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Objectives: Cryoablation (CRYO) is an alternative to radiofrequency (RF) for catheter ablation of cavotricuspid isthmus (CTI)-dependent atrial flutter (AFL). We aimed to study whether different CTI morphologies had different impacts on procedural success for CRYO and RF.Design: This study randomized 153 patients with CTI-dependent AFL (median age 65 years; range 34-82) to RF or CRYO (78 CRYO; 75 RF). Biplane angiography (RAO 30° and LAO 60°) was done before the ablation procedure and isthmuses were classified as straight (n = 81), concave (n = 43) or pouch-like (n = 29). RF was performed with a 3.5-mm open-irrigated tip catheter and CRYO was performed with a 9 F, 8-mm tip catheter. The ablation endpoint was bidirectional block of CTI.Results: Acute procedural success was achieved in 70/75 patients in the RF group and in 72/78 patients in the CRYO group. With regard to CRYO or RF, acute procedural success rates were similar between the three isthmus types: straight: CRYO (92%) and RF (96%); concave: CRYO (92%) and RF (94%); and pouch-like: CRYO (94%) and RF (85%). There were no significant differences regarding success rate between the different morphologies in the CRYO or the RF group. The CTI was longer in patients with acute failure compared to the patients with acute success (38 ± 7 mm versus 33 ± 6 mm, p = 0.045).Conclusion: The CTI morphology did not influence the acute success rate for either the CRYO or the RF ablation of CTI-dependent AFL. A longer CTI was associated with a lower success rate regardless of energy source. [ABSTRACT FROM AUTHOR]

Aim. Pulmonary vein isolation (PVI) is an established method for treatment of drug refractory atrial fibrillation. The aim of this study was to evaluate whether a more active regular supply of analgesic and sedative drugs reduces pain and discomfort. We also wanted to evaluate gender differences in pain perception and to compare standard radiofrequency (RF) with cryo balloon ablation (Cryo) from this perspective. Methods. A total of 80 patients, 40 men, median age 58 (range 23-76) years, who underwent PVI under conscious sedation were studied. They were randomized to either standard treatment with morphine and diazepam (control group, C) or to a more active analgesic strategy (A) with pre-medication with oral midazolam mixture and intravenous alfentanil and midazolam regularly administrated during the procedure. Forty patients were treated with RF and 40 with Cryo. Results. The majority of the patients experienced pain during the procedure. The maximal pain assessed with numerical rating scale (NRS), was lower in the active group compared with that in controls ( p = 0.02). Women experienced more pain than men ( p = 0.01). RF was more painful than Cryo ( p < 0.001). Conclusion. An active regular supply of analgesic and sedative drugs reduce pain and discomfort during PVI. Women experience more pain than men during this procedure and PVI performed with Cryo is less painful than with RF. [ABSTRACT FROM AUTHOR]

Objectives. In the context of catheter ablation of atrial fibrillation, oral anticoagulant therapy has been traditionally replaced by bridging with heparin during the periprocedural period. We wanted to study the feasibility and safety of continuous warfarin therapy compared to traditional bridging therapy. Design. The complication rates were compared retrospectively in a consecutive patient series. In the bridging group, warfarin was discontinued three days and low molecular weight heparin started one day prior to the procedure. Warfarin was reinitiated one day after and low molecular weight heparin was continued until the therapeutic INR target was reached. Patients on continuous therapy received warfarin throughout the periprocedural period. All patients received unfractionated heparin during the procedure. Results. Three thromboembolic cerebrovascular events (1.9%) occurred in the bridging group (n = 157) and seven (0.82%) in the warfarin group (n = 850) (p = 0.142). The number of cardiac tamponades was one (0.64%) and four (0.47%), respectively (p = 0.786). Total number of severe bleeding and thromboembolic complications was more common in the bridging group: 9 (5.7%) versus 22 (2.6%); p = 0.036. In multivariate analysis, female gender, advanced age, and bridging therapy predicted complications. Conclusions. Continuous oral anticoagulant therapy is a safe and feasible alternative for bridging therapy in patients undergoing catheter ablation of atrial fibrillation. [ABSTRACT FROM AUTHOR]