Abstract
Introduction
Cryoablation is an effective treatment for children with supraventricular tachycardias (SVT). The present study documents the effect of two different cryoablation protocols on acute and chronic success rates.
Methods and results
Fifty-three consecutive patients (age range, 5–20 years) were treated; patients 1 to 17 were treated by a standard ablation protocol and patients 18 to 53 were treated by a modified ablation protocol that required lengthier cryoablations plus delivery of a bonus cryoapplication to consolidate the acutely successful irreversible lesion created at intervention. Electrophysiological study (EPS) was performed with diagnostic catheters and cryoablations were performed with a 7FR 4 mm tip catheter (CryoCath Technologies). Acute endpoints for non-inducibility of atrioventricular nodal re-entrant tachycardia (AVNRT) by programmed atrial stimulation at baseline or during isoproterenol performed 30 min post procedure, as well as non-inducibility and conduction block over the accessory pathway (AP). The chronic endpoint was arrhythmia recurrence post intervention. No permanent cryo-related complications or adverse outcomes were reported. Acute success rates for patients 1 to 17 and 18 to 53 were 88 and 100%, respectively. The cumulative percentage of patients without arrhythmia recurrence at 12 month follow-up was significantly different at 73 and 90%, respectively.
Conclusions
Lengthier cryoablation delivery, approximating 7 min per cryoablation, increases the acute success rate at intervention. Moreover, these lengthier cryoablation deliveries plus a bonus cryoapplication to consolidate the acutely successful irreversible lesion created at intervention may also significantly improve the chronic success rate, while also maintaining an excellent safety profile for cryoablation treatment of children with SVT such as AVNRT and AP located near the AV junction.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Calkins, H., Yong, P., Miller, J. M., Olshansky, B., Carlson, M., Saul, J. P. 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(2), 262–270.
Mandapati, R., Berul, C. I., Triedman, J. K., Alexander, M. E., & Walsh, E. P. (2003). Radiofrequency catheter ablation of septal accessory pathways in the pediatric age group. American Journal of Cardiology, 92(8), 947–950.
Celiker, A., Kafali, G., Karagoz, T., Ceviz, N., & Ozer, S. (2003). The results of electrophysiological study and radio-frequency catheter ablation in pediatric patients with tachyarrhythmia. Turkish Journal of Pediatrics, 45(3), 209–216.
Iturralde Torres, P., Garrido Garcia, L. M., Cordero, A., Llamas Esperon, G., Colin Lizalde, L., Kershenovich, S. et al. (1998). Radiofrequency ablation in the treatment of supraventricular arrhythmias in pediatrics. Experience with 203 consecutive patients. Archivos del Instituto de Cardiologia de Mexico, 68(1), 27–36.
Kriebel, T., Kroll, M., & Paul, T. (2003). Radiofrequency catheter ablation therapy in the young: Current status. Expert Review of Cardiovascular Therapy, 1(3), 421–437.
Ro, P. S., & Rhodes, L. A. (2001). Atrioventricular node reentry tachycardia in pediatric patients. Progress in Pediatric Cardiology, 13(1), 3–10.
Soongswang, J., Bhuripanyo, K., Raungratanaamporn, O., Sriratanasathavorn, C., Krittayaphong, R., Nutakul, T. et al. (2000). Radiofrequency catheter ablation in pediatrics: Experience at Siriraj Hospital. Journal of the Medical Association of Thailand, 83(11), 1340–1347.
Teixeira, O. H., Balaji, S., Case, C. L., & Gillette, P. C. (1994). Radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia in children. Pacing and Clinical Electrophysiology, 17(10), 1621–1626.
Schaffer, M. S., Silka, M. J., Ross, B. A., & Kugler, J. D. (1996). Inadvertent atrioventricular block during radiofrequency catheter ablation. Results of the Pediatric Radiofrequency Ablation Registry. Pediatric Electrophysiology Society. Circulation, 94(12), 3214–3220.
Gaita, F., Haissaguerre, M., Giustetto, C., Grossi, S., Caruzzo, E., Bianchi, F. et al. (2003). Safety and efficacy of cryoablation of accessory pathways adjacent to the normal conduction system. Journal of Cardiovascular Electrophysiology, 14(8), 825–829.
Van Hare, G. F., Javitz, H., Carmelli, D., Saul, J. P., Tanel, R. E., Fischbach, P. S. et al. (2004). Prospective assessment after pediatric cardiac ablation: Demographics, medical profiles, and initial outcomes. Journal of Cardiovascular Electrophysiology, 15(7), 759–770.
Bubolz, B., Case, C. L., McKay, C. A., O’Connor, B. K., Knick, B. J., & Gillette, P. C. (1996). Learning curve for radiofrequency catheter ablation in pediatrics at a single institution. American Heart Journal, 131(5), 956–960.
Tanel, R. E., Walsh, E. P., Triedman, J. K., Epstein, M. R., Bergau, D. M., & Saul, J. P. (1997). Five-year experience with radiofrequency catheter ablation: Implications for management of arrhythmias in pediatric and young adult patients. Jornal de Pediatria, 131(6), 878–887.
Friedman, P. L. (2005). Catheter cryoablation of cardiac arrhythmias. Current Opinion in Cardiology, 20(1), 48–54.
Gaita, F., Antonio, M., 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(3), 263–268.
Drago, F., De Santis, A., Grutter, G., & Silvetti, M. S. (2005). Transvenous cryothermal catheter ablation of re-entry circuit located near the atrioventricular junction in pediatric patients: Efficacy, safety, and midterm follow-up. Journal of the American College of Cardiology, 45(7), 1096–1103.
Kirsh, J. A., Gross, G. J., O’Connor, S., & Hamilton, R. M. (2005). Transcatheter cryoablation of tachyarrhythmias in children: Initial experience from an international registry. Journal of the American College of Cardiology, 45(1), 133–136.
Miyazaki, A., Blaufox, A. D., Fairbrother, D. L., & Saul, J. P. (2005). Cryo-ablation for septal tachycardia substrates in pediatric patients: Mid-term results. Journal of the American College of Cardiology, 45(4), 581–588.
Riccardi, R., Gaita, F., Caponi, D., Grossi, S., Scaglione, M., Caruzzo, E. et al. (2003). Percutaneous catheter cryothermal ablation of atrioventricular nodal reentrant tachycardia: Efficacy and safety of a new ablation technique. Italian Heart Journal, 4(1), 35–43.
Kriebel, T., Broistedt, C., Kroll, M., Sigler, M., & Paul, T. (2005). Efficacy and safety of cryoenergy in the ablation of atrioventricular reentrant tachycardia substrates in children and adolescents. Journal of Cardiovascular Electrophysiology, 16(9), 960–966.
Angkeow, P., & Calkins, H. G. (2001). Complications associated with radiofrequency catheter ablation of cardiac arrhythmias. Cardiology in Review, 9(3), 121–130.
Dubin, A. M., & Van Hare, G. F. (2000). Radiofrequency catheter ablation: Indications and complications. Pediatric Cardiology, 21(6), 551–556.
Iturralde, P., Colin, L., Kershenovich, S., Guevara, M. E., Medeiros, A., Buendia, A. et al. (2000). Radiofrequency catheter ablation for the treatment of supraventricular tachycardias in children and adolescents. Cardiology in the Young, 10(4), 376–383.
Schaffer, M. S., Gow, R. M., Moak, J. P., & Saul, J. P. (2000). Mortality following radiofrequency catheter ablation (from the Pediatric Radiofrequency Ablation Registry). Participating members of the Pediatric Electrophysiology Society. American Journal of Cardiology, 86(6), 639–643.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Drago, F., Silvetti, M.S., De Santis, A. et al. Lengthier cryoablation and a bonus cryoapplication is associated with improved efficacy for cryothermal catheter ablation of supraventricular tachycardias in children. J Interv Card Electrophysiol 16, 191–198 (2006). https://doi.org/10.1007/s10840-006-9028-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-006-9028-2