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Effective cryoablation of a lateral accessory pathway within the distal coronary sinus

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Abstract

Limited information is available on the efficacy of cryoablation in the coronary venous system in humans. A patient with a lateral accessory pathway was referred to our center after several unsuccessful endocardial and epicardial (within the coronary sinus) attempts using standard radiofrequency energy. Ablation was subsequently performed successfully by applying cryoenergy distally into the coronary sinus, using a temperature of −50°C and a freezing application time of 45 s. There were no complications. Angiography of the left coronary circumflex artery and coronary venous system was performed at 12 months follow-up using cardiac multislice computed tomography, and no coronary stenosis or anatomic anomaly was found. Neither pre-excitation or any arrhythmia recurred during follow-up. This experience suggests that ablating in the distal coronary sinus can be safely performed using cryoenergy.

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References

  1. Morady, F., Strickberger, A., Man, K. C., et al. (1996). Reasons for prolonged or failed attempts at radiofrequency catheter ablation of accessory pathways. Journal of the American College of Cardiology, 7, 683–689.

    Article  Google Scholar 

  2. Xie, B., Heald, S. C., Camm, A. J., Rowland, E., & Ward, D. E. (1997). Radiofrequency catheter ablation of accessory atrioventricular pathways: Primary failure and recurrence of conduction. Heart, 77, 363–368.

    PubMed  CAS  Google Scholar 

  3. Gaita, F., Haissaguerre, M., Giustetto, C., et al. (2003). Safety and efficacy of cryoablation of accessory pathways adjacent to the normal conduction system. Journal of Cardiovascular Electrophysiology, 14, 825–829.

    Article  PubMed  Google Scholar 

  4. Friedman, P. L., Dubuc, M., Green, M. S., Jackman, W. M., Keane, D. T., Marinchak, R. A., et al. (2004). Catheter cryoablation of supraventricular tachycardia: Results of the multicenter prospective “frosty” trial. Heart Rhythm, 1, 129–138.

    Article  PubMed  Google Scholar 

  5. Zrenner, B., Dong, J., Schreieck, J., Deisenhofer, I., Estner, H., Luani, B., et al. (2004). Transvenous cryoablation versus radiofrequency ablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia: A prospective randomized pilot study. European Heart Journal, 25, 2226–2231.

    Article  PubMed  Google Scholar 

  6. Kimman, G. P., Theuns, D. A. M. J., Szili-Torok, T., Scholten, M. F., Res, J. C., & Jordaens, L. J. (2004). CRAVT: A prospective, randomized study comparing transvenous cryothermal and radiofrequency ablation in atrioventricular re-entrant tachycardia. European Heart Journal, 25, 2232–2237.

    Article  PubMed  CAS  Google Scholar 

  7. Collins, K. K., Dubin, A. M., Chiesa, N. A., Avasarala, K., & Van Hare, G. F. (2006). Cryoablation versus radiofrequency ablation for treatment of pediatric atrioventricular reentrant tachycardia: Initial experience with 4-mm cryocatheter. Heart Rhythm, 3, 564–570.

    Article  PubMed  Google Scholar 

  8. Atienza, F., Arenal, A., Torrecilla, E. G., García-Alberola, A., Jiménez, J., Ortiz, M., et al. (2004). 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. American Journal of Cardiology, 93, 1302–1305.

    Article  PubMed  Google Scholar 

  9. De Sisti, A., Tonet, J., Barakett, N., Lacotte, J., Leclercq, J. F., & Frank, R. (2007). Transvenous cryoablation of the slow pathway for the treatment of atrioventricular nodal re-entrant tachycardia: A single center initial experience study. Europace, 9, 401–406.

    Article  PubMed  Google Scholar 

  10. Gaita, F., Paperini, L., Riccardi, R., & Ferraro, A. (2002). Cryothermic ablation within the coronary sinus of an epicardial posterolateral pathway. Journal of Cardiovascular Electrophysiology, 13, 1160–1163.

    Article  PubMed  Google Scholar 

  11. Gaita, F., Montefusco, A., Riccardi, R., Giustetto, C., Grossi, S., Caruzzo, E., et al. (2004). Cryoenergy catheter ablation: A new technique for treatment of permanent junctional reciprocating tachycardia in children. Journal of Cardiovascular Electrophysiology, 15, 263–268.

    PubMed  Google Scholar 

  12. Collins, K. K., Rhee, F. K., Kirsh, J. A., Cannon, B. C., Fish, F. A., Dubin, A. M., et al. (2007). Cryoablation of accessory pathways in the coronary sinus in young patients: A multicenter study from the Pediatric and Congenital Electrophysiology Society’s Working Group on Cryoablation. Journal of Cardiovascular Electrophysiology, 30, 592–597.

    Article  Google Scholar 

  13. Lustgarten, D. L., Keane, D., & Ruskin, J. (1999). Cryothermal ablation: Mechanism of tissue injury and current experience in the treatment of tachyarrhythmias. Progress in Cardiovascular Disease, 41, 481–498.

    Article  CAS  Google Scholar 

  14. Lechat, P., Tonet, J. L., Fontaine, G., Frank, R., & Grosgogeat, Y. (1984). Effects of aminophylline and atropine on nodal block induced by adenosine triphosphate. Therapie, 39, 609–617.

    PubMed  CAS  Google Scholar 

  15. Schroeder, S., Achenbach, S., Bengel, F., Burgstahler, C., Cademartiri, F., de Feyter, P., et al. (2008). Cardiac computed tomography: Indications, applications, limitations, and training requirements: Report of a Writing Group deployed by the Working Group Nuclear Cardiology and Cardiac CT of the European Society of Cardiology and the European Council of Nuclear Cardiology. European Heart Journal, 29, 531–556.

    Article  PubMed  Google Scholar 

  16. Langberg, J., Griffin, J. C., Herre, J. M., Chin, M. C., Lev, M., Bharati, S., et al. (1989). Catheter ablation of accessory pathways using radiofrequency energy in the canine coronary sinus. Journal of American College of Cardiology, 13, 491–496.

    Article  CAS  Google Scholar 

  17. Huang, S. K., Graham, A. R., Bharati, S., Lee, M. A., Gorman, G., & Lev, M. (1988). Short- and long-term effects of transcatheter ablation of the coronary sinus by radiofrequency energy. Circulation, 78, 416–427.

    PubMed  CAS  Google Scholar 

  18. Aoyama, H., Nakagawa, H., Pitha, J. V., Khammar, G. S., Chandrasekaran, K., Matsudaira, K., et al. (2005). Comparison of cryothermia and radiofrequency current in safety and efficacy of catheter ablation within the canine coronary sinus close to the left circumflex coronary artery. Journal of Cardiovascular Electrophysiology, 16, 1218–1226.

    Article  PubMed  Google Scholar 

  19. Skanes, A. C., Jones, D. L., Teefy, P., Guiraudon, C., Yee, R., Krahn, A. D., et al. (2004). Safety and feasibility of cryothermal ablation within the mid- and distal coronary sinus. Journal of Cardiovascular Electrophysiology, 15, 1319–23.

    Article  PubMed  Google Scholar 

  20. Haissaguerre, M., Gaita, F., Fischer, B., Egloff, P., Lemetayer, P., & Warin, J. F. (1992). Radiofrequency catheter ablation of left lateral accessory pathways via the coronary sinus. Circulation, 86, 1464–1468.

    PubMed  CAS  Google Scholar 

  21. Giorgberidze, I., Saksena, S., Krol, R. B., & Mathew, P. (1995). Efficacy and safety of radiofrequency catheter ablation of left-sided accessory pathways through the coronary sinus. American Journal of Cardiology, 76, 359–365.

    Article  PubMed  CAS  Google Scholar 

  22. Takahashi, Y., Jaïs, P., Hocini, M., Sanders, P., Rotter, M., Rostock, T., et al. (2005). Acute occlusion of the left circumflex coronary artery during mitral isthmus linear ablation. Journal of Cardiovascular Electrophysiology, 16, 1104–1107.

    Article  PubMed  Google Scholar 

  23. Sun, Y., Arruda, M., Otomo, K., Beckman, K., Nakagawa, H., Calame, J., et al. (2002). Coronary sinus—Ventricular accessory connections producing posteroseptal and left posterior accessory pathways. Incidence and electrophysiological identification. Circulation, 10(106), 1362–1367.

    Article  Google Scholar 

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Authors and Affiliations

  1. Rhythmology Unit, Pitié-Salpetrière Hospital, Paris, France

    Antonio De Sisti, Joelci Tonet, Sonia Marrakchi, Denis Raguin & Robert Frank

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  1. Antonio De Sisti
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  2. Joelci Tonet
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  3. Sonia Marrakchi
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  4. Denis Raguin
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  5. Robert Frank
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Correspondence to Antonio De Sisti.

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De Sisti, A., Tonet, J., Marrakchi, S. et al. Effective cryoablation of a lateral accessory pathway within the distal coronary sinus. J Interv Card Electrophysiol 22, 189–193 (2008). https://doi.org/10.1007/s10840-008-9273-7

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  • DOI: https://doi.org/10.1007/s10840-008-9273-7

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