Key result
Prolonged focal cryoablation for parahisian PVCs triggers late, reversible AV block after ~350 seconds.
Case Report (n=1)
Lesion formation during cryoablation can continue to evolve after several minutes, necessitating continuous monitoring for AV block during parahisian ablation.
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Requires continuous AV monitoring throughout parahisian cryoablation; leaves open optimal lesion duration and safety margins.
A 54-year-old woman with symptomatic premature ventricular contractions (PVC) was referred for electrophysiological study. The earliest activation was located at the parahisian area, so it was decided to ablate using cryoenergy. No AV conduction impairment was observed during cryomapping. PVCs were abolished after the first 15 seconds of cryoablation, without recurrence. However, after 354 seconds of cryoablation, a mild PR prolongation was followed by first degree and 2-to-1 AV block. Termination of cryoablation led to complete recovery without definitive damage and with elimination of the PVC. This case illustrates how lesion formation using cryoenergy can continue to evolve even after several minutes, highlighting the need of monitoring throughout the whole target duration.
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Rivera et al. (2022) conducted a case report in Parahisian premature ventricular complexes (n=1). Focal cryoablation was evaluated on Atrioventricular conduction and PVC suppression. Prolonged focal cryoablation for parahisian PVCs led to late, reversible 2-to-1 atrioventricular block after 354 seconds despite uneventful cryomapping, demonstrating that cryothermal effects evolve over several minutes.
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