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Efficacy and safety of cryoablation of para-Hisian and mid-septal accessory pathways using a specific protocol: single-center experience in consecutive patients

  • Jacopo Marazzato
  • Giuseppe Fonte
  • Raffaella Marazzi
  • Lorenzo A. Doni
  • Gianfranco Mitacchione
  • Manola Vilotta
  • Roberto De Ponti
Article
  • 16 Downloads

Abstract

Purpose

Radiofrequency (RF) catheter ablation of para-Hisian (P-H) and mid-septal (M-S) accessory pathways (APs) is a potentially harmful procedure due to their close location to the A-V node. Conversely, cryoablation (CA) appears safer in this setting. The aim of this study was to assess the efficacy and safety of CA of these APs using a specific protocol.

Methods

Fifty-three patients undergoing CA for P-H (45) or M-S (8) APs were included. CA was performed with a 4-mm catheter at − 75 °C for 480 s in the site where conduction block over the AP was obtained by a specific cryomapping protocol. Optimal catheter-tissue contact was achieved by inferior or superior vena cava approach. In case of failure, a 6-mm catheter and/or trans-septal catheterization (TSC) were considered. Normal AV conduction was monitored throughout CA, which was interrupted in case of its inadvertent modifications.

Results

In 46 patients (87%), CA was successful. Reasons for failure were as follows: lack of AP interruption (3 patients), intraprocedure AP conduction resumption (3), or transient A-H interval prolongation (1). Failure was associated with more aggressive approach including multiple procedures, greater use of 6-mm catheters, TSC, and longer CA applications. No major complications were observed. Three out of 46 patients (6.5%) experienced relapse of AP conduction during follow-up and were successfully re-treated by CA.

Conclusions

CA of P-H and M-S APs is highly safe and effective and a specific protocol for cryomapping and CA could lead to a low recurrence rate at follow-up.

Keywords

Wolff-Parkinson-White syndrome Catheter ablation Accessory pathways Cryomapping Cryoablation 

Abbreviations

AP

Accessory pathways

A-V

Atrio-ventricular

AVRT

Atrio-ventricular re-entrant tachycardia

AVB

Atrio-ventricular block

CA

Cryoablation

DAP

Dose area product

EP

Electrophysiological study

IVC

Inferior vena cava

M-S

Mid-septal

P-H

Para-Hisian

RF

Radiofrequency

SD

Standard deviation

SVC

Superior vena cava

TSP

Trans-septal

VPE

Ventricular pre-excitation

Notes

Compliance with ethical standards

This study conforms to the Declaration of Helsinki on human research and was approved by the Ethical Committee at our institution.

Conflict of interest

Dr. De Ponti has received educational grants from Medtronic; none for the other authors.

References

  1. 1.
    Bravo L, Atienza F, Eidelman G, Ávila P, Pelliza M, Castellanos E, et al. Safety and efficacy of cryoablation vs. radiofrequency ablation of septal accessory pathways: systematic review of the literature and meta-analyses. Europace. 2018;20:1334–42.CrossRefGoogle Scholar
  2. 2.
    De Ponti R, Marazzi R, Doni LA, Cremona V, Marazzato J, Salerno-Uriarte JA. Invasive electrophysiological evaluation and ablation in patients with asymptomatic ventricular pre-excitation persistent at exercise stress test. Europace. 2015;17:946–52.CrossRefGoogle Scholar
  3. 3.
    De Ponti R. Cryothermal energy ablation of cardiac arrhythmias 2005: state of the art. Indian Pacing Electrophysiol J. 2005;5:12–24.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Page RL, Joglar JA, Caldwell MA, Calkins H, Conti JB, Deal BJ, et al. 2015 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia: a Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2016;13:e136–221.CrossRefGoogle Scholar
  5. 5.
    Kriebel T, Broistedt C, Kroll M, Sigler M, Paul T. Efficacy and safety of cryoenergy in the ablation of atrioventricular reentrant tachycardia substrates in children and adolescents. J Cardiovasc Electrophysiol. 2005;16:960–6.CrossRefGoogle Scholar
  6. 6.
    Gaita F, Haissaguerre M, Giustetto C, Grossi S, Caruzzo E, Bianchi F, et al. Safety and efficacy of cryoablation of accessory pathways adjacent to the normal conduction system. J Cardiovasc Electrophysiol. 2003;14:825–9.CrossRefGoogle Scholar
  7. 7.
    Atienza F, Arenal A, Torrecilla EG, García-Alberola A, Jiménez J, Ortiz M, et al. Acute and long-term outcome of transvenous cryoablation of midseptal and parahissian accessory pathways in patients at high risk of atrioventricular block during radiofrequency ablation. Am J Cardiol. 2004;93:1302–5.CrossRefGoogle Scholar
  8. 8.
    Kirsh JA, Gross GJ, O'Connor S, Hamilton RM. Cryocath International Patient Registry. Transcatheter cryoablation of tachyarrhythmias in children: initial experience from an international registry. J Am Coll Cardiol. 2005;45:133–6.CrossRefGoogle Scholar
  9. 9.
    Drago F, De Santis A, Grutter G, Silvetti MS. Transvenous cryothermal catheter ablation of re-entry circuit located near the atrioventricular junction in pediatric patients: efficacy, safety, and midterm follow-up. J Am Coll Cardiol. 2005;45:1096–103.CrossRefGoogle Scholar
  10. 10.
    Bar-Cohen Y, Cecchin F, Alexander ME, Berul CI, Triedman JK, Walsh EP. Cryoablation for accessory pathways located near normal conduction tissues or within the coronary venous system in children and young adults. Heart Rhythm. 2006;3:253–8.CrossRefGoogle Scholar
  11. 11.
    Gaita F, Montefusco A, Riccardi R, Scaglione M, Grossi S, Caponi D, et al. Acute and long-term outcome of transvenous cryothermal catheter ablation of supraventricular arrhythmias involving the perinodal region. J Cardiovasc Med (Hagerstown). 2006;7:785–92.CrossRefGoogle Scholar
  12. 12.
    Kaltman JR, Tanel RE, Wegrzynowicz B, Kozodoy E, Wieand T, Ennis J, et al. Time and temperature profile of catheter cryoablation of right septal and free wall accessory pathways in children. J Cardiovasc Electrophysiol. 2008;19:343–7.CrossRefGoogle Scholar
  13. 13.
    Bastani H, Insulander P, Schwieler J, Tabrizi F, Braunschweig F, Kennebäck G, et al. Cryoablation of superoparaseptal and septal accessory pathways: a single centre experience. Europace. 2010;12:972–7.CrossRefGoogle Scholar
  14. 14.
    Drago F, Righi D, Placidi S, Russo MS, Di Mambro C, Silvetti MS, et al. Cryoablation of right-sided accessory pathways in children: report of efficacy and safety after 10-year experience and follow-up. Europace. 2013;15:1651–6.CrossRefGoogle Scholar
  15. 15.
    Ergul Y, Tola HT, Kiplapinar N, Akdeniz C, Saygi M, Tuzcu V. Cryoablation of anteroseptal accessory pathways in children with limited fluoroscopy exposure. Pediatr Cardiol. 2013;34:802–8.CrossRefGoogle Scholar
  16. 16.
    Yildirim I, Karagöz T, Ertuğrul İ, Karagöz AH, Özer S. Efficacy and safety of cryoablation of parahissian accessory pathways in children: a single institution study. Pacing Clin Electrophysiol. 2013;36:1495–502.CrossRefGoogle Scholar
  17. 17.
    Insulander P, Bastani H, Braunschweig F, Drca N, Gudmundsson K, Kennebäck G, et al. Cryoablation of substrates adjacent to the atrioventricular node: acute and long-term safety of 1303 ablation procedures. Europace. 2014;16:271–6.CrossRefGoogle Scholar
  18. 18.
    Karadeniz C, Akdeniz C, Turan O, Tuzcu V. Cryoablation of septal accessory pathways in children: midterm results. Pacing Clin Electrophysiol. 2014;37:1095–9.CrossRefGoogle Scholar
  19. 19.
    Swissa M, Birk E, Dagan T, Fogelman M, Einbinder T, Bruckheimer E, et al. Cryotherapy ablation of parahisian accessory pathways in children. Heart Rhythm. 2015;12:917–25.CrossRefGoogle Scholar
  20. 20.
    Jiang H, Li X. Cryoablation of the right anteroseptal or midseptal accessory pathways in children: a 2-year single-center experience. Pacing Clin Electrophysiol. 2018;41:1123–8.CrossRefGoogle Scholar
  21. 21.
    Drago F, Russo MS, Silvetti MS, De Santis A, Onofrio MT. ‘Time to effect’ during cryomapping: a parameter related to the long-term success of accessory pathways cryoablation in children. Europace. 2009;11:630–4.CrossRefGoogle Scholar
  22. 22.
    Tanidir IC, Ergul Y, Ozturk E, Dalgic F, Kiplapinar N, Tola HT, et al. Cryoablation with an 8-mm-tip catheter for right-sided accessory pathways in children. Pacing Clin Electrophysiol. 2016;39:797–804.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Heart and Vessels, Ospedale di Circolo e Fondazione MacchiUniversity of InsubriaVareseItaly

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