Safety and outcomes of cryoablation for ventricular tachyarrhythmias: Results from a multicenter experience

Luigi Di Biase, Amin Al-Ahamad, Pasquale Santangeli, Henry H. Hsia, Javier Sanchez, Rong Bai, Shane Bailey, Rodney Horton, G. Joseph Gallinghouse, David J. Burkhardt, Dhanunjay Lakkireddy, Yanfei Yang, Nitish Badhwar, Melvin Scheinman, Roderick Tung, Antonio Dello Russo, Gemma Pelargonio, Michela Casella, Gery Tomassoni, Kalyanam ShivkumarAndrea Natale

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported. Objective: The purpose of this study was to assess the feasibility and safety of cryoablation for VA. Methods: Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate. Results: Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45% ± 5%. In 15 (45%) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55%) patients. Cryoablation was successful in all parahisian cases (100%). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA. Conclusion: Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed.

Original languageEnglish (US)
Pages (from-to)968-974
Number of pages7
JournalHeart Rhythm
Volume8
Issue number7
DOIs
StatePublished - Jul 2011
Externally publishedYes

Fingerprint

Cryosurgery
Tachycardia
Cardiac Arrhythmias
Safety
Bundle of His
Phrenic Nerve
Coronary Vessels
Catheters
Catheter Ablation
Coronary Sinus
Dissection
Heart Diseases

Keywords

  • Cardiomyopathy
  • Cryocatheter ablation
  • Normal heart
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Safety and outcomes of cryoablation for ventricular tachyarrhythmias : Results from a multicenter experience. / Di Biase, Luigi; Al-Ahamad, Amin; Santangeli, Pasquale; Hsia, Henry H.; Sanchez, Javier; Bai, Rong; Bailey, Shane; Horton, Rodney; Gallinghouse, G. Joseph; Burkhardt, David J.; Lakkireddy, Dhanunjay; Yang, Yanfei; Badhwar, Nitish; Scheinman, Melvin; Tung, Roderick; Dello Russo, Antonio; Pelargonio, Gemma; Casella, Michela; Tomassoni, Gery; Shivkumar, Kalyanam; Natale, Andrea.

In: Heart Rhythm, Vol. 8, No. 7, 07.2011, p. 968-974.

Research output: Contribution to journalArticle

Di Biase, L, Al-Ahamad, A, Santangeli, P, Hsia, HH, Sanchez, J, Bai, R, Bailey, S, Horton, R, Gallinghouse, GJ, Burkhardt, DJ, Lakkireddy, D, Yang, Y, Badhwar, N, Scheinman, M, Tung, R, Dello Russo, A, Pelargonio, G, Casella, M, Tomassoni, G, Shivkumar, K & Natale, A 2011, 'Safety and outcomes of cryoablation for ventricular tachyarrhythmias: Results from a multicenter experience', Heart Rhythm, vol. 8, no. 7, pp. 968-974. https://doi.org/10.1016/j.hrthm.2011.02.038
Di Biase, Luigi ; Al-Ahamad, Amin ; Santangeli, Pasquale ; Hsia, Henry H. ; Sanchez, Javier ; Bai, Rong ; Bailey, Shane ; Horton, Rodney ; Gallinghouse, G. Joseph ; Burkhardt, David J. ; Lakkireddy, Dhanunjay ; Yang, Yanfei ; Badhwar, Nitish ; Scheinman, Melvin ; Tung, Roderick ; Dello Russo, Antonio ; Pelargonio, Gemma ; Casella, Michela ; Tomassoni, Gery ; Shivkumar, Kalyanam ; Natale, Andrea. / Safety and outcomes of cryoablation for ventricular tachyarrhythmias : Results from a multicenter experience. In: Heart Rhythm. 2011 ; Vol. 8, No. 7. pp. 968-974.
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abstract = "Background: Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported. Objective: The purpose of this study was to assess the feasibility and safety of cryoablation for VA. Methods: Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate. Results: Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45{\%} ± 5{\%}. In 15 (45{\%}) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55{\%}) patients. Cryoablation was successful in all parahisian cases (100{\%}). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA. Conclusion: Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed.",
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AU - Di Biase, Luigi

AU - Al-Ahamad, Amin

AU - Santangeli, Pasquale

AU - Hsia, Henry H.

AU - Sanchez, Javier

AU - Bai, Rong

AU - Bailey, Shane

AU - Horton, Rodney

AU - Gallinghouse, G. Joseph

AU - Burkhardt, David J.

AU - Lakkireddy, Dhanunjay

AU - Yang, Yanfei

AU - Badhwar, Nitish

AU - Scheinman, Melvin

AU - Tung, Roderick

AU - Dello Russo, Antonio

AU - Pelargonio, Gemma

AU - Casella, Michela

AU - Tomassoni, Gery

AU - Shivkumar, Kalyanam

AU - Natale, Andrea

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N2 - Background: Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported. Objective: The purpose of this study was to assess the feasibility and safety of cryoablation for VA. Methods: Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate. Results: Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45% ± 5%. In 15 (45%) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55%) patients. Cryoablation was successful in all parahisian cases (100%). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA. Conclusion: Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed.

AB - Background: Catheter ablation of ventricular arrhythmias (VAs) with cryoenergy has not been widely reported. Objective: The purpose of this study was to assess the feasibility and safety of cryoablation for VA. Methods: Cases where cryoablation of VA was attempted as the initial strategy or was considered to prevent potential damage to other structures such as the coronary arteries, phrenic nerve, and His bundle were collected. Thirty-three patients with either normal heart or structural heart disease undergoing VA ablation using cryoenergy at six different institutions were enrolled in the study. Epicardial access was obtained when appropriate. Results: Fifteen patients (7 men) underwent endocardial ablation, 13 (9 men) epicardial ablation (from the coronary sinus in 7), and 5 (2 men) aortic cusp ablation. Mean age was 54 ± 8 years, and ejection fraction was 45% ± 5%. In 15 (45%) patients, VAs were successfully ablated, whereas cryoablation was unsuccessful in the remaining 18 (55%) patients. Cryoablation was successful in all parahisian cases (100%). In three patients, epicardial cryoablation was successful after several failed attempts with open irrigated catheter. An aortic dissection occurred during catheter placement in the aortic cusp. At follow-up of 24 ± 5 months, all patients with acute success were free from clinical VA. Conclusion: Use of cryoenergy for ablation of VA has excellent success for arrhythmias near the His bundle; however, success rates at other sites appear less favorable. Cryoablation may be considered as an alternative approach for reducing complications during ablation of VAs originating from sites close to other relevant cardiac structures (conduction system, coronary arteries, phrenic nerve) and, in rare cases, could be used epicardially when radiofrequency energy applications have failed.

KW - Cardiomyopathy

KW - Cryocatheter ablation

KW - Normal heart

KW - Ventricular tachycardia

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