Cryofreezing catheter ablation of adenosine triphosphate sensitive atrial tachycardia

• Published in: Journal of cardiovascular electrophysiology Vol. 30; no. 4; pp. 528 - 537
• Main Authors: Okishige, Kaoru, Shigeta, Takatoshi, Nishimura, Takuro, Nakamura, Rena A., Hirao, Tatsuhiko, Yoshida, Hiroshi, Yamauchi, Yasuteru, Sasano, Tetsuo, Hirao, Kenzo
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-04-2019
• Subjects: Ablation; adenosine; Adenosine triphosphate; ATP; atrial tachycardia; Cardiac arrhythmia; catheter ablation; Catheters; Conduction; cryofreezing; Electrocardiography; Energy; Medical instruments; Patients; Radio frequency; Radiofrequency ablation; Tachycardia; Temperature; Ventricle; adenosine; catheter ablation; cryofreezing; atrial tachycardia
• ISSN: 1045-3873; 1540-8167
• DOI: 10.1111/jce.13844

Introduction
Adenosine triphosphate (ATP) sensitive atrial tachycardia (AT) has been treated by radiofrequency catheter ablation. Cryofreezing energy has emerged as a novel energy source for catheter ablation. The aim of this study was to investigate the efficacy and safety of cryofreezing ablation for ATP‐sensitive AT.
Methods and Results
A total of six patients with ATP‐sensitive ATs were included in this study. A single atrial extrastimulation was able to initiate and terminate these ATs in all six patients. The electrophysiological findings satisfied the diagnostic criteria of ATP‐sensitive AT. The ablation catheter was located at the earliest activation site of atrial excitation during the AT, and cryofreezing energy was delivered through a cryoablation catheter to perform cryomapping at temperature of −30 or −80°C. When cryomapping successfully terminated the ATs, cryoablation at a temperature of −80°C was subsequently performed. The earliest atrial activation during AT was recorded at the Koch's triangle area associated with a distinct intra‐atrial activation sequence from that recorded during ventricular pacing. Cryoablation was performed at successful cryomapping sites and resulted in the complete elimination of the AT in all six patients without affecting the bidirectional atrioventricular (AV) nodal conduction.
Conclusion
Cryofreezing energy was safe and effective in treating ATP‐sensitive ATs even in patients with its origins located in the vicinity of the AV node.