title: Time-limited cryomapping during tachycardia: improved long-term outcomes for cryoablation of AVNRT.
abstract: OBJECTIVE
  Cryothermal ablation (CTA) for atrioventricular nodal reentrant tachycardia (AVNRT) is considered safer than radiofrequency ablation (RFA) since it eliminates the risk of inadvertent AV block. However, it has not been widely adopted due to high late recurrence rate (LRR). In an effort to improve LRR, we evaluated a new approach to cryothermal mapping (CTM): "time to tachycardia termination" (TTT).
  
  
  METHODS
  This single-center study had 88 consecutive patients who underwent CTA using TTT for AVNRT. The CTA catheter was positioned in sinus rhythm at the posteroseptal tricuspid annulus, and then AVNRT was induced. The CTA target site was identified by prompt tachycardia termination in ≤20 s during CTM. Procedural success was defined as no inducible AVNRT and ≤1 single AV nodal echoes.
  
  
  RESULTS
  Acute procedural success was achieved in 87 of 88 patients (98.9 %) and was similar to prior studies for both CTA and RFA. No permanent AV block was observed. LRR was 3.7 % at a mean follow-up of 19.7 months. LRR was equivalent to that commonly reported for RFA and improved when compared to conventional CTA.
  
  
  CONCLUSIONS
  TTT for CTA of AVNRT provides enhanced safety and similar long-term efficacy when compared to RFA. Based upon this experience, TTT provides an enhancement to conventional CTA that appears to result in improved long-term outcomes. In light of these findings, it seems reasonable to undertake additional randomized trials to determine whether RFA or CTA using TTT is the optimal approach for the catheter ablation of AVNRT.
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Paula L S
authors.initials: PL
authors.lastname: Eryazici
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA. mansour.razminia@advocatehealth.com.
authors.forename: Mansour
authors.initials: M
authors.lastname: Razminia
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Oliver
authors.initials: O
authors.lastname: D'Silva
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Jaime R
authors.initials: JR
authors.lastname: Chavez
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Ferah D
authors.initials: FD
authors.lastname: Ciftci
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Marianne
authors.initials: M
authors.lastname: Turner
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Theodore
authors.initials: T
authors.lastname: Wang
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Terry A
authors.initials: TA
authors.lastname: Zheutlin
authors.affiliation: Advocate Illinois Masonic Medical Center, 3000 N. Halsted St., Suite 803, Chicago, IL, 60657, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Kehoe
mesh_terms: D018780:Body Surface Potential Mapping / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D025321:Surgery, Computer-Assisted / Q000379:methods*; D013611:Tachycardia, Atrioventricular Nodal Reentry / Q000000981:diagnostic imaging* / Q000601:surgery*; D016896:Treatment Outcome
keywords: AVNRT; Cryoablation; Cryomapping; Time to effect; Time to tachycardia termination