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CLINICAL RESEARCH: HEART RHYTHM DISORDER

Long-term efficacy of cryo catheter ablation for the treatment of atrial flutter

Results from a repeat electrophysiologic study

Annibale S. Montenero, MD^*,*, Nicola Bruno, MD^*, Andrea Antonelli, MD^*, Daniele Mangiameli, MD^*, Luca Barbieri, MD^*, Peter Andrew, MMedSci, PhD^*,, Olive Murphy, MSc, Stephen O'Connor, PhD and Francesco Zumbo, MD^*

^* Cardiology Department and Arrhythmia Center of Policlinico MultiMedica, Sesto S.Giovanni, Milan, Italy
Atlas Medical Science Writers Inc., Montreal, Canada
CryoCath Technologies Inc., Kirkland, Canada

Manuscript received August 3, 2004; revised manuscript received October 18, 2004, accepted October 19, 2004.

^* Reprint requests and correspondence: Dr. Annibale S. Montenero, Divisione di Cardiologia, Policlinico MultiMedica, Via Milanese 300, 20099, Sesto S.Giovanni (MI), Milan, Italy (Email: montenero{at}hotmail.com).

OBJECTIVES: We investigated the long-term efficacy of cryo ablation for treatment of atrial flutter.

BACKGROUND: To our knowledge, no study has assessed the long-term efficacy of cryo ablation by assessing both symptom and conduction recurrence.

METHODS: A total of 45 consecutive patients with symptomatic atrial flutter were ablated with a 7-F, 6-mm-tip, quadripolar cryo catheter (Freezor Xtra, CryoCath Technologies Inc., Kirkland, Canada). Electrophysiologic studies (EPS) were performed with diagnostic catheters. Cryo ablation was at –75°C for 4 min, beginning at the inferior rim of the coronary sinus os and creating a posterior line to the Eustachian ridge. Safety, bi-directional isthmus block at intervention, and recurrence at three, six, and nine months post procedure were assessed.

RESULTS: There were no adverse events reported. All patients were free of discomfort on cryo energy delivery. The acute success rate at intervention was 87%. Follow-up data from 39 acutely successful patients showed 27 (69%) without conduction recurrence on repeat EPS at three months, and none (0%) had symptom recurrence documented by Holter monitoring, electrocardiogram, and/or patient diary records at three, six, and nine months follow-up.

CONCLUSIONS: Our experience with a new 7-F, 6-mm-tip, quadripolar cryo catheter yielded a fairly high success rate at intervention, an excellent safety profile, and a good chronic success rate in terms of symptom recurrence. However, further monitoring is necessary to determine whether all asymptomatic patients continue to remain free of symptoms, given the small pool of patients demonstrated to have conduction recurrence.

Abbreviations and Acronyms   CS = coronary sinus   CTI = cavotricuspid isthmus   ECG = electrocardiogram   EPS = electrophysiologic study   LVEF = left ventricular ejection fraction   RF = radiofrequency