Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan.
Arrhythmia Center, Tokyo Medical and Dental University, Tokyo, Japan.
J Cardiovasc Electrophysiol. 2019 Apr;30(4):528-537. doi: 10.1111/jce.13844. Epub 2019 Jan 24.
Adenosine triphosphate (ATP) sensitive atrial tachycardia (AT) has been treated by radiofrequency catheter ablation. Cryofreezing energy has emerged as a novel energy source for catheter ablation. The aim of this study was to investigate the efficacy and safety of cryofreezing ablation for ATP-sensitive AT.
A total of six patients with ATP-sensitive ATs were included in this study. A single atrial extrastimulation was able to initiate and terminate these ATs in all six patients. The electrophysiological findings satisfied the diagnostic criteria of ATP-sensitive AT. The ablation catheter was located at the earliest activation site of atrial excitation during the AT, and cryofreezing energy was delivered through a cryoablation catheter to perform cryomapping at temperature of -30 or -80°C. When cryomapping successfully terminated the ATs, cryoablation at a temperature of -80°C was subsequently performed. The earliest atrial activation during AT was recorded at the Koch's triangle area associated with a distinct intra-atrial activation sequence from that recorded during ventricular pacing. Cryoablation was performed at successful cryomapping sites and resulted in the complete elimination of the AT in all six patients without affecting the bidirectional atrioventricular (AV) nodal conduction.
Cryofreezing energy was safe and effective in treating ATP-sensitive ATs even in patients with its origins located in the vicinity of the AV node.
三磷酸腺苷（ATP）敏感的房性心动过速（AT）可通过射频导管消融进行治疗。冷冻能量已成为导管消融的一种新型能源。本研究旨在探讨冷冻消融治疗 ATP 敏感 AT 的疗效和安全性。
本研究共纳入 6 例 ATP 敏感 AT 患者。所有 6 例患者均能通过单次心房超速刺激诱发和终止这些 AT。电生理发现符合 ATP 敏感 AT 的诊断标准。消融导管位于 AT 时心房激动的最早激活部位，并通过冷冻消融导管输送冷冻能量，以-30°C 或-80°C 的温度进行冷冻标测。当冷冻标测成功终止 AT 时，随后以-80°C 的温度进行冷冻消融。AT 期间最早的心房激活记录在 Koch 三角区域，与心室起搏时记录到的明显的房内激活序列不同。在成功的冷冻标测部位进行冷冻消融，结果在所有 6 例患者中完全消除了 AT，而不影响双向房室（AV）结传导。
冷冻能量在治疗 ATP 敏感 AT 时是安全有效的，即使起源部位靠近 AV 结的患者也是如此。
