Published Online
on March 15, 2004

A more recent version of this article appeared on April 6, 2004

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Submitted on July 28, 2003
Revised on January 7, 2004
Accepted on January 12, 2004

Catheter-Based Cryoablation Permanently Cures Patients With Common Atrial Flutter

Randy Manusama MD, Carl Timmermans MD, Froylan Limon MD, Suzanne Philippens RN, Harry J.G.M. Crijns MD, and Luz-Maria Rodriguez MD^*

From the Department of Cardiology, Academic Hospital Maastricht, Maastricht, the Netherlands.

^* To whom correspondence should be addressed. E-mail: lm.rodriguez{at}cardio.unimaas.nl.

Background--Cryoablation (cryo) has a high success rate in the short-term treatment of atrial flutter (AFL), but evidence of long-term efficacy is lacking. The present study reports the long-term effect of cryo of the cavotricuspid isthmus (CTI) in patients with common AFL.

Methods and Results--Thirty-five consecutive patients (28 men; mean age, 53 years) underwent cryo of the CTI. In 34 patients, the AFL had a counterclockwise rotation (cycle length, 242±43 ms). Eleven patients had structural heart disease. Cryo was performed with a 10F catheter with a 6-mm-tip electrode (CryoCor). Applications (3 to 5 minutes each) were delivered by use of a point-by-point technique to create the ablation line. The acute end point of the procedure was creation of bidirectional isthmus conduction block and noninducibility of AFL. A median of 14 applications (range, 4 to 30) at 10 sites (range, 4 to 19) was given along the CTI with a mean temperature of -80.0±5.0°C. Mean fluoroscopy and procedure times were 40±26 minutes and 3.2±1.3 hours, respectively. Of the 35 patients, 34 were acutely successfully ablated (97%). After a mean follow-up of 17.6±6.2 months (range, 9.6 to 26.1 months), 31 patients (89%) did not have recurrence of AFL. Three of the 4 patients with recurrence had a second successful procedure. One patient had transient ST elevation in the inferior leads during cryoapplication.

Conclusions--Cryo produces permanent bidirectional isthmus conduction block of the CTI. Short- and long-term success rates are comparable to those for radiofrequency ablation.

Key words: ablation • atrial flutter • catheter ablation

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