references.pmid: 12687877
references.citation: Circulation. 2003 Apr 22;107(15):2045-50
references.pmid: 12668527
references.citation: Circulation. 1995 Sep 15;92(6):1389-92
references.pmid: 7664417
references.citation: J Interv Card Electrophysiol. 2002 Dec;7(3):225-31
references.pmid: 12510133
references.citation: Circulation. 1996 Jan 15;93(2):284-94
references.pmid: 8548901
references.citation: Circulation. 1999 Dec 21-28;100(25):2507-13
references.pmid: 10604888
references.citation: Pacing Clin Electrophysiol. 2003 Mar;26(3):743-6
references.pmid: 12698676
references.citation: Circulation. 2004 Apr 6;109(13):1636-9
references.pmid: 15023886
references.citation: J Cardiovasc Electrophysiol. 1998 Feb;9(2):152-63
references.pmid: 9511889
references.citation: Circulation. 2003 Mar 11;107(9):1250-2
references.pmid: 12628943
references.citation: J Med Eng Technol. 1999 Jan-Feb;23(1):20-5
references.pmid: 10202699
references.citation: J Cardiovasc Electrophysiol. 1998 Feb;9(2):115-21
references.pmid: 9511885