title: Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial.
abstract: BACKGROUND
  Cryoablation has emerged as an alternative to radiofrequency catheter ablation (RFCA) for the treatment of atrioventricular (AV) nodal reentrant tachycardia (AVNRT). The purpose of this prospective randomized study was to test whether cryoablation is as effective as RFCA during both short-term and long-term follow-up with a lower risk of permanent AV block.
  
  
  RESULTS
  A total of 509 patients underwent slow pathway cryoablation (n=251) or RFCA (n=258). The primary end point was immediate ablation failure, permanent AV block, and AVNRT recurrence during a 6-month follow-up. Secondary end points included procedural parameters, device functionality, and pain perception. Significantly more patients in the cryoablation group than the RFCA group reached the primary end point (12.6% versus 6.3%; P=0.018). Whereas immediate ablation success (96.8% versus 98.4%) and occurrence of permanent AV block (0% versus 0.4%) did not differ, AVNRT recurrence was significantly more frequent in the cryoablation group (9.4% versus 4.4%; P=0.029). In the cryoablation group, procedure duration was longer (138±54 versus 123±48 minutes; P=0.0012) and more device problems occurred (13 versus 2 patients; P=0.033). Pain perception was lower in the cryoablation group (P<0.001).
  
  
  CONCLUSIONS
  Cryoablation for AVNRT is as effective as RFCA over the short term but is associated with a higher recurrence rate at the 6-month follow-up. The risk of permanent AV block does not differ significantly between cryoablation and RFCA. The potential benefits of cryoenergy relative to ablation safety and pain perception are counterbalanced by longer procedure times, more device problems, and a high recurrence rate.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00196222.
authors.affiliation: Deutsches Herzzentrum München, Lazarettstrasse 36, D-80636 Munich, Germany. deisenhofer@dhm.mhn.de
authors.forename: Isabel
authors.initials: I
authors.lastname: Deisenhofer
authors.forename: Bernhard
authors.initials: B
authors.lastname: Zrenner
authors.forename: Yue-Hui
authors.initials: YH
authors.lastname: Yin
authors.forename: Heinz-Friedrich
authors.initials: HF
authors.lastname: Pitschner
authors.forename: Malte
authors.initials: M
authors.lastname: Kuniss
authors.forename: Georg
authors.initials: G
authors.lastname: Grossmann
authors.forename: Sascha
authors.initials: S
authors.lastname: Stiller
authors.forename: Armin
authors.initials: A
authors.lastname: Luik
authors.forename: Christian
authors.initials: C
authors.lastname: Veltmann
authors.forename: Julia
authors.initials: J
authors.lastname: Frank
authors.forename: Julia
authors.initials: J
authors.lastname: Linner
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Estner
authors.forename: Andreas
authors.initials: A
authors.lastname: Pflaumer
authors.forename: Jinjin
authors.initials: J
authors.lastname: Wu
authors.forename: Christian
authors.initials: C
authors.lastname: von Bary
authors.forename: Ekrem
authors.initials: E
authors.lastname: Ucer
authors.forename: Tilko
authors.initials: T
authors.lastname: Reents
authors.forename: Stylianos
authors.initials: S
authors.lastname: Tzeis
authors.forename: Stephanie
authors.initials: S
authors.lastname: Fichtner
authors.forename: Susanne
authors.initials: S
authors.lastname: Kathan
authors.forename: Martin R
authors.initials: MR
authors.lastname: Karch
authors.forename: Clemens
authors.initials: C
authors.lastname: Jilek
authors.forename: Sonia
authors.initials: S
authors.lastname: Ammar
authors.forename: Christof
authors.initials: C
authors.lastname: Kolb
authors.forename: Zeng-Chang
authors.initials: ZC
authors.lastname: Liu
authors.forename: Bernhard
authors.initials: B
authors.lastname: Haller
authors.forename: Claus
authors.initials: C
authors.lastname: Schmitt
authors.forename: Gabriele
authors.initials: G
authors.lastname: Hessling
mesh_terms: D000328:Adult; D000368:Aged; D054537:Atrioventricular Block / Q000453:epidemiology; D017115:Catheter Ablation / Q000379:methods*; D002681:China; D003452:Cryosurgery / Q000379:methods*; D023381:Endpoint Determination; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000401:mortality / Q000601:surgery*; D016896:Treatment Outcome