The incidence of Wolff-Parkinson-White syndrome oscillates between 0.6 and 4.5/1,000 people. Radiofrequency is the most commonly used energy source for the treatment of cardiac arrhythmias with optimal results. Despite its high sucess rate, radiofrequency energy may sometimes present limitations, especially in case of ablation of anteroseptal and midseptal accessory pathways due to the possibility of causing an inadvertent atrioventricular block which requires a permanent pacemaker. In that particular situation, a good outcome and a low rate of complications can be achieved through the implementation of special techniques. Cryoablation shows some comparative advantages, among them, the main advantage of cryothermal technology is that the creation of a permanent lesion can be preceded by test applications (cryomapping) causing only a reversible loss of the functional properties of the tissue, this allows timely discontinuation of the application as soon as signs of possible initial damage to the normal conduction pathway are observed. Another advantage consists of the fact that cooling causes tight adherence of the catheter tip to the adjacent tissue. Hence, cryoablation can be safely continued even when sudden changes in heart rhythm, that usually displace the ablation catheter, occur; and on the other hand, these applications do not cause pain, which proves to be useful in young patients. In this review, both technologies presented are applied to the anteroseptal and midseptal accessory pathways with its comparative advantages and limitations. Nowadays, both energy sources are available and we consider that ablation of these accessory pathways can be carried out with good results and low rate complications in experienced centres.
Ablación por radiofrecuencia o crioablación transcatéter en pacientes con vías accesorias ántero y medioseptales. Cuál es la técnica más segura y eficaz?
DE PONTI, ROBERTO;SALERNO URIARTE, JORGE ANTONIO
2012-01-01
Abstract
The incidence of Wolff-Parkinson-White syndrome oscillates between 0.6 and 4.5/1,000 people. Radiofrequency is the most commonly used energy source for the treatment of cardiac arrhythmias with optimal results. Despite its high sucess rate, radiofrequency energy may sometimes present limitations, especially in case of ablation of anteroseptal and midseptal accessory pathways due to the possibility of causing an inadvertent atrioventricular block which requires a permanent pacemaker. In that particular situation, a good outcome and a low rate of complications can be achieved through the implementation of special techniques. Cryoablation shows some comparative advantages, among them, the main advantage of cryothermal technology is that the creation of a permanent lesion can be preceded by test applications (cryomapping) causing only a reversible loss of the functional properties of the tissue, this allows timely discontinuation of the application as soon as signs of possible initial damage to the normal conduction pathway are observed. Another advantage consists of the fact that cooling causes tight adherence of the catheter tip to the adjacent tissue. Hence, cryoablation can be safely continued even when sudden changes in heart rhythm, that usually displace the ablation catheter, occur; and on the other hand, these applications do not cause pain, which proves to be useful in young patients. In this review, both technologies presented are applied to the anteroseptal and midseptal accessory pathways with its comparative advantages and limitations. Nowadays, both energy sources are available and we consider that ablation of these accessory pathways can be carried out with good results and low rate complications in experienced centres.
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