Abstract
The advent of radiofrequency energy has changed the therapy for supraventricular arrhythmias. Radiofrequency ablation is highly effective and safe. However, the demand for specific ablation lesion characteristic (deep focal lesions or long continuous transmural lesions) has highlighted some of the limitations of radiofrequency as an ablation energy source. Cryothermy as an arrhythmia ablation technology has been well studied and found to be a highly effective and safe technology in the surgical literature. Recently, catheter-based cryoablation has become available. This article reviews some of the unique feature of catheter-based cryoablation and highlights some of its potential advantages. Specifically, the ability to reversibly test the functionality of an ablation site prior to the production of a permanent lesion, so called “ice mapping”, has obvious appeal. In fact, the ability to ice map para-Hisian pathways or the slow pathway in close proximity to the AV node may make this the technology of choice for such substrates. Recent animal work has re-confirmed the safety of cryothermal ablation within the coronary sinus, in close proximity to epicardial coronary arteries. Also, clinical work suggests that this technology may result in less endothelial disruption and less pulmonary venous stenosis, although this requires confirmation in larger trials. The ultimate role of catheter-based cryoablation remains to be determined. A number of promising aspects of this ablation energy make it an exciting technology.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Fujimura O, Guiraudon GM, Yee R, Sharma AD, Klein GJ. Operative therapy of atrioventricular node reentry and results of an anatomically guided procedure. Am J Cardiol 1989;64(19):1327–1332.
Guiraudon GM, and Klein GJ. Closed heart surgery for Wolff-Parkinson-White syndrome. Int J Cardiol 1984;5(3):387–391.
Guiraudon GM, Klein GJ, Sharma AD, Yee R. Surgical alternatives for supraventricular tachycardias. Am J Cardiol 1989;64(20):92J–96J.
Guiraudon GM, Guiraudon CM, Klein GJ, Yee R, Thakur RK. Operation for theWolff-Parkinson-White syndrome in the catheter ablation era. Ann Thorac Surg 1994;57(5):1084–1088.
Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, Huang SK, Liem LB, Klein LS, Moser SA, Bloch DA, Gillette P, Prystowsky E. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: Final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation 1999;99:262–270 (Abstract).
Hindricks G. The Multicentre European Radiofrequency Survey (MERFS): Complications of radiofrequency catheter ablation of arrhythmias. The Multicentre European Radiofrequency Survey (MERFS) investigators of the Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1993;14:1644–1653.
Hindricks G. Incidence of complete atrioventricular block following attempted radiofrequency catheter modification of the atrioventricular node in 880 patients. Results of the Multicenter European Radiofrequency Survey (MERFS). The Working Group on Arrhythmias of the European Society of Cardiology. Eur Heart J 1996;17:82–88.
Engelstein ED, Stein KM, Markowitz SM, Lerman BB. Posterior fast atrioventricular node pathways: Implications for radiofrequency catheter ablation of atrioventricular node reentrant tachycardia. J Am Coll Cardiol 1996;27:1098–1105(Abstract).
Jais P, Shah DC, Haissaguerre M, Takahashi A, Lavergne T, Hocini M, Garrigue S, Barold SS, Le Metayer P, Clementy J. Efficacy and safety of septal and leftatrial linear ablation for atrial fibrillation. Am J Cardiol 1999;84:139R–146R.
Klein GJ, Guiraudon GM, Perkins DG, Jones DL, Yee R, Jarvis E. Surgical correction of theWolff-Parkinson-White syndrome in the closed heart using cryosurgery: A simpli-fied approach. J Am Coll Cardiol 1984;3:405–409.
Klein GJ, Guiraudon GM, Perkins DG, Sharma AD, Jones DL. Controlled cryothermal injury to the AV node: Feasibility for AV nodal modification. Pacing Clin Electrophysiol 1985;8:630–638.
Szabo TS, Jones DL, Guiraudon GM, Rattes MF, Perkins DG, Sharma AD, Klein GJ. Cryosurgical modification of the atrioventricular node: A closed heart approach in the dog. J Am Coll Cardiol 1987;10:389–398.
Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology 1998;37:171–186.
Chauvet P, Santoianni D, Tanguay J, Sirois MG, Lehmann J, Macle L, Dubuc M. Cryoablation produces less endothelial thrombus than RF ablation. Circulation 2001;(Abstract).
Klein GJ, Harrison L, Ideker RF, Smith WM, Kasell J, Wallace AG, Gallagher JJ. Reaction of the myocardium to cryosurgery: Electrophysiology and arrhythmogenic potential. Circulation 1979;59:364–372.
Skanes AC, Dubuc M, Klein GJ, Thibault B, Krahn AD, Yee R, Roy D, Guerra P, Talajic M. Cryothermal ablation of the slow pathway for the elimination of atrioventricular nodal reentrant tachycardia. Circulation 2000;102:2856–2860.
Dubuc M, Roy D, Thibault B, Ducharme A, Tardif JC, Villemaire C, Leung TK, Talajic M. Transvenous catheter ice mapping and cryoablation of the atrioventricular node in dogs. Pacing Clin Electrophysiol 1999;22:1488–1498.
Skanes AC, Jones D, Teefy P, Klein GJ, Krahn AD, Yee R. Cryoablation of accessory pathways via the distal coronary sinus: Safety and feasibility in a swine model. PACE 2002;25:660 (Abstract).
Yagi T, Nakagawa H, Khammar GS, Chandrasekaran S, Myer JH, Pitha JV, Campbell B, Matsudaira K, Lazzara R, Jackman W. Safety and efficacy of cryo-ablation in the canine coronary sinus. Circulation 2001 (Abstract).
Tondo C, Fassini G, De Martino G, Riva S, Giraldi F, Berti M, Trevisi N, Della Bella P. Catheter isolation of the pulmonary veins by cryothermal ablation: Preliminary results. PACE 2002;25:612 (Abstract).
Wong T, Markides V, Chow AWC, Schilling RJ, Peters NS, Davies DW. Percutaneous cryoablation pulmonary vein isolation to treat atrial fibrillation. PACE 2002;25:552 (Abstract).
Yu WC, Hsu TL, Tai CT, Tsai CF, Hsieh MH, Lin WS, Lin YK, Tsao HM, Ding YA, Chang MS, Chen SA. Acquired pulmonary vein stenosis after radiofrequency catheter ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 2001;12:887–892.
Chen SA, Yu WC, Tai CT. Editorial comment: can we avoid pulmonary vein stenosis following ablation of atrial fibrillation? J Interv Card Electrophysiol 2000;4:633–634.
Gillinov AM, Pettersson G, Rice TW. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg 2001;122:1239–1240.
Hindricks G, Doll N, Elsner C, Mohr FW, Dorszewski A, Schirdewahn P, Wetzel U, Vanaarnhem G, Kottkamp H. Intraoperaive radiofrequency ablation of atrial fibrillation in 385 consecutive patients: Risks and prevention of severe complications. PACE 2002;25:559 (Abstract).
Calkins H, Yong P, Miller JM, Olshansky B, Carlson M, Saul JP, Huang SK, Liem LB, Klein LS, Moser SA, Bloch DA, Gillette P, Prystowsky E. Catheter ablation of accessory pathways, atrioventricular nodal reentrant tachycardia, and the atrioventricular junction: Final results of a prospective, multicenter clinical trial. The Atakr Multicenter Investigators Group. Circulation 1999;99:262–270.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Skanes, A.C., Yee, R., Krahn, A.D. et al. Cryoablation of Atrial Arrhythmias. Card Electrophysiol Rev 6, 383–388 (2002). https://doi.org/10.1023/A:1021128207078
Issue Date:
DOI: https://doi.org/10.1023/A:1021128207078