title: Correlations between long-term results after cryoablation for atrioventricular nodal reentry tachycardia and a residual jump associated or not with a single echo.
abstract: OBJECTIVE
  While in radiofrequency ablation for atrioventricular nodal reentry tachycardia (AVNRT) a residual jump and a single echo do not seem to substantially modify long-term results, in cryoablation procedures their effects are still under evaluation. The purpose of this study was to evaluate if a residual jump associated or not with an isolated echo is correlated with outcome.
  
  
  RESULTS
  
  
  
  METHODS
  acute successful slow pathway cryoablation for slow-fast AVNRT.
  
  
  METHODS
  use of a 4 mm tip cryocatheter, no baseline elicitable jump or inducible AVNRT, and unwanted persistent first degree atrioventricular (AV) block at the end of the procedure. Cryoablation (-80°C × 4 min) was applied after successful cryomapping. Atrioventricular nodal reentry tachycardia inducibility was checked 30 min later on and off isoproterenol. Acute success was defined as AVNRT non-inducibility. Among 332 patients (pts) who had undergone cryoablation from May 2002 to March 2010 in our institutions, 245 of them fulfilled the entry criteria (173 women, mean age 41 ± 16 years, ineffective drugs 1.3 ± 1.1). A 7-Fr 6-mm tip cryocatheter (CryoCath®) was used in all cases. Baseline AV nodal effective refractory period (ERP) was 271 ± 55 ms, post-procedural ERP 331 ± 60 ms (P< 0.001), and the mean of the difference between baseline and post-procedural ERP 63 ± 38 ms. A/V ratio at successful site was 1 ± 0.4. Forty-four pts (18%) had a residual jump at the end of the procedure, and 14 of them had an associated single echo. Global cryoapplication time was 993 ± 797 s. During a follow-up of 40 ± 10 months, 43 pts (17.5%) had recurrences. At 12 months follow-up, actuarial rate of recurrence-free pts was 85% in the group without residual jump (201 pts), 63.3% with residual jump and no echo (30 pts), and 60.6% with residual jump associated with a single echo (P< 0.003 among groups). Univariate predictors of recurrences were persistence of a residual jump (P< 0.001) and total cryoapplication time (P< 0.02). In a multivariate model, only residual jump was independently correlated with recurrences (P< 0.01).
  
  
  CONCLUSIONS
  In patients undergoing AVNRT cryoablation, slow-pathway suppression is correlated with a better outcome. A single echo is associated with a recurrence risk similar to residual jump without echo. It may be suggested that pursuing a procedural endpoint up to slow pathway complete suppression may improve long-term success.
authors.affiliation: Rhythmology Unit, Cardiology Institute, Pitié-Salpêtrière Hospital, Paris, France.
authors.forename: Antonio
authors.initials: A
authors.lastname: De Sisti
authors.forename: Joelci
authors.initials: J
authors.lastname: Tonet
authors.forename: Walid
authors.initials: W
authors.lastname: Amara
authors.forename: Denis
authors.initials: D
authors.lastname: Raguin
authors.forename: Philip
authors.initials: P
authors.lastname: Aouate
authors.forename: Fatima
authors.initials: F
authors.lastname: Gueffaf
authors.forename: Faouzi
authors.initials: F
authors.lastname: Touil
authors.forename: Françoise
authors.initials: F
authors.lastname: Hidden-Lucet
mesh_terms: D000328:Adult; D003452:Cryosurgery / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008297:Male; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000453:epidemiology* / Q000601:surgery*; D016896:Treatment Outcome