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A prospective randomised comparison of large-tip cryoablation and 8-mm-tip radiofrequency catheter ablation of atrial flutter

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Abstract

Purpose

Although radiofrequency (RF) energy is routinely used for tricuspid isthmus (TI) ablation, it is often associated with discomfort. The paucity of studies comparing the feasibility and efficacy of cryo- versus RF energy for TI-ablation urged us to conduct a prospective, randomised trial.

Methods

Forty patients with atrial flutter (AFl) were randomised to RF- or cryoenergy for TI-ablation. Perceived pain was scored from 1 to 10 on a Visual Analogue Scale.

Results

Significantly lower pain scores were recorded for cryoablation versus RF ablation (0.96 ± 0.73 versus 4.2 ± 2.4, p = 0.00004). Cryoablation was associated with significantly longer procedure duration and ablation time (137 ± 35 versus 111 ± 29 min, p = 0.016 and 81 ± 40 versus 48 ± 30 min, p = 0.007) and lower acute success rate (56% versus 100%, p = 0.001) than RF ablation. The recurrence of AFl was 20% (cryo) versus 15% (RF; p = 0.45) after a mean of 15.1 months follow-up.

Conclusion

Cryoablation results in significantly less pain and discomfort compared to RF ablation of AFl, which is offset by the significantly lower acute success rate.

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References

  1. Anselme, F., Saoudi, N., Poty, H., Douillet, R., & Cribier, A. (1999). Radiofrequency catheter ablation of common atrial flutter: significance of palpitations and quality-of-life evaluation in patients with proven isthmus block. Circulation, 99, 534–540.

    PubMed  CAS  Google Scholar 

  2. Natale, A., Newby, K. H., Pisano, E., Leonelli, F., Fanell, R., Potenza, D., et al. (2000). Prospective randomized comparison of antiarrhythmic therapy versus first-line radiofrequency ablation in patients with atrial flutter. Journal of the American College of Cardiology, 35, 1898–1904.

    Article  PubMed  CAS  Google Scholar 

  3. Da Costa, A., Thévenin, J., Roche, F., Romeyer-Bouchard, C., Abdellaoui, L., Messier, M., et al. (2006). Result from the Loire-Ardèche-Drome-Isère-Puy-dr-Dome (LAPID) trial on atrial flutter, a multicentre study comparing amiodarone and radiofrequency ablation after the first episode of symptomatic atrial flutter. Circulation, 114, 1676–1681.

    Article  PubMed  Google Scholar 

  4. Calkins, H., Canby, R., Weiss, R., Taylor, G., Wells, P., Chinitz, L., et al. (2004). Results of catheter ablation of typical atrial flutter. The American Journal of Cardiology, 94, 437–442.

    Article  PubMed  Google Scholar 

  5. Gilligan, D. M., Zakaib, J. S., Fuller, I., Shepard, R. K., Dan, D., Wood, M. A., et al. (2003). Long-term outcome of patients after successful radiofrequency ablation for typical atrial flutter. Pacing and Clinical Electrophysiology, 26, 53–58.

    Article  PubMed  Google Scholar 

  6. Hsieh, M. H., Tai, C. H., Chiang, C. E., Tsai, C. F., Yu, W. C., Chen, Y. J., et al. (2002). Recurrent atrial flutter and atrial fibrillation after catheter ablation of the cavotricuspid isthmus: a very long follow-up of 333 patients. Journal of Interventional Cardiac Electrophysiology, 7, 225–231.

    Article  PubMed  Google Scholar 

  7. Timmermans, C., Ayers, G. M., Crijns, H. J. G. M., & Rodriguez, L. M. (2003). Randomized study comparing radiofrequency ablation with cryoablation for the treatment of atrial flutter with emphasis on pain perception. Circulation, 107, 1250–1252.

    Article  PubMed  Google Scholar 

  8. Collins, N. J., Barlow, M., Varghese, P., & Leitch, J. (2006). Cryoablation versus radiofrequency ablation in the treatment of atrial flutter trial (CRAAFT). Journal of Interventional Cardiac Electrophysiology, 16, 1–5.

    Article  PubMed  Google Scholar 

  9. Manusama, R., Timmermans, C., Limon, F., Philippens, S., Crijns, H., & Rodriguez, L. M. (2004). Catheter-based cryoablation permanently cures patients with common atrial flutter. Circulation, 109, 1636–1639.

    Article  PubMed  Google Scholar 

  10. Kuniss, M., Kurzidim, K., Greiss, H., Berkowitsch, A., Sperzel, J., Hamm, C., et al. (2006). Acute success and persistence of bidirectional conduction block in the cavotricuspid isthmus one month past cryocatheter ablation of common atrial flutter. Pacing and Clinical Electrophysiology, 29, 146–152.

    Article  PubMed  Google Scholar 

  11. Montenero, A. S., Bruno, N., Antonelli, A., Mangiameli, D., Barbieri, L., Andrew, P., et al. (2005). Long term efficacy of cryocatheter ablation for the treatment of atrial flutter: Result from a repeat electrophysiologic study. Journal of the American College of Cardiology, 45, 573–580.

    Article  PubMed  Google Scholar 

  12. Montenero, A. S., Bruno, N., Antonelli, A., Mangiameli, D., Barbieri, L., Andrew, P., 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 atrial flutter. Journal of Interventional Cardiac Electrophysiology, 13, 56–59.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Uppsala University Hospital, SE-751 85, Uppsala, Sweden

    Helena Malmborg, Stefan Lönnerholm & Carina Blomström Lundqvist

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  1. Helena Malmborg
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  2. Stefan Lönnerholm
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  3. Carina Blomström Lundqvist
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Correspondence to Helena Malmborg.

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Malmborg, H., Lönnerholm, S. & Lundqvist, C.B. A prospective randomised comparison of large-tip cryoablation and 8-mm-tip radiofrequency catheter ablation of atrial flutter. J Interv Card Electrophysiol 24, 127–131 (2009). https://doi.org/10.1007/s10840-008-9315-1

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  • DOI: https://doi.org/10.1007/s10840-008-9315-1

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