Leung Lisa Wm, Evranos Banu, Gonna Hanney, Harding Idris, Domenichini Giulia, Gallagher Mark M
Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK.
Department of Cardiology, St. George's University Hospitals NHS Foundation Trust, UK.
Indian Pacing Electrophysiol J. 2024 Jan-Feb;24(1):1-5. doi: 10.1016/j.ipej.2023.11.002. Epub 2023 Nov 17.
To investigate the utility of simultaneous multi-catheter cryotherapy for the treatment of APs that were previously resistant to standard radiofrequency (RF) catheter ablation.
Catheter ablation is established in the treatment of accessory pathways (AP), with high rates of permanent procedural success with a single attempt. However, there are still instances of acute procedural failure and AP recurrences with standard RF and cryotherapy methods.
Seven consecutive cases of pre-excitation syndromes with prior failed RF catheter ablation had the novel treatment. Cryotherapy was delivered using two 8 mm tip focal cryoablation catheters (Freezor® Max, Medtronic, Minneapolis, Minnesota, USA).
Accessory pathway localisation was septal in 5 cases, left posterolateral in 1, right lateral in 1. In all cases, ablation of the AP was acutely successful with no procedural complications. Median procedure and fluoroscopy durations were 199 and 35 min, sequentially. Median Procedure duration fell significantly in the second half of series (174 min) compared to the first half (233 min, P = 0.05). One patient had evidence of a recurring AP conduction with pre-excitation at 5-week follow up. After a median follow up of 66.8+-6.5 months, 6 out of 7 patients remained asymptomatic and free of pre-excitation.
Simultaneous multi-catheter cryotherapy is feasible, safe and can provide definitive cure of accessory pathways that were previously resistant to standard radiofrequency ablation. Further study is required in the assessment of this novel form of advanced cryotherapy to treat complex and resistant arrhythmias.
探讨同步多导管冷冻消融术治疗既往对标准射频（RF）导管消融耐药的房室旁道（AP）的效用。
导管消融术已用于治疗房室旁道（AP），单次尝试的永久手术成功率较高。然而，标准RF和冷冻消融方法仍存在急性手术失败和AP复发的情况。
对7例先前RF导管消融失败的预激综合征患者进行了这种新的治疗。使用两根8毫米尖端聚焦冷冻消融导管（Freezor® Max，美敦力公司，明尼阿波利斯，明尼苏达州，美国）进行冷冻消融。
5例AP位于间隔部，1例位于左后外侧，1例位于右侧。所有病例中，AP消融均即刻成功，无手术并发症。手术和透视的中位持续时间分别为199分钟和35分钟。与前半部分（233分钟，P = 0.05）相比，后半部分系列的中位手术持续时间显著缩短（174分钟）。1例患者在5周随访时有AP传导复发伴预激的证据。中位随访66.8±6.5个月后，7例患者中有6例无症状且无预激。
同步多导管冷冻消融术可行、安全，可治愈先前对标准射频消融耐药的房室旁道。需要进一步研究评估这种新型高级冷冻消融术治疗复杂耐药性心律失常的效果。
