Author + information
- Received November 9, 2017
- Revision received December 20, 2017
- Accepted December 21, 2017
- Published online March 19, 2018.
- Koji Miyamoto, MD,
- Suraj Kapa, MD,
- Siva K. Mulpuru, MD,
- Abhishek J. Deshmukh, MBBS,
- Samuel J. Asirvatham, MD,
- Thomas M. Munger, MD,
- Paul A. Friedman, MD∗ ( and )
- Douglas L. Packer, MD
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
- ↵∗Address for correspondence:
Dr. Paul A. Friedman, Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, Minnesota 55905.
Objectives This study aimed to assess the outcome of cryoablation in patients with ventricular arrhythmias (VAs) originating from the para-Hisian region.
Background There are few data regarding the outcome of cryoablation in patients with VAs originating from the para-Hisian region, where there is the risk of injury to the conduction system.
Methods The study analyzed all patients undergoing cryoablation at the Mayo Clinic (Rochester, Minnesota) as part of an ablation for VAs originating from the para-Hisian region.
Results The study population consisted of 10 patients (64 ± 15 years of age, 7 men). Cryoenergy was applied after an unsuccessful radiofrequency (RF) ablation in 8 (80%) patients. The VAs were successfully ablated with cryoablation in 7 (70%) patients; RF ablation after an unsuccessful cryoablation eliminated the VAs at almost the same location with careful monitoring in 1 patient. The authors could not ablate the actual focus because a transient atrioventricular block developed during cryo- and RF energy applications, which led to an unsuccessful ablation in the remaining 2 patients. A complete atrioventricular block occurred during the cryoenergy application in 1 patient, who needed a permanent pacemaker implantation. There were no VA recurrences in 4 of 8 (50%) patients with procedural success during a median follow-up period of 122 days (interquartile range: 43 to 574 days).
Conclusions Cryoablation is clinically effective in some patients with VAs originating from the para-Hisian region, where there is the risk of injury to the conduction system, and therefore should be considered as an alternative to or in addition to RF ablation in these cases. Cryoablation requires care because it can also lead to major complications.
Dr. Packer has served as a consultant for Abbott, Aperture Diagnostics, Biosense Webster, Boston Scientific, CardioFocus, Johnson & Johnson Healthcare Systems, Johnson & Johnson, MediaSphere Medical, Medtronic, St. Jude Medical, Siemens, and Spectrum dynamics; has received research funding from Abbott, Biosense Webster, Boston Scientific/EPT, CardioInsight, CardioFocus, Endosense, Hansen Medical, Medtronic, the National Institutes of Health, Robertson Foundation, St. Jude Medical, Siemens, and Thermedical; and has received royalties from Wiley & Sons, Oxford, and St. Jude Medical. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received November 9, 2017.
- Revision received December 20, 2017.
- Accepted December 21, 2017.
- 2018 American College of Cardiology Foundation
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