creators_name: De Ponti, Roberto editors_name: Singh, Balbir editors_name: Lokhandwala, Yash editors_name: Francis, Johnson editors_name: Gupta, Anup type: journalp datestamp: 2005-04-13 lastmod: 2011-03-11 08:55:53 metadata_visibility: show title: Cryothermal Energy Ablation Of Cardiac Arrhythmias 2005: State Of The Art ispublished: pub subjects: ipej full_text_status: public keywords: cryoablation; cardiac arrhythmia abstract: At the time of antiarrhythmic surgery, cryothermal energy application by a hand-held probe was used to complement dissections and resections and permanently abolish the arrhythmogenic substrate. Over the last decade, significant engineering advances allowed percutaneous cryoablation based on catheters, apparently not very different from standard radiofrequency ablation catheters. Cryothermal energy has peculiar characteristics. In fact, it allows testing in a reversible way the effects of energy application at higher temperature, before producing a permanent lesion at –75°C. Moreover, slow formation of the lesion allows timely discontinuation of the application, as soon as inadvertent modifications of normal atrioventricular conduction are observed during ablation in the proximity of atrioventricular node and His bundle, avoiding its permanent damage. Over the last years, percutaneous cryothermal ablation has been widely used for a variety of cardiac arrhythmias. From the data gathered, it is unlikely that cryoablation will replace standard ablation in unselected cases. Nevertheless, for the above mentioned peculiarities, cryothermal ablation has proved very effective and safe for ablation of arrhythmogenic substrates close to the normal conduction pathways, becoming the first choice method to ablate anteroseptal and midseptal accessory pathways. It can be also the best treatment for ablation of the slow pathway to abolish atrioventricular node reentrant tachycardia in pediatrics or when particular anatomy of the Koch’s triangle is observed. Cryothermal ablation of the pulmonary veins for atrial fibrillation, although longer than radiofrequency ablation, is not associated with pulmonary vein stenosis and is expected to be less thrombogenic; new catheter designs for cryothermal ablation of this challenging arrhythmia are to be tested to assess their efficacy and clinical usefulness. date: 2005-01 date_type: published publication: Indian Pacing and Electrophysiology Journal volume: 5 number: 1 publisher: Indian Pacing and Electrophysiology Group pagerange: 12-24 refereed: TRUE referencetext: 1. Klein GJ, Guiraudon GM, Perkins DG, Jones DL, Yee R, Jarvis E. Surgical correction of the Wolff-Parkinson-White syndrome in the closed heart using cryosurgery: a simplified approach. J Am Coll Cardiol 1984; 3: 405-409 2. 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