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Low clinical recurrence and procedure benefits following treatment of common atrial flutter by electrogram-guided hot spot focal cryoablation

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Abstract

Background: The study sought to evaluate whether electrogram-aided identification of hot spot targets produces additional clinical and/or procedure benefits when using a non-traditional focal cryo ablation method to treat common atrial flutter.

Methods: A preliminary study identified a specific electrogram criterion (e.g., a stimulus to onset of electrogram time of 74 [± 5] ms) that produced successful cryo testing plus subsequent cryoablation with demonstrable bi-directional isthmus block created at intervention site. In the present study, 26 consecutive patients with symptomatic common atrial flutter were ablated with a 9FR 8 mm tip cryo catheter using electrogram-aided identification of hot spot targets with a stimulus to onset of electrogram time of ≥70 ms. Outcomes measured were bi-directional isthmus block at intervention, symptom and conduction recurrence at 3 month follow-up, symptom recurrence at 6 month follow-up, and procedure characteristics.

Results: Acute success rate at intervention was 100%. The percentage of patients with symptom recurrence by 3 month follow-up was 4.5% and no additional patients had arrhythmia symptoms documented by 12 month follow-up. Repeat electrophysiological study (EPS) at 3 month follow-up identified 44% of patients with conduction recurrence. The mean ± SD number of cryo tests and ablations were 11 ± 9 and 2 ± 1, respectively. Procedure, fluoroscopy and cryoapplication times were 77 ± 29 min, 11 ± 7 min, and 28 ± 11 min, respectively.

Conclusions: A high acute success rate, plus low long-term clinical recurrence rate and procedure benefits may be achieved with electrogram-aided identification of hot spots for focal cryo ablation treatment of common atrial flutter using a 9FR 8 mm tip cryo catheter. The population of patients who were asymptomatic and had demonstrated conduction recurrence on repeat EPS at 3 month follow-up require close scrutiny over the long-term to ascertain whether they eventually experience arrhythmic symptoms. However, should these patients remain symptom-free over the long-term it would suggest that the entire isthmus may not be needed to support symptomatic common atrial flutter.

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References

  1. Cosio FG, Lopez-Gil M, Goicolea A, Arribas F, Barroso JL. Radiofrequency ablation of the inferior vena cava-tricuspid valve isthmus in common atrial flutter. Am J Cardiol 1993;71(8):705–909.

    Article  PubMed  CAS  Google Scholar 

  2. Kirkorian G, Moncada E, Chevalier P, Canu G, Claudel J, Bellon C, Lyon L, Touboul P. Radiofrequency ablation of atrial flutter. Efficacy of an anatomically guided approach. Circulation 1994;90(6):2804–2814.

    PubMed  CAS  Google Scholar 

  3. 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  PubMed  Google Scholar 

  4. Montenero AS, Bruno N, Antonelli A, Mangiameli D, Murphy O, O’Connor S, 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 

  5. Montenero AS, Bruno N, Zumbo F, Antonelli A, Fiocca L, Barbieri L, De Bernardi F, Andrew P, Affinito V. Cryothermal ablation treatment of atrial flutter—Experience with a new 9 French 8 mm tip catheter. J Interv Card Electrophysiol 2005;12(1):45–54.

    Article  PubMed  Google Scholar 

  6. Montenero A, Bruno N, Antonelli A, Mangiameli D, Barbieri L, Andrew P, Murphy O, O’Connor S, Zumbo F. Long-term efficacy of cryo catheter ablation for the treatment of atrial flutter—results from a repeat electrophysiologic study. J Am Coll Cardiol 2005;45:573–580.

    Article  PubMed  Google Scholar 

  7. Riccardi R, Gaita F, Caponi D, Grossi S, Scaglione M, Caruzzo E, Di Donna P, Pistis G, Richiardi E, Giustetto C, Bocchiardo M. Percutaneous catheter cryothermal ablation of atrioventricular nodal reentrant tachycardia: Efficacy and safety of a new ablation technique. Ital Heart J 2003;4(1):35–43.

    PubMed  Google Scholar 

  8. Skanes AC, Dubuc M, Klein GJ, Thibault B, Krahn AD, Yee R, Roy D, Guerra P, Talajic M. Cryothermal ablation of the slow pathway for the elimination of atrioventricular nodal reentrant tachycardia. Circulation 2000;102(23):2856–2860.

    PubMed  CAS  Google Scholar 

  9. Lanzotti ME, De Ponti R, Tritto M, Spadacini G, Salerno-Uriarte JA. Successful treatment of anteroseptal accessory pathways by transvenous cryomapping and cryoablation. Ital Heart J 2002;3(2):128–132.

    PubMed  Google Scholar 

  10. Tang K, Ma J, Zhang S, Chu J, Wang F, Zhang K, Chen X. Unipolar electrogram in identification of successful targets for radiofrequency catheter ablation of focal atrial tachycardia. Chin Med J (Engl) 2003;116(10):1455–1458.

    Google Scholar 

  11. Montenero AS, Crea F, Bendini MG, Pelargonio G, Intini A, Finocchiaro ML, Biscione F, Pigozzi F, Bellocci F, Zecchi P. Electrograms for identification of the atrial ablation site during catheter ablation of accessory pathways. Pacing Clin Electrophysiol 1996;19(6):905–912.

    PubMed  CAS  Google Scholar 

  12. Feld GK, Fleck RP, Chen PS, Boyce K, Bahnson TD, Stein JB, Calisi CM, Ibarra M. Radiofrequency catheter ablation for the treatment of human type 1 atrial flutter. Identification of a critical zone in the reentrant circuit by endocardial mapping techniques. Circulation 1992;86(4):1233–1240.

    PubMed  CAS  Google Scholar 

  13. Chen SA, Chiang CE, Wu TJ, Tai CT, Lee SH, Cheng CC, Chiou CW, Ueng KC, Wen ZC, Chang, MS. Radiofrequency catheter ablation of common atrial flutter: Comparison of electrophysiologically guided focal ablation technique and linear ablation technique. J Am Coll Cardiol 1996;27(4):860–868.

    Article  PubMed  CAS  Google Scholar 

  14. Cosio FG, Lopez Gil M, Arribas F, Palacios J, Goicolea A, Nunez A. Mechanisms of entrainment of human common flutter studied with multiple endocardial recordings. Circulation 1994;89(5):2117–2125.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  16. 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.

    PubMed  CAS  Google Scholar 

  17. Anselme F, Klug D, Scanu P, Poty H, Lacroix D, Kacet S, Cribier A, Saoudi N. Randomized comparison of two targets in typical atrial flutter ablation. Am J Cardiol 2000;85(11):1302–1307.

    Article  PubMed  CAS  Google Scholar 

  18. Waki K, Saito T, Becker AE. Right atrial flutter isthmus revisited: Normal anatomy favors nonuniform anisotropic conduction. J Cardiovasc Electrophysiol 2000;11(1):90–94.

    PubMed  CAS  Google Scholar 

  19. Cabrera JA, Sanchez-Quintana D, Ho SY, Medina A, Anderson RH. The architecture of the atrial musculature between the orifice of the inferior caval vein and the tricuspid valve: The anatomy of the isthmus. J Cardiovasc Electrophysiol 1998;9(11):1186–1195.

    PubMed  CAS  Google Scholar 

  20. Fang P, Radtke NL, Simmons TW, Haisty WK, Jr., Ramaswamy K, Fitzgerald DM. Electroanatomic mapping of the right atrium: Anatomic abnormality is an important substrate. Chin Med J (Engl) 2003;116(3):341–345.

    Google Scholar 

  21. Cabrera JA, Sanchez-Quintana D, Ho SY, Medina A, Wanguemert F, Gross E, Grillo J, Hernandez E, Anderson RH. Angiographic anatomy of the inferior right atrial isthmus in patients with and without history of common atrial flutter. Circulation 1999;99(23):3017–3023.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

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

    Annibale S. Montenero, Nicola Bruno, Andrea Antonelli, Daniele Mangiameli, Luca Barbieri & Francesco Zumbo

  2. ATLAS Medical Research Inc., Saint Lazare, Canada

    Peter Andrew

Authors
  1. Annibale S. Montenero
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  2. Nicola Bruno
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  3. Andrea Antonelli
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  4. Daniele Mangiameli
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  5. Luca Barbieri
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  6. Francesco Zumbo
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  7. Peter Andrew
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Correspondence to Peter Andrew.

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Montenero, A.S., Bruno, N., Antonelli, A. et al. Low clinical recurrence and procedure benefits following treatment of common atrial flutter by electrogram-guided hot spot focal cryoablation. J Interv Card Electrophysiol 15, 83–92 (2006). https://doi.org/10.1007/s10840-006-8486-x

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  • DOI: https://doi.org/10.1007/s10840-006-8486-x

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