Advertisement

Cryocatheter Ablation for Atrial Flutter

  • Peter Andrew
  • Annibale Sandro Montenero
Conference paper

Abstract

Atrial flutter (AFl), a common supraventricular tachyarrhythmia (SVT), results in the atria beating up to five times faster than normal, i.e., 240 to 400 beats per minute [1]. A 2:1 relation between atrial and ventricular contractions is typically observed by electrocardiogram (ECG) [2], and under these conditions of accelerated and mismatched contractile activity of the heart chambers there is ineffective pumping of blood to the systemic circulation. While AFl is usually a non life-threatening arrhythmia, it can be a chronic, life-long condition that is episodic and transient. It can cause hypotension, impair cardiac output, exacerbate pulmonary congestion, initiate myocardial ischemia, and in rare cases may lead to a tachycardia-mediated cardiomyopathy [2]. Symptoms commonly experienced by individuals with AFl include palpitations, dizziness, chest tightness, shortness of breath, and fatigue. However, some individuals are asymptomatic.

Keywords

Catheter Ablation Atrial Flutter Symptom Recurrence Electrical Cardioversion Radiofrequency Catheter Ablation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Lee KW, Yang Y, Scheinman MM (2005) Atrial flutter: a review of its history, mechanisms, clinical features, and current therapy. Curr Probl Cardiol 30(3):121–167PubMedCrossRefGoogle Scholar
  2. 2.
    Wellens HJ (2002) Contemporary management of atrial flutter. Circulation 106(6):649–652PubMedCrossRefGoogle Scholar
  3. 3.
    Foldesi C, Pandozi C, Peichl P et al (2003) Atrial flutter: arrhythmia circuit and basis for radiofrequency catheter ablation. Ital Heart J 4(6):395–403PubMedGoogle Scholar
  4. 4.
    Yee R, Connolly S, Noorani H (2003) Clinical review of radiofrequency catheter ablation for cardiac arrhythmias. Can J Cardiol 19(11):1273–1284PubMedGoogle Scholar
  5. 5.
    Feld GK (2004) Radiofrequency ablation of atrial flutter using large-tip electrode catheters. J Cardiovasc Electrophysiol 15(10 Suppl):S18–S23PubMedCrossRefGoogle Scholar
  6. 6.
    Feld G, Wharton M, Plumb V et al (2004) Radiofrequency catheter ablation of type 1 atrial flutter using large-tip 8-or 10-mm electrode catheters and a high-output radiofrequency energy generator: results of a multicenter safety and efficacy study. J Am Coll Cardiol 43(8):1466–1472PubMedCrossRefGoogle Scholar
  7. 7.
    Montenero AS, Bruno N, Antonelli A et al (2006) Low clinical recurrence and procedure benefits following treatment of common atrial flutter by electrogram-guided hot spot focal cryo ablation. J Interv Card Electrophysiol 15(2):83–92PubMedCrossRefGoogle Scholar
  8. 8.
    Natale A, Newby KH, Pisano E et al (2000) Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. J Am Coll Cardiol 35(7):1898–1904PubMedCrossRefGoogle Scholar
  9. 9.
    Marrouche NF, Schweikert R, Saliba W et al (2003) Use of different catheter ablation technologies for treatment of typical atrial flutter: acute results and long-term follow-up. Pacing Clin Electrophysiol 26(3):743–746PubMedCrossRefGoogle Scholar
  10. 10.
    Montenero AS, Bruno N, Antonelli A et al (2004) Safety and efficacy of catheter cryoablation for the treatment of atrial flutter: acute and long term results. Ital Heart J 5(Suppl 1):131S–137SGoogle Scholar
  11. 11.
    Manusama R, Timmermans C, Limon F et al (2004) Catheter-based cryoablation permanently cures patients with common atrial flutter. Circulation 109(13):1636–1639PubMedCrossRefGoogle Scholar
  12. 12.
    Nakagawa H, McClelland J, Beckman K et al (1993) Radiofrequency catheter ablation of common type atrial flutter. Pacing Clin Electrophysiol 16:850CrossRefGoogle Scholar
  13. 13.
    Fischer B, Jais P, Shah D et al (1996) Radiofrequency catheter ablation of common atrial flutter in 200 patients. J Cardiovasc Electrophysiol 7(12):1225–1233PubMedCrossRefGoogle Scholar
  14. 14.
    Montenero A, Bruno N, Antonelli A et al (2005) Long-term efficacy of cryo catheter ablation for the treatment of atrial flutter — results from a repeat electrophysiologic study. J Am Coll Cardiol 45:573–580PubMedCrossRefGoogle Scholar
  15. 15.
    Montenero AS, Bruno N, Antonelli A et al (2005) Comparison between a 7 French 6 mm tip cryothermal catheter and a 9 French 8 mm tip cryothermal catheter for cryoablation treatment of common atrial flutter. J Interv Card Electrophysiol 13(1):59–69PubMedCrossRefGoogle Scholar
  16. 16.
    Calkins H, Canby R, Weiss R et al (2004) Results of catheter ablation of typical atrial flutter. Am J Cardiol 94(4):437–442PubMedCrossRefGoogle Scholar
  17. 17.
    Tracy CM, Akhtar M, DiMarco JP et al (2000) American College of Cardiology/American Heart Association Clinical Competence Statement on invasive electrophysiology studies, catheter ablation, and cardioversion: a report of the American College of Cardiology/American Heart Association/American College of Physicians-American Society of Internal Medicine Task Force on Clinical Competence. Circulation 102(18):2309–2320PubMedGoogle Scholar
  18. 18.
    Garcia-Cosio F, Pastor A, Nunez A (1999) [Radiofrequency ablation as the first line of treatment in patients with common atrial flutter. The arguments con]. Rev Esp Cardiol 52(4):233–236PubMedGoogle Scholar
  19. 19.
    Cosio FG (2005) Should ablation be the first line treatment for supraventricular arrhythmias? Heart 91(1):5–6PubMedCrossRefGoogle Scholar
  20. 20.
    Bertaglia E, Zoppo F, Bonso A et al (2004) Long term follow up of radiofrequency catheter ablation of atrial flutter: clinical course and predictors of atrial fibrillation occurrence. Heart 90(1):59–63PubMedCrossRefGoogle Scholar
  21. 21.
    De Sisti A, Leclercq JF, Fiorello P et al (1998) [The effects of the ablation of atrial flutter in patients with and without a clinical history of paroxysmal atrial fibrillation]. G Ital Cardiol 28(11):1253–1260PubMedGoogle Scholar
  22. 22.
    Schmieder S, Ndrepepa G, Dong J et al (2003) Acute and long-term results of radiofrequency ablation of common atrial flutter and the influence of the right atrial isthmus ablation on the occurrence of atrial fibrillation. Eur Heart J 24(10):956–962PubMedCrossRefGoogle Scholar
  23. 23.
    Anne W, Willems R, Adriaenssens B et al (2006) Long-term symptomatic benefit after radiofrequency catheter ablation for atrial flutter despite a high incidence of post-procedural atrial fibrillation. Acta Cardiol 61(1):75–82PubMedCrossRefGoogle Scholar
  24. 24.
    Della BP, Fraticelli A, Tondo C et al (2002) Atypical atrial flutter: clinical features, electrophysiological characteristics and response to radiofrequency catheter ablation. Europace 4(3):241–253PubMedCrossRefGoogle Scholar
  25. 25.
    Cheng CH, Sanders GD, Hlatky MA et al (2000) Cost-effectiveness of radiofrequency ablation for supraventricular tachycardia. Ann Intern Med 133(11):864–876PubMedGoogle Scholar
  26. 26.
    Bathina MN, Mickelsen S, Brooks C et al (1998) Radiofrequency catheter ablation versus medical therapy for initial treatment of supraventricular tachycardia and its impact on quality of life and healthcare costs. Am J Cardiol 82(5):589–593PubMedCrossRefGoogle Scholar
  27. 27.
    Montenero AS, Bruno N, Zumbo F et al (2005) Cryothermal ablation treatment of atrial flutter-experience with a new 9 French 8 mm tip catheter. J Interv Card Electrophysiol 12(1):45–54PubMedCrossRefGoogle Scholar
  28. 28.
    Manusama R, Timmermans C, Philippens S et al (2004) Single cryothermia applications of less than five minutes produce permanent cavotricuspid isthmus block in humans. Heart Rhythm 1(5):594–599PubMedCrossRefGoogle Scholar
  29. 29.
    Rodriguez LM, Geller JC, Tse HF et al (2002) Acute results of transvenous cryoablation of supraventricular tachycardia (atrial fibrillation, atrial flutter, Wolff-Parkinson-White syndrome, atrioventricular nodal reentry tachycardia). J Cardiovasc Electrophysiol 13(11):1082–1089PubMedCrossRefGoogle Scholar
  30. 30.
    Timmermans C, Ayers GM, Crijns HJ, Rodriguez LM (2003) Randomized study comparing radiofrequency ablation with cryoablation for the treatment of atrial flutter with emphasis on pain perception. Circulation 107(9):1250–1252PubMedCrossRefGoogle Scholar
  31. 31.
    Collins N, Barlow M, Leitch JW et al (2005) Cryoablation Versus Radiofrequency Ablation in the Treatment of Atrial Flutter Trial (CRAAFT). Heart Rhythm 2005 Scientific Sessions, New Orleans, LA, USA, May 4–7, 2005Google Scholar
  32. 32.
    Daubert JP, Hoyt RH, John R et al (2005) Performance of a new cardiac cryoablation system in the treatment of cavotricuspid valve isthmus-dependent atrial flutter. Pacing Clin Electrophysiol 28(Suppl 1):S142–S145PubMedCrossRefGoogle Scholar
  33. 33.
    Friedman PL (2005) Catheter cryoablation of cardiac arrhythmias. Curr Opin Cardiol 20(1):48–54PubMedGoogle Scholar
  34. 34.
    Khairy P, Chauvet P, Lehmann J et al (2003) Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 107(15):2045–2050PubMedCrossRefGoogle Scholar
  35. 35.
    Kuniss M, Kurzidim K, Greiss H et al (2005) Persistency of bi-directional conduction block in the cavotricuspid isthmus one month after cryocatheter ablation (8mm-tip) of common atrial flutter. Heart Rhythm 2005 Scientific Sessions, New Orleans, LA, USA, May 4–7, 2005Google Scholar
  36. 36.
    Lowe MD, Meara M, Mason J et al (2003) Catheter cryoablation of supraventricular arrhythmias: a painless alternative to radiofrequency energy. Pacing Clin Electrophysiol 26(1 Pt 2):500–503PubMedCrossRefGoogle Scholar
  37. 37.
    Rodriguez LM, Timmermans C (2004) Transvenous cryoablation of cardiac arrhythmias. Technol Cancer Res Treat 3(5):515–524PubMedGoogle Scholar
  38. 38.
    Skanes AC, Yee R, Krahn AD, Klein GJ (2002) Cryoablation of atrial arrhythmias. Card Electrophysiol Rev 6(4):383–388PubMedCrossRefGoogle Scholar
  39. 39.
    Skanes AC, Klein G, Krahn A, Yee R (2004) Cryoablation: potentials and pitfalls. J Cardiovasc Electrophysiol 15(10 Suppl):S28–S34PubMedCrossRefGoogle Scholar
  40. 40.
    van Oeveren W, Crijns HJ, Korteling BJ et al (1999) Blood damage, platelet and clotting activation during application of radiofrequency or cryoablation catheters: a comparative in v itro study. J Med Eng Technol 23(1):20–25PubMedCrossRefGoogle Scholar
  41. 41.
    Laurent G, Bertaux G, Martel A et al (2006) A randomized clinical trial of continuous flow nitrous oxide and nalbuphine infusion for sedation of patients during radiofrequency atrial flutter ablation. Pacing Clin Electrophysiol 29(4):351–357PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2007

Authors and Affiliations

  • Peter Andrew
    • 1
  • Annibale Sandro Montenero
    • 2
  1. 1.ATLAS Medical Research IncMiamiUSA
  2. 2.Cardiology Department and Arrhythmia Center of Cardiovascular Research InstituteIRCCS Policlinico MultiMedicaSesto S. Giovanni (MI)Italy

Personalised recommendations