Time and Temperature Profile of Catheter Cryoablation of Right Septal and Free Wall Accessory Pathways in Children

INTRODUCTION: The overall acute success with cryoablation for accessory pathways (APs) has been reported to be lower than with radiofrequency ablation. Generally, prior cryomapping (limited to -30 degrees C) has been used to test for loss of AP conduction and absence of atrioventricular (AV) node impairment. However, the temperature at which loss of AP conduction occurs may be variable. The purpose of this study was to evaluate the time and temperature profile at which loss of AP conduction occurs. METHODS AND RESULTS: A retrospective study evaluated 25 patients (mean age 13.3 +/- 3.6 years) who underwent cryoablation for right-sided APs (22 manifest/3 concealed). Direct cryoablation (-80 degrees C) without cryomapping was performed using a "time to success" strategy. If AP conduction was successfully interrupted within 25 seconds of the onset of cryoablation, the lesion was continued for 240 seconds; otherwise it was terminated and further mapping was performed. Cryoablation was successful in 24/25 (96%) patients. Temperature at loss of AP conduction was -66.2 +/--16.7 degrees C (range +32 to -84 degrees C) with conduction block at temperatures lower than -30 degrees C for all but 3 APs. Critical time to success (interval from cryoadherence to loss of AP conduction) was significantly shorter for permanently successful cryolesions, compared with transiently successful lesions (6.3 +/- 4.1 vs. 11.2 +/- 2.2 sec; P < 0.001). There were no major complications. CONCLUSIONS: Cryothermal energy required for successful ablation may be variable and restricting test applications to -30 degrees may limit its efficacy. A "time to success" strategy may improve outcome of cryoablation for right-sided APs in children without compromising safety.