Moondra Vaibhav K, Greenberg Mark L, Gerling Barbara R, Holzberger Peter T, Weindling Steven N, Sangha Rajbir S
Heart and Vascular Institute of Florida, Clearwater, FL, United States.
Section of Cardiology, Department of Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine, Dartmouth, United States.
Indian Pacing Electrophysiol J. 2017 Jul-Aug;17(4):95-99. doi: 10.1016/j.ipej.2016.12.007. Epub 2017 Jan 6.
Most literature for cryoablation of atrioventricular nodal reentry tachycardia (AVNRT) is based on -30 degree celsius cryomapping with 4 & 6 mm distal electrode catheters. The cryomapping mode is not available on the 6 mm cryocatheter in the United States. We describe a technique for 'pseudo' mapping at -80° using a 6 mm cryocatheter and report on short and long term outcomes.
A retrospective analysis of all index cases (n = 253) of cryoablation of AVNRT at a single North American institution during the period of 2003-2010 was performed. The majority of cases utilized a 6 mm distal electrode tip catheter. Long term follow up (2.4 ± 1.8 years) was performed via review of the medical record and by questionnaire or telephone if necessary.
Acute ablation success was achieved in 93% of cases, with transient conduction defects noted in 39% of cases, and long term conduction defects in 1.6% of cases (4 patients with PR prolongation, 2 of which were permanent). General anesthesia, male gender and presence of structural heart disease were more common in the acute failure cohort. The recurrence rate for AVNRT was 8%. These patients tended to be younger and had more transient A-V conduction defects during the index procedure than those without a recurrence.
In conclusion, anatomic cryoablation of AVNRT utilizing a 6 mm electrode catheter with mapping performed at -80° Celsius is a safe procedure with good long term efficacy. Transient A-V block during the index procedure increases the risk of late recurrence.
大多数关于房室结折返性心动过速（AVNRT）冷冻消融的文献是基于使用4毫米和6毫米远端电极导管进行-30摄氏度的冷冻标测。在美国，6毫米冷冻导管上没有这种冷冻标测模式。我们描述了一种使用6毫米冷冻导管在-80°进行“伪”标测的技术，并报告短期和长期结果。
对2003年至2010年期间北美一家机构进行的所有AVNRT冷冻消融索引病例（n = 253）进行回顾性分析。大多数病例使用6毫米远端电极尖端导管。通过查阅病历并在必要时通过问卷调查或电话进行长期随访（2.4±1.8年）。
93%的病例实现了急性消融成功，39%的病例出现短暂传导缺陷，1.6%的病例出现长期传导缺陷（4例PR延长，其中2例为永久性）。急性失败队列中全身麻醉、男性和结构性心脏病更为常见。AVNRT的复发率为8%。与未复发的患者相比，这些患者往往更年轻，在索引手术期间有更多短暂的房室传导缺陷。
总之，使用6毫米电极导管在-80摄氏度进行标测对AVNRT进行解剖学冷冻消融是一种安全的手术，长期疗效良好。索引手术期间的短暂房室传导阻滞会增加晚期复发的风险。
