Multi-catheter cryotherapy for the treatment of resistant accessory pathways.
Accessory pathway
Catheter ablation
Cryoablation
Pre-excitation
Wolff Parkinson white syndrome
Journal
Indian pacing and electrophysiology journal
ISSN: 0972-6292
Titre abrégé: Indian Pacing Electrophysiol J
Pays: Netherlands
ID NLM: 101157207
Informations de publication
Date de publication:
17 Nov 2023
17 Nov 2023
Historique:
received:
27
08
2023
revised:
25
10
2023
accepted:
02
11
2023
pubmed:
18
11
2023
medline:
18
11
2023
entrez:
17
11
2023
Statut:
aheadofprint
Résumé
To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation. Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods. Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA). Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation. Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
Sections du résumé
OBJECTIVE
OBJECTIVE
To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation.
BACKGROUND
BACKGROUND
Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods.
METHODS
METHODS
Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA).
RESULTS
RESULTS
Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation.
CONCLUSION
CONCLUSIONS
Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
Identifiants
pubmed: 37977548
pii: S0972-6292(23)00107-9
doi: 10.1016/j.ipej.2023.11.002
pii:
doi:
Types de publication
Journal Article
Langues
eng
Informations de copyright
Copyright © 2023 Indian Heart Rhythm Society. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest Dr Gallagher has received research funding from Attune medical and has acted as a consultant and paid speaker for Biosense Webster. No other author has any conflict of interest.