Cryothermal ablation treatment of atrial flutter--experience with a new 9 French 8 mm tip catheter. 2005

Annibale S Montenero, and Nicola Bruno, and Francesco Zumbo, and Andrea Antonelli, and Luigi Fiocca, and Luca Barbieri, and Francesca De Bernardi, and Peter Andrew, and Vincenzo Affinito
Cardiology Department and Arrhythmia Center of Policlinico MultiMedica, Sesto S. Giovanni, Milan, Italy. montenero@hotmail.com

BACKGROUND Cardiac cryoablation has been used to successfully treat a variety of arrhythmias. OBJECTIVE This study documents our experience with a new 9 French (FR) 8 mm cryocatheter for ablation treatment of symptomatic atrial flutter. METHODS A total of 77 consecutive patients with symptomatic atrial flutter were treated. Electrophysiological studies (EPS) were performed with diagnostic catheters and ablation was performed with a 9FR, 8 mm tip, quadripolar cryocatheter (Freezor MAX catheter, CryoCath Technologies Inc., Kirkland, Canada). Cryoablation at -75 degrees C for 8 minutes was performed, beginning at the inferior rim of the coronary sinus (CS) os and creating a posterior line to the Eustachian ridge. Safety, bidirectional isthmus block at intervention, and recurrence at 3 months post procedure were assessed. RESULTS There were no adverse events reported. All patients remained free of discomfort on cryoenergy delivery. The acute success rate at intervention was 96% for all patients and 100% for those with common atrial flutter. Follow-up data from 47 patients showed 33 (70%) patients without conduction recurrence on repeat EPS at 3 months. Although, 1 (2%) patient had both symptom and conduction recurrence. Data available from 53 acutely successful patients at 6 month clinical follow-up showed that 48 (91%) patients were asymptomatic and 5 (9%) patients had recurrence documented by ECG and/or patient diary records. CONCLUSIONS Our experience with a new 9FR, 8 mm tip, quadripolar cryocatheter yielded a high success rate at intervention and an excellent safety profile. Although repeat EPS at 3 months post ablation identified conduction recurrence in 30% of patients, at 6 month clinical follow-up only 9% of patients had recurrence. Further monitoring is necessary to assess whether the relatively low recurrence rate observed at 6 month clinical follow-up is maintained over the long term.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D003452 Cryosurgery The use of freezing as a special surgical technique to destroy or excise tissue. Cryoablation,Cryoablations,Cryosurgeries
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D001282 Atrial Flutter Rapid, irregular atrial contractions caused by a block of electrical impulse conduction in the right atrium and a reentrant wave front traveling up the inter-atrial septum and down the right atrial free wall or vice versa. Unlike ATRIAL FIBRILLATION which is caused by abnormal impulse generation, typical atrial flutter is caused by abnormal impulse conduction. As in atrial fibrillation, patients with atrial flutter cannot effectively pump blood into the lower chambers of the heart (HEART VENTRICLES). Auricular Flutter,Atrial Flutters,Auricular Flutters,Flutter, Atrial,Flutter, Auricular,Flutters, Atrial,Flutters, Auricular
D016896 Treatment Outcome Evaluation undertaken to assess the results or consequences of management and procedures used in combating disease in order to determine the efficacy, effectiveness, safety, and practicability of these interventions in individual cases or series. Rehabilitation Outcome,Treatment Effectiveness,Clinical Effectiveness,Clinical Efficacy,Patient-Relevant Outcome,Treatment Efficacy,Effectiveness, Clinical,Effectiveness, Treatment,Efficacy, Clinical,Efficacy, Treatment,Outcome, Patient-Relevant,Outcome, Rehabilitation,Outcome, Treatment,Outcomes, Patient-Relevant,Patient Relevant Outcome,Patient-Relevant Outcomes
D017115 Catheter Ablation Removal of tissue with electrical current delivered via electrodes positioned at the distal end of a catheter. Energy sources are commonly direct current (DC-shock) or alternating current at radiofrequencies (usually 750 kHz). The technique is used most often to ablate the AV junction and/or accessory pathways in order to interrupt AV conduction and produce AV block in the treatment of various tachyarrhythmias. Ablation, Transvenous Electric,Catheter Ablation, Electric,Catheter Ablation, Percutaneous,Catheter Ablation, Radiofrequency,Catheter Ablation, Transvenous,Ablation, Catheter,Ablation, Transvenous Electrical,Catheter Ablation, Electrical,Electric Catheter Ablation,Electrical Catheter Ablation,Percutaneous Catheter Ablation,Radiofrequency Catheter Ablation,Transvenous Catheter Ablation,Ablation, Electric Catheter,Ablation, Electrical Catheter,Ablation, Percutaneous Catheter,Ablation, Radiofrequency Catheter,Ablation, Transvenous Catheter,Electric Ablation, Transvenous,Electrical Ablation, Transvenous,Transvenous Electric Ablation,Transvenous Electrical Ablation
D022062 Electrophysiologic Techniques, Cardiac Methods to induce and measure electrical activities at specific sites in the heart to diagnose and treat problems with the heart's electrical system. Cardiac Electrophysiologic Techniques,Electrophysiologic Study, Cardiac,Atrial Electrogram,Bundle of His Electrogram,Cardiac Electrophysiologic Technics,Cardiac Electrophysiological Techniques,Electrophysiologic Techniques, Intracardiac,Electrophysiological Techniques, Cardiac,Electrophysiological Techniques, Intracardiac,His Bundle Electrogram,Intra-Atrial Electrogram,Intracardiac Electrogram,Intracardiac Electrophysiologic Techniques,Intracardiac Electrophysiological Technics,Intracardiac Electrophysiological Techniques,Programmed Electrostimulation, Cardiac,Transesophageal Electrophysiologic Study,Transesophageal Electrophysiological Study,Atrial Electrograms,Bundle Electrogram, His,Bundle Electrograms, His,Cardiac Electrophysiologic Studies,Cardiac Electrophysiologic Study,Cardiac Electrophysiologic Technic,Cardiac Electrophysiologic Technique,Cardiac Electrophysiological Technique,Cardiac Programmed Electrostimulation,Cardiac Programmed Electrostimulations,Electrogram Bundle, His,Electrogram Bundles, His,Electrogram, Atrial,Electrogram, His Bundle,Electrogram, Intra-Atrial,Electrogram, Intracardiac,Electrograms, Atrial,Electrograms, His Bundle,Electrograms, Intra-Atrial,Electrograms, Intracardiac,Electrophysiologic Studies, Cardiac,Electrophysiologic Studies, Transesophageal,Electrophysiologic Study, Transesophageal,Electrophysiologic Technic, Cardiac,Electrophysiologic Technics, Cardiac,Electrophysiologic Technique, Cardiac,Electrophysiologic Technique, Intracardiac,Electrophysiological Studies, Transesophageal,Electrophysiological Study, Transesophageal,Electrophysiological Technic, Intracardiac,Electrophysiological Technics, Intracardiac,Electrophysiological Technique, Cardiac,Electrophysiological Technique, Intracardiac,Electrostimulation, Cardiac Programmed,Electrostimulations, Cardiac Programmed,His Bundle Electrograms,His Electrogram Bundle,His Electrogram Bundles,Intra Atrial Electrogram,Intra-Atrial Electrograms,Intracardiac Electrograms,Intracardiac Electrophysiologic Technique,Intracardiac Electrophysiological Technic,Intracardiac Electrophysiological Technique,Programmed Electrostimulations, Cardiac,Studies, Cardiac Electrophysiologic,Studies, Transesophageal Electrophysiologic,Studies, Transesophageal Electrophysiological,Study, Cardiac Electrophysiologic,Study, Transesophageal Electrophysiologic,Study, Transesophageal Electrophysiological,Technic, Cardiac Electrophysiologic,Technic, Intracardiac Electrophysiological,Technics, Cardiac Electrophysiologic,Technics, Intracardiac Electrophysiological,Technique, Cardiac Electrophysiologic,Technique, Cardiac Electrophysiological,Technique, Intracardiac Electrophysiologic,Technique, Intracardiac Electrophysiological,Techniques, Cardiac Electrophysiologic,Techniques, Cardiac Electrophysiological,Techniques, Intracardiac Electrophysiologic,Techniques, Intracardiac Electrophysiological,Transesophageal Electrophysiologic Studies,Transesophageal Electrophysiological Studies

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