Objectives: Radiofrequency (RF) ablation near the AV node carries a significant risk of AV block. We report our initial experience of using cryomapping function to aid the safe cryoablation close to the compact atrioventricular (AV) node.
Methods: Five consecutive patients with para-Hisian accessory pathways (AP) ( n = 2), or focal atrial tachycardia (AT) originating near the AV node ( n = 3) underwent cryoablation using a 7F 4 mm-tipped catheter. At each prospective ablation site, cryo-mapping (-30 degrees C) which causes transient electrical dysfunction was performed, and in the absence of AH interval prolongation, a full cryoablation (<or=-70 degrees C) was applied to the same site.
Results: The AT foci, left in 2 patients and right in 1, and the APs were located 1.9 +/- 3.0 mm and 4.5 +/- 8.1 mm from the catheter recording the His deflection in two orthogonal radiographic projections. A His signal (0.18 +/- 0.07 mV) was recorded at the site of successful cryoablation in both patients with AP and 1 with right AT. There was no change in AV nodal function during/after ablation. At each successful cryoablation site, interruption of target pathway/focus function was observed during cryo-mapping after 19.8 +/- 12.4 s. Full cryoablation at sites where cryo-mapping had not caused an effect did not then produce any further electrophysiologic effect. All pathways and foci were ablated successfully without complications, using 3.2 +/- 3.9 cryothermic applications alone in 4 patients, and after a supplementary RF ablation in 1. All patients remained free of arrhythmia at 15 +/- 8 months follow-up.
Conclusion: Cryomapping may help identify sites for safe and effective ablation of pathways and foci located near the AV node.