Safety and outcomes of cryoablation for ventricular tachyarrhythmias: results from a multicenter experience
| Autor: | Kalyanam Shivkumar, Andrea Natale, Michela Casella, Javier Sanchez, Rong Bai, Gemma Pelargonio, Pasquale Santangeli, Luigi Di Biase, Gery Tomassoni, Shane Bailey, David Burkhardt, Melvin M. Scheinman, Henry H. Hsia, Rodney Horton, Dhanunjay Lakkireddy, G. Joseph Gallinghouse, Antonio Russo, Nitish Badhwar, Roderick Tung, Amin Al-Ahamad, Yanfei Yang |
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| Rok vydání: | 2010 |
| Předmět: |
Tachycardia
Male medicine.medical_specialty medicine.medical_treatment Catheter ablation Ventricular tachycardia Cryosurgery Endosonography Heart Conduction System Heart Rate Physiology (medical) Internal medicine medicine Humans Coronary sinus Aortic dissection Ejection fraction business.industry Body Surface Potential Mapping Cryoablation Middle Aged medicine.disease Ablation Surgery Treatment Outcome Echocardiography Cardiology Tachycardia Ventricular Feasibility Studies Female medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | Heart rhythm. 8(7) |
| ISSN: | 1556-3871 |
| Popis: | Background Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported. Objective The purpose of this study was to assess the feasibility and safety of cryoablation for VA. Methods Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate. Results Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45% ± 5%. In 15 (45%) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55%) patients. Cryoablation was successful in all parahisian cases (100%). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA. Conclusion Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed. |
| Databáze: | OpenAIRE |
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