Article thumbnail

Cryothermal Energy Ablation Of Cardiac Arrhythmias 2005: State Of The Art

By Roberto De Ponti


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

Topics: Indian Pacing and Electrophysiology Journal
Publisher: Indian Pacing and Electrophysiology Group
Year: 2005
OAI identifier:

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles


  1. (2003). Catheter cryoablation of supraventricular arrhythmias: a painless alternative to radiofrequency energy. Pacing Clin Electrophysiol doi
  2. (2004). Catheter cryoablation of supraventricular tachycardia: results of the multicenter prospective “Frosty” trial. Heart Rhythm doi
  3. (2004). Catheter-based cryoablation permanently cures patients with common atrial flutter. Circulation
  4. (1985). Controlled cryothermal injury to the AV node: feasibility for AV nodal modification. Pacing Clin Electrophysiol doi
  5. (2004). Cryoablation of focal atrial tachycardia originating close to the atrioventricular node.
  6. (2004). Cryoablation treatment of atrial flutter: experience with a new 9 Fr 8 mm tip catheter.
  7. (2004). Cryoablation: potentials and pitfalls. doi
  8. (2004). Cryoenergy catheter ablation: a new technique for treatment of permanent junctional reciprocating tachycardia in children.
  9. (1987). Cryosurgical treatment of atrioventricular node reentrant tachycardia. Circulation
  10. (2000). Cryothermal ablation of the slow pathway for the elimination of atrioventricular nodal reentrant tachycardia. Circulation doi
  11. (1980). Cryothermal mapping and cryoablation in the treatment of refractory cardiac arrhythmias. Circulation
  12. (2002). Cryothermic ablation within the coronary sinus of an epicardial posterolateral pathway. doi
  13. (2003). Effect of heating on pulmonary veins: how to avoid pulmonary veins stenosis.
  14. (1994). Encircling endocardial cryoablation for ventricular tachycardia after myocardial infarction: experience with 33 patients.
  15. (1998). Endocardial and epicardial ablation guided by nonsurgical transthoracic epicardial mapping to treat recurrent ventricular tachycardia. doi
  16. (2004). Feasibility of catheter cryoablation in normal ventricular myocardium and healed myocardial infarction. Pacing Clin Electrophysiol doi
  17. (2004). Ice mapping during cryothermal ablation of accessory pathways in WPW: the role of the temperature time constant. Europace
  18. (2005). Indian Pacing and Electrophysiology
  19. (1998). Large encircling cryoablation without mapping for ventricular tachycardia after anterior myocardial infarction: long-term outcome. J Thorac Cardiovasc Surg
  20. (2003). Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation
  21. (1998). Mechanism of tissue injury by in cryosurgery. Cryobiology
  22. (2003). Percutaneous catheter cryothermal ablation of atrioventricular nodal reentrant tachycardia: efficacy and safety of a new ablation technique. Ital Heart J doi
  23. (2003). Pulmonary vein diameter reduction after radiofrequency catheter ablation for paroxysmal atrial fibrillation evaluated by contrast-enhanced three dimensional magnetic resonance imaging. Circulation
  24. (2003). Pulmonary vein isolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis. doi
  25. (2003). Pulmonary vein siolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis. doi
  26. (2003). Pulmonary veins stenosis by ostial irrigated tip ablation: incidence, time course, and prediction.
  27. (2003). Randomized study comparing radiofrequency ablation with cryoablation for the treatment of atrial flutter with emphasis on pain perception. Circulation
  28. (2004). Safety and feasibility of cryothermal ablation within the mid- and dsital coronary sinus. doi
  29. (1990). Surgery of tachyarrhythmia: intracardiac closed heart cryoablation. Pacing Clin Electrophysiol
  30. (1984). Surgical correction of the Wolff-Parkinson-White syndrome in the closed heart using cryosurgery: a simplified approach.
  31. (1993). Surgical treatment of Wolff-Parkinson-White syndrome: epicardial approach without the use of cardiopulmonary by-pass.
  32. (2003). Total pulmonary vein occlusion as a consequence of catheter ablation for atrial fibrillation mimicking primary lung disease.
  33. (1998). Transvenous cold mapping and cryoablation of the AV node in dogs: observations in chronic lesions and coparison to those obtained using radiofrequency ablation J Cardiovasc Electrophysiol doi