Key result
Fractionated potential-guided cryoablation for AVNRT is linked to ~56% fewer ablation points versus conventional RF.
Why the study?
To evaluate FP-guided cryoablation to terminate AVNRT while minimizing redundant applications, and explore the significance of anteroseptal tiny, dull potentials.
Does fractionated potential-guided cryoablation reduce the number of ablation applications compared to radiofrequency ablation in patients with slow-fast AVNRT?
Cohort (n=53)
No
Does fractionated potential-guided cryoablation reduce the number of ablation applications compared to radiofrequency ablation in patients with slow-fast AVNRT?
Fractionated potential-guided cryoablation for AVNRT requires fewer ablation applications than RF ablation, and avoiding the tiny dull potential area during ablation reduces the risk of AV block.
Answers are grounded in this paper and cite their sources.
May reduce ablation applications in AVNRT; leaves open whether fractionated potential-guided cryoablation improves safety versus radiofrequency ablation.
Background Fractionated potential (FP) ablation during atrioventricular nodal reentrant tachycardia (AVNRT), is an effective strategy that minimizes redundant radiofrequency (RF) applications. This study aimed to evaluate the utility of cryoablation targeting FPs to effectively terminate AVNRT while further minimizing redundant cryoapplications. Moreover, we observed what appeared to be compact AVN (cAVN) or proximal His potentials—tiny, dull potentials (TDPs) with continuity to the His potential during sinus rhythm (SR) and AVNRT—in the anteroseptal area. The second aim of this study was to explore the significance of those potentials. Methods Analyzed were 53 slow-fast AVNRT patients who underwent ablation procedures. Ultra-high resolution activation maps in the triangle of Koch were obtained during SR (n=34) and AVNRT (n=46). TDPs during SR and AVNRT in the anteroseptal area were identified and annotated using the LUMIPOINT Activation Search tool. Results FP areas were observed in 19 patients (56%) during SR and in 46 (100%) during AVNRT. This area corresponded to the AVNRT termination and/or successful ablation site in all, with peak numbers of 8.8±1.4 during AVNRT and 5.3±1.3 during SR. The number of ablation points was 3.6±1.5 for the FP-guided cryoablation (n=32) (Bonferroni corrected P<0.05 vs. anatomical RF; and P<0.05 vs. FP-guided RF), 5.4±2.1 for the FP-guided RF ablation (n=11) (P=0.0825 vs. anatomical RF), and 8.2±3.2 for the conventional RF ablation (n=10). Transient AV block occurred in 11 patients (21%). All AV block sites overlapped with the TDP area in the phase just before the His potential during AVNRT and SR, with a confidence setting of ≥24% (35[24-60]%). Conversely, in 42 patients without AV block, no ablation was performed in this area. Conclusion The FP-guided cryoablation strategy targeting AVNRT termination required fewer cryoapplications than RF ablation. The RF/cryo application in the TDP area during SR and AVNRT posed a risk of AV block.
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Hirata et al. (2024) conducted a cohort in Slow-fast Atrioventricular Nodal Reentrant Tachycardia (AVNRT) (n=53). Fractionated potential-guided cryoablation vs. Conventional anatomical radiofrequency (RF) ablation was evaluated on Number of ablation points to achieve acute success (p=<0.05). Fractionated potential-guided cryoablation targeting AVNRT termination required significantly fewer ablation points (3.6 vs 8.2) than conventional radiofrequency ablation.
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