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(Circulation. 2004;109:1636-1639.)
© 2004 American Heart Association, Inc.

Clinical Investigation and Reports

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; Luz-Maria Rodriguez, MD

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

Correspondence to L.M. Rodriguez, MD, Department of Cardiology, Academic Hospital Maastricht, and Cardiovascular Research Institute, Maastricht (CARIM), PO Box 5800, AZ 6202 Maastricht, The Netherlands. E-mail lm.rodriguez{at}cardio.unimaas.nl

Received July 28, 2003; de novo received October 13, 2003; revision received January 7, 2004; accepted January 12, 2004.

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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