Department of Cardiology at the Karolinska Institute, Karolinska University Hospital, S-141 86 Stockholm, Sweden.
Europace. 2010 Jul;12(7):972-7. doi: 10.1093/europace/euq079. Epub 2010 Mar 27.
Radiofrequency (RF) catheter ablation in the septum close to the atrioventricular (AV) node or His bundle has an increased risk of irreversible complications. Cryothermal energy has the advantages of reversible cryomapping and increased catheter stability. This study evaluates the usefulness of cryoablation in superoparaseptal and septal accessory pathways (APs).
Twenty-seven consecutive patients (16 men, 11 women, median age 29 years, range 15-65) underwent cryoablation for APs either located in the superoparaseptal (n=18) or septal (n=9) area. Cryomapping, using exclusively a 6 mm tip catheter, at -30 degrees C was performed before ablation with a goal temperature of -80 degrees C for 240 s. Acute success was achieved in 26 out of 27 patients (96%). Total procedure and fluoroscopy time was 163+/-61 and 30+/-22 min, respectively. During a follow-up for a mean of 996+/-511 days, seven patients (27%) had recurrences of arrhythmia. Five out of these seven underwent a second cryoablation with successful results, giving a total success rate of 89%. Two patients developed transient second degree AV block during cryoablation; however, no permanent AV block was observed. The recurrence rate was significantly higher in patients with procedure-related transient mechanical AP block (6/7; 86%) due to catheter trauma compared with those without mechanical block (5/20; 25%; P=0.006).
Cryoablation of the superoparaseptal and septal APs is a safe and effective alternative to RF therapy. Procedure-related transient mechanical AP block predicts worse late outcome.
靠近房室（AV）结或希氏束的间隔射频（RF）导管消融具有不可逆并发症风险增加的风险。冷冻能量具有可逆转的冷冻映射和增加导管稳定性的优点。本研究评估了冷冻消融在间隔上部和间隔旁道（APs）中的作用。
27 例连续患者（16 名男性，11 名女性，中位年龄 29 岁，范围 15-65 岁）因间隔上部（n=18）或间隔（n=9）区域的 AP 接受冷冻消融。在消融前使用仅带有 6 毫米尖端导管的冷冻映射，温度设定为-30°C，消融目标温度为-80°C，持续 240 秒。27 例患者中的 26 例（96%）即刻成功。总手术和透视时间分别为 163+/-61 和 30+/-22 分钟。平均随访 996+/-511 天后，7 例患者（27%）出现心律失常复发。其中 5 例再次接受冷冻消融，结果成功，总成功率为 89%。2 例患者在冷冻消融过程中出现短暂的二度房室传导阻滞，但未观察到永久性房室传导阻滞。由于导管创伤引起的与操作相关的短暂机械 AP 阻塞的患者（6/7；86%）的复发率明显高于无机械阻塞的患者（5/20；25%；P=0.006）。
间隔上部和间隔旁道的冷冻消融是 RF 治疗的安全有效替代方法。与操作相关的短暂机械 AP 阻塞预示着晚期结果较差。
