Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia
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Ablation of the slow pathway is an established cure for atrioventricular nodal reentrant tachycardia (AVNRT). Periprocedural damage to the conduction system is a major concern during AVNRT ablation, and cryoablation (CRYO) has been suggested to improve the procedural safety compared to standard radiofrequency (RF) ablation, without reducing the procedural success.
We performed a systematic review and meta-analysis of studies comparing CRYO with RF ablation of AVNRT.
We searched PubMed, CENTRAL, the BioMed Central, EMBASE, CardioSource, clinicaltrials.gov, and ISI Web of Science (January 1980 to July 2013). No language restriction was applied. Two independent reviewers screened titles and abstracts to identify studies that compared the procedural outcomes of AVNRT ablation with either CRYO or RF energy. Two independent reviewers assessed the risk of bias according to the Cochrane Collaboration, and extracted patient, study characteristics, and procedural outcome data. Results are expressed as odds ratio (OR) or as weighted mean difference (WMD) with their 95 % confidence interval (CI).
Fourteen studies (5 prospective randomized and 9 observational) with 2,340 patients (mean age range 13 to 53 years, 1,522 (65 %) females) were included in the analysis. RF ablation was performed in 1,262 (54 %) patients, while CRYO in 1,078 (46 %) patients. Acute success (abolition of dual atrioventricular node physiology or single echo beats) was achieved in 88 % of patients treated with RF versus 83 % of those treated with CRYO (OR = 0.72, 95 % CI 0.46 to 1.13; P = 0.157). RF ablation was associated with shorter total procedure time (WMD = −13.7 min, 95 % CI −23 to −4.3 min; P = 0.004), but slightly longer fluoroscopy time (WMD = +4.6 min 95 % CI +1.7 to +7.6 min; P = 0.002). Permanent atrioventricular block occurred in 0.87 % RF cases and in no CRYO case (OR = 3.60, 95 % CI 1.09 to 11.81; P = 0.035). Over a median follow-up of 10.5 months (range 6 to 12 months), freedom from recurrent AVNRT was 96.5 % in the RF group versus 90.9 % in the CRYO group (OR = 0.40, 95 % CI 0.28 to 0.58; P < 0.001). At meta-regression analysis, no clinical or procedural variable had a significant interaction with the results above.
In patients undergoing AVNRT ablation, RF significantly reduces the risk of long-term arrhythmia recurrence compared to CRYO, but is associated with a higher risk of permanent atrioventricular block.
KeywordsAtrioventricular nodal reentrant tachycardia Cryoablation Radiofrequency ablation
- 1.Blomstrom-Lundqvist, C., Scheinman, M. M., Aliot, E. M., et al. (2003). ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias). Circulation, 108, 1871–1909.PubMedCrossRefGoogle Scholar
- 5.Calkins, H., Yong, P., Miller, J. M., et al. (1999). 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, 99, 262–270.PubMedCrossRefGoogle Scholar
- 10.Zrenner, B., Dong, J., Schreieck, J., et al. (2004). Transvenous cryoablation versus radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal reentrant tachycardia: a prospective randomized pilot study. European Heart Journal, 25, 2226–2231.PubMedCrossRefGoogle Scholar
- 15.Deisenhofer, I., Zrenner, B., Yin, Y. H., et al. (2010). Cryoablation versus radiofrequency energy for the ablation of atrioventricular nodal reentrant tachycardia (the CYRANO Study): results from a large multicenter prospective randomized trial. Circulation, 122, 2239–2245.PubMedCrossRefGoogle Scholar
- 16.Opel, A., Murray, S., Kamath, N., et al. (2010). Cryoablation versus radiofrequency ablation for treatment of atrioventricular nodal reentrant tachycardia: cryoablation with 6-mm-tip catheters is still less effective than radiofrequency ablation. Heart Rhythm, 7, 340–343.PubMedCrossRefGoogle Scholar
- 20.Schwagten, B., Knops, P., Janse, P., et al. (2011). Long-term follow-up after catheter ablation for atrioventricular nodal reentrant tachycardia: a comparison of cryothermal and radiofrequency energy in a large series of patients. Journal of interventional cardiac electrophysiology, 30, 55–61.PubMedCentralPubMedCrossRefGoogle Scholar
- 22.Rodriguez-Entem, F. J., Exposito, V., Gonzalez-Enriquez, S., & Olalla-Antolin, J. J. (2013). Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study. Journal of interventional cardiac electrophysiology, 36, 41–45. discussion 45.PubMedCrossRefGoogle Scholar
- 23.Cochrane Handbook for systematic reviews of interventions, Version 5.1.0. Updated March 2011, The Cochrane Collaboration, available from ≤http://www.cochrane-handbook.org/%3E.
- 24.Santangeli, P., Di Biase, L., Pelargonio, G., et al. (2011). Cardiac resynchronization therapy in patients with mild heart failure: a systematic review and meta-analysis. Journal of interventional cardiac electrophysiology: an international journal of arrhythmias and pacing, 32, 125–135.CrossRefGoogle Scholar
- 31.Hanninen, M., Yeung-Lai-Wah, N., Massel, D., et al. (2013). Cryoablation versus RF ablation for AVNRT: a meta-analysis and systematic review. Journal of cardiovascular electrophysiology; In press.Google Scholar
- 33.Doughty, R. N., Whalley, G. A., Gamble, G., MacMahon, S., & Sharpe, N. (1997). Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia–New Zealand Heart Failure Research Collaborative Group. Journal of the American College of Cardiology, 29, 1060–1066.PubMedCrossRefGoogle Scholar