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Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study

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Abstract

Purpose

Radiofrequency ablation (RF) of atrioventricular reentrant tachycardia (AVNRT) is an effective method for treating this arrhythmia. However, inadverted AV block requiring implantation of permanent pacemaker is a worrisome side effect. Although permanent AV block seems to be rare nowadays, patients are by no means spared from this severe complication. Catheter cryoablation is emerging as an alternative technology with an excellent safety profile, but limited data exist regarding its efficacy.

Methods

We conducted a randomized study among patients with AVNRT remitted to our center for EP study and ablation between January 2008 and June 2010. After giving a written consent, patients were randomized to conventional RF or cryoablation, unless specific preference of patient was stated. Primary outcomes were acute success, SVT recurrence, and complications, including AV block.

Results

One hundred nineteen patients were included (60 cryoablation and 59 conventional RF). There were no differences in demographic and clinical baseline data between groups. Acute procedural success was achieved in 59 patients (98 %) in cryoablation group and 59 (100 %) in RF. One patient in RF group underwent complete AV block and pacemaker implantation. Over a mean follow-up period of 256.6 days, there was a significant difference in AVNRT recurrence between cryoablation and RF patients (15 versus 3.4 %, p = 0.03).

Conclusion

Catheter cryoablation of AVNRT is a clinically effective alternative to RF ablation, with excellent acute success rate. Despite a slightly higher rate of recurrence during long-term follow-up, these results suggest that cryoablation may be considered as first-line approach, especially in younger people, where the risk of permanent pacing because of inadvertent AV block may be relevant.

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Authors and Affiliations

  1. Unidad de Arritmias, Servicio de Cardiología, HU Marqués de Valdecilla, Santander, Spain

    Felipe J. Rodriguez-Entem, Víctor Expósito, Susana Gonzalez-Enriquez & Juan José Olalla-Antolin

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  1. Felipe J. Rodriguez-Entem
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  2. Víctor Expósito
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  3. Susana Gonzalez-Enriquez
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  4. Juan José Olalla-Antolin
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Correspondence to Víctor Expósito.

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Editorial Commentary

JICE2003R1

Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study

Dr. Victor Expósito

Dr. Expósito and colleagues' manuscript provides additional information on the relative utility of cryoablation versus standard radiofrequency ablation for the treatment of AVNRT. Specifically, this study found that cryoablation was not associated with a risk of heart block, but had a higher rate of arrhythmia recurrence. These data help to better define the role of cryoablation for the treatment of AVNRT, providing important information for clinicians.

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Rodriguez-Entem, F.J., Expósito, V., Gonzalez-Enriquez, S. et al. Cryoablation versus radiofrequency ablation for the treatment of atrioventricular nodal reentrant tachycardia: results of a prospective randomized study. J Interv Card Electrophysiol 36, 41–45 (2013). https://doi.org/10.1007/s10840-012-9732-z

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  • DOI: https://doi.org/10.1007/s10840-012-9732-z

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