Skip to main content
SpringerLink
Log in

Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia

  • REVIEWS
  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

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.

Objective

We performed a systematic review and meta-analysis of studies comparing CRYO with RF ablation of AVNRT.

Methods

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).

Results

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.

Conclusions

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  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.

    Article  PubMed  Google Scholar 

  2. Goyal, R., Zivin, A., Souza, J., et al. (1996). Comparison of the ages of tachycardia onset in patients with atrioventricular nodal reentrant tachycardia and accessory pathway-mediated tachycardia. American Heart Journal, 132, 765–767.

    Article  CAS  PubMed  Google Scholar 

  3. Lee, K. W., Badhwar, N., & Scheinman, M. M. (2008). Supraventricular tachycardia–part I. Current Problems in Cardiology, 33, 467–546.

    Article  PubMed  Google Scholar 

  4. Jackman, W. M., Beckman, K. J., McClelland, J. H., et al. (1992). Treatment of supraventricular tachycardia due to atrioventricular nodal reentry by radiofrequency catheter ablation of slow-pathway conduction. New England Journal of Medicine, 327, 313–318.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google Scholar 

  6. Scheinman, M. M., & Huang, S. (2000). The 1998 NASPE prospective catheter ablation registry. Pacing and Clinical Electrophysiology, 23, 1020–1028.

    Article  CAS  PubMed  Google Scholar 

  7. Baust, J. G., & Gage, A. A. (2005). The molecular basis of cryosurgery. BJU International, 95, 1187–1191.

    Article  PubMed  Google Scholar 

  8. Jentzer, J. H., Goyal, R., Williamson, B. D., et al. (1994). Analysis of junctional ectopy during radiofrequency ablation of the slow pathway in patients with atrioventricular nodal reentrant tachycardia. Circulation, 90, 2820–2826.

    Article  CAS  PubMed  Google Scholar 

  9. Kimman, G. P., Theuns, D. A., Szili-Torok, T., et al. (2004). CRAVT: a prospective, randomized study comparing transvenous cryothermal and radiofrequency ablation in atrioventricular nodal reentrant tachycardia. European Heart Journal, 25, 2232–2237.

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  11. 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 nodal reentrant tachycardia: initial experience with 4-mm cryocatheter. Heart Rhythm, 3, 564–570.

    Article  PubMed  Google Scholar 

  12. Gupta, D., Al-Lamee, R. K., Earley, M. J., et al. (2006). Cryoablation compared with radiofrequency ablation for atrioventricular nodal reentrant tachycardia: analysis of factors contributing to acute and follow-up outcome. Europace, 8, 1022–1026.

    Article  PubMed  Google Scholar 

  13. Avari, J. N., Jay, K. S., & Rhee, E. K. (2008). Experience and results during transition from radiofrequency ablation to cryoablation for treatment of pediatric atrioventricular nodal reentrant tachycardia. Pacing and Clinical Electrophysiology, 31, 454–460.

    Article  PubMed  Google Scholar 

  14. Chan, N. Y., Mok, N. S., Lau, C. L., et al. (2009). Treatment of atrioventricular nodal reentrant tachycardia by cryoablation with a 6-mm-tip catheter versus radiofrequency ablation. Europace, 11, 1065–1070.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  17. Papagiannis, J., Papadopoulou, K., Rammos, S., & Katritsis, D. (2010). Cryoablation versus radiofrequency ablation for atrioventricular nodal reentrant tachycardia in children: long-term results. Hellenic journal of cardiology. Hellenic journal of cardiology, 51, 122–126.

    PubMed  Google Scholar 

  18. Chan, N. Y., Choy, C. C., Lau, C. L., et al. (2011). Cryoablation versus radiofrequency ablation for atrioventricular nodal reentrant tachycardia: patient pain perception and operator stress. Pacing and Clinical Electrophysiology, 34, 2–7.

    Article  PubMed  Google Scholar 

  19. Ding, Y. H., Qu, B. M., Che, X. D., et al. (2011). [Comparison of cryoablation and radiofrequency ablation for treating atrioventricular nodal reentrant tachycardia]. Zhonghua xin xue guan bing za zhi, 39, 625–627.

    PubMed  Google 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.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Chan, N. Y., Mok, N. S., Choy, C. C., et al. (2012). Treatment of atrioventricular nodal reentrant tachycardia by cryoablation with an 8-mm-tip catheter versus radiofrequency ablation. Journal of interventional cardiac electrophysiology, 34, 295–301.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  Google Scholar 

  25. Santangeli, P., Di Biase, L., Dello Russo, A., et al. (2010). Meta-analysis: age and effectiveness of prophylactic implantable cardioverter-defibrillators. Annals of Internal Medicine, 153, 592–599.

    Article  PubMed  Google Scholar 

  26. Egger, M., Davey Smith, G., Schneider, M., & Minder, C. (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ, 315, 629–634.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151, 264–269. W64.

    Article  PubMed  Google Scholar 

  28. Spector, P., Reynolds, M. R., Calkins, H., et al. (2009). Meta-analysis of ablation of atrial flutter and supraventricular tachycardia. American Journal of Cardiology, 104, 671–677.

    Article  PubMed  Google Scholar 

  29. 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 Diseases, 41, 481–498.

    Article  CAS  PubMed  Google Scholar 

  30. Mikat, E. M., Hackel, D. B., Harrison, L., Gallagher, J. J., & Wallace, A. G. (1977). Reaction of the myocardium and coronary arteries to cryosurgery. Laboratory Investigation, 37, 632–641.

    CAS  PubMed  Google 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.

  32. De Sisti, A., Tonet, J., Gueffaf, F., et al. (2008). Effects of inadvertent atrioventricular block on clinical outcomes during cryoablation of the slow pathway in the treatment of atrioventricular nodal reentrant tachycardia. Europace, 10, 1421–1427.

    Article  PubMed  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.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiac Arrhythmia Service, Stanford University School of Medicine, 300 Pasteur Drive H 2146, Stanford, CA, 94305, USA

    Pasquale Santangeli

  2. Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX, USA

    Luigi Di Biase, Rong Bai & Andrea Natale

  3. University of Foggia, Foggia, Italy

    Pasquale Santangeli & Luigi Di Biase

  4. Ospedale Sacco, Milan, Italy

    Riccardo Proietti

Authors
  1. Pasquale Santangeli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Riccardo Proietti
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luigi Di Biase
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rong Bai
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrea Natale
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Pasquale Santangeli.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Santangeli, P., Proietti, R., Di Biase, L. et al. Cryoablation versus radiofrequency ablation of atrioventricular nodal reentrant tachycardia. J Interv Card Electrophysiol 39, 111–119 (2014). https://doi.org/10.1007/s10840-013-9842-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-013-9842-2

Keywords

Search

Navigation