Safety and efficacy of cryoablation of atrial tachycardia with high risk of ablation-related injuries.
OBJECTIVE
The purpose of this study was to evaluate the safety and efficacy of cryoablation as an alternative to radio frequency (RF) ablation in high-risk-located atrial tachycardia (AT).


RESULTS
Between 2004 and 2007, 164 patients underwent catheter ablation due to AT at our institution. Twenty-six of these patients (22 women and 4 men), median age 58 years (range 14-76), were considered having high-risk-located AT and were treated by cryoablation. Seven patients had failed prior RF ablation due to high risk of complications. The AT foci distribution was: close to the AV node (n = 14), vicinity of the sinus node (n = 7), and crista terminalis adjacent to the phrenic nerve (n = 5). Cryomapping, using a 6 mm tip catheter, at -30 degrees C was performed before ablation with a goal temperature of -80 degrees C for 240 s. Acute success rate was achieved in 25/26 patients (96%). During a follow-up of 493 +/- 258 days, three patients had recurrences. Two of these underwent a second successful cryoablation procedure. Long-term success rate was 92%. Phrenic nerve palsy occurred in two patients with complete recovery after 1 day and 5 months, respectively.


CONCLUSIONS
Cryoablation of high-risk-located AT foci is a safe and effective alternative to RF therapy.
Bastani
Hamid
H
Department of Cardiology, Karolinska Institute, Karolinska University Hospital, S-141 86 Stockholm, Sweden. hamid.bastani@karolinska.se
Insulander
Per
P
Schwieler
Jonas
J
Tabrizi
Fariborz
F
Braunschweig
Frieder
F
Kennebäck
Göran
G
Drca
Nikola
N
Sadigh
Bita
B
Jensen-Urstad
Mats
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D001283:Atrioventricular Node / Q000503:physiopathology*; D003452:Cryosurgery / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010791:Phrenic Nerve / Q000293:injuries*; D012307:Risk Factors; D012849:Sinoatrial Node / Q000503:physiopathology*; D013612:Tachycardia, Ectopic Atrial / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult