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

41 Scopus citations

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 1 2011
Externally publishedYes

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Keywords

  • Cardiomyopathy
  • Cryocatheter ablation
  • Normal heart
  • Ventricular tachycardia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Di Biase, L., Al-Ahamad, A., Santangeli, P., Hsia, H. H., Sanchez, J., Bai, R., Bailey, S., Horton, R., Gallinghouse, G. J., Burkhardt, D. J., Lakkireddy, D., Yang, Y., Badhwar, N., Scheinman, M., Tung, R., Dello Russo, A., Pelargonio, G., Casella, M., Tomassoni, G., ... Natale, A. (2011). Safety and outcomes of cryoablation for ventricular tachyarrhythmias: Results from a multicenter experience. Heart Rhythm, 8(7), 968-974. https://doi.org/10.1016/j.hrthm.2011.02.038