Skip to main content
SpringerLink
Log in

Cryothermal Ablation Treatment of Atrial Flutter—Experience with a New 9 French 8 mm Tip Catheter

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

Abstract

Background: Cardiac cryoablation has been used to successfully treat a variety of arrhythmias.

Objective: This study documents our experience with a new 9 French (FR) 8 mm cryocatheter for ablation treatment of symptomatic atrial flutter.

Methods: A total of 77 consecutive patients with symptomatic atrial flutter were treated. Electrophysiological studies (EPS) were performed with diagnostic catheters and ablation was performed with a 9FR, 8 mm tip, quadripolar cryocatheter (Freezor® MAX catheter, CryoCath Technologies Inc., Kirkland, Canada). Cryoablation at −75°C for 8 minutes was performed, beginning at the inferior rim of the coronary sinus (CS) os and creating a posterior line to the Eustachian ridge. Safety, bidirectional isthmus block at intervention, and recurrence at 3 months post procedure were assessed.

Results: There were no adverse events reported. All patients remained free of discomfort on cryoenergy delivery. The acute success rate at intervention was 96% for all patients and 100% for those with common atrial flutter. Follow-up data from 47 patients showed 33 (70%) patients without conduction recurrence on repeat EPS at 3 months. Although, 1 (2%) patient had both symptom and conduction recurrence. Data available from 53 acutely successful patients at 6 month clinical follow-up showed that 48 (91%) patients were asymptomatic and 5 (9%) patients had recurrence documented by ECG and/or patient diary records.

Conclusions: Our experience with a new 9FR, 8 mm tip, quadripolar cryocatheter yielded a high success rate at intervention and an excellent safety profile. Although repeat EPS at 3 months post ablation identified conduction recurrence in 30% of patients, at 6 month clinical follow-up only 9% of patients had recurrence. Further monitoring is necessary to assess whether the relatively low recurrence rate observed at 6 month clinical follow-up is maintained over the long term.

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

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Marrouche NF, Schweikert R, Saliba W, Pavia SV, Martin DO, Dresing T, Cole C, Balaban K, Saad E, Perez-Lugones A, Bash D, Tchou P, Natale A. Use of different catheter ablation technologies for treatment of typical atrial flutter: Acute results and long-term follow-up. Pacing Clin Electrophysiol 2003;26(3):743–746.

    Article  Google Scholar 

  2. Chen J, de Chillou C, Basiouny T, Sadoul N, Filho JD, Magnin-Poull I, Messier M, Aliot E. Cavotricuspid isthmus mapping to assess bidirectional block during common atrial flutter radiofrequency ablation. Circulation 1999;100(25):2507–2513.

    Google Scholar 

  3. Cauchemez B, Haissaguerre M, Fischer B, Thomas O, Clementy J, Coumel P. Electrophysiological effects of catheter ablation of inferior vena cava-tricuspid annulus isthmus in common atrial flutter. Circulation 1996;93(2):284–294.

    Google Scholar 

  4. Poty H, Saoudi N, Abdel Aziz A, Nair M, Letac B. Radiofrequency catheter ablation of type 1 atrial flutter. Prediction of late success by electrophysiological criteria. Circulation 1995;92(6):1389–1392.

    Google Scholar 

  5. Poty H, Saoudi N, Nair M, Anselme F, Letac B. Radiofrequency catheter ablation of atrial flutter. Further insights into the various types of isthmus block: Application to ablation during sinus rhythm. Circulation 1996;94(12):3204–3213.

    Google Scholar 

  6. Camm J, Ward DE, Spurrell RA, Rees GM. Cryothermal mapping and cryoablation in the treatment of refractory cardiac arrhythmias. Circulation 1980;62(1):67-74.

    Google Scholar 

  7. Dubuc M, Talajic M, Roy D, Thibault B, Leung TK, Friedman PL. Feasibility of cardiac cryoablation using a transvenous steerable electrode catheter. J Interv Card Electrophysiol 1998;2(3):285–292.

    Article  Google Scholar 

  8. Manusama R, Timmermans C, Limon F, Philippens S, Crijns HJGM, Rodriguez L-M. Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter. Circulation 2004;109(13):1636–1639.

    Article  Google Scholar 

  9. Montenero AS, Bruno N, Zumbo F, et al. Safety and efficacy of a 7 French, 6 mm tip cryoablation catheter for the treatment of atrial flutter in 98 consecutive patients. Europace 2003;4(Suppl A):A4.

    Google Scholar 

  10. Montenero AS, Bruno N, Antonelli A, et al. Safety and efficacy of catheter cryoablation for the treatment of atrial flutter: Acute and long term results. Ital Heart J 2004;5(Suppl. 1):131S–137S.

    Google Scholar 

  11. Timmermans C, Ayers GM, Crijns HJ, Rodriguez LM. Randomized study comparing radiofrequency ablation with cryoablation for the treatment of atrial flutter with emphasis on pain perception. Circulation 2003;107(9):1250–1252.

    Article  Google Scholar 

  12. van Oeveren W, Crijns HJ, Korteling BJ, Wegereef EW, Haan J, Tigchelaar I, Hoekstra A. Blood damage, platelet and clotting activation during application of radiofrequency or cryoablation catheters: A comparative in vitro study. J Med Eng Technol 1999;23(1):20–25.

    Article  Google Scholar 

  13. Khairy P, Chauvet P, Lehmann J, Lambert J, Macle L, Tanguay JF, Sirois MG, Santoianni D, Dubuc M. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 2003;107(15):2045–2050.

    Article  Google Scholar 

  14. Tai CT, Chen SA, Chiang CE, Lee SH, Wen ZC, Huang JL, Chen YJ, Yu WC, Feng AN, Lin YJ, Ding YA, Chang MS. Long-term outcome of radiofrequency catheter ablation for typical atrial flutter: Risk prediction of recurrent arrhythmias. J Cardiovasc Electrophysiol 1998;9(2):115-121.

    Google Scholar 

  15. Celiker A, Kafali G, Karagoz T, Ceviz N, Ozer S. The results of electrophysiological study and radio-frequency catheter ablation in pediatric patients with tachyarrhythmia. Turk J Pediatr 2003;45(3):209–216.

    Google Scholar 

  16. Hsieh MH, Tai CT, Chiang CE, Tsai CF, Yu WC, Chen YJ, Ding YA, Chen SA. Recurrent atrial flutter and atrial fibrillation after catheter ablation of the cavotricuspid isthmus: A very long-term follow-up of 333 patients. J Interv Card Electrophysiol 2002;7(3):225–231.

    Article  Google Scholar 

  17. Skanes AC, Yee R, Krahn AD, Klein GJ. Cryoablation of atrial arrhythmias. Card Electrophysiol Rev 2002;6(4):383–388.

    Article  Google Scholar 

  18. Lowe MD, Meara M, Mason J, Grace AA, Murgatroyd FD. Catheter cryoablation of supraventricular arrhythmias: A painless alternative to radiofrequency energy. Pacing Clin Electrophysiol 2003;26(1 Pt 2):500–503.

    Article  Google Scholar 

  19. Schumacher B, Pfeiffer D, Tebbenjohanns J, Lewalter T, Jung W, Luderitz B. Acute and long-term effects of consecutive radiofrequency applications on conduction properties of the subeustachian isthmus in type I atrial flutter. J Cardiovasc Electrophysiol 1998;9(2):152–163.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Department and Arrhythmia Center of Policlinico MultiMedica, Sesto S. Giovanni, Milan, Italy

    Annibale S. Montenero (Prof.), Nicola Bruno, Francesco Zumbo, Andrea Antonelli, Luigi Fiocca, Luca Barbieri, Francesca De Bernardi & Peter Andrew

  2. Cardiology Service of Bambino Gesu’Hospital, Palidoro, Rome, Italy

    Vincenzo Affinito

  3. Divisione di Cardiologia, Policlinico MultiMedica, Via Milanese 300, 20099, Sesto S. Giovanni, MI, Italy

    Annibale S. Montenero (Prof.)

Authors
  1. Annibale S. Montenero
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nicola Bruno
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francesco Zumbo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Andrea Antonelli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luigi Fiocca
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luca Barbieri
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Francesca De Bernardi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Peter Andrew
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Vincenzo Affinito
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Annibale S. Montenero.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Montenero, A.S., Bruno, N., Zumbo, F. et al. Cryothermal Ablation Treatment of Atrial Flutter—Experience with a New 9 French 8 mm Tip Catheter. J Interv Card Electrophysiol 12, 45–54 (2005). https://doi.org/10.1007/s10840-005-5840-3

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-005-5840-3

Key Words

Search

Navigation