Thromboembolic risk of the hot- and cold-catheter ablation for atrial fibrillation

Abstract

In the last decade, catheter ablation procedures aimed at the electrical isolation of arrhythmogenic pulmonary veins (PVs) and/or modification of left atrial substrate have evolved as an important therapeutic option for patients with atrial fibrillation (AF). 1 Lip G.Y. Tse H.F. Management of atrial fibrillation. Lancet. 2007; 370: 604-618 Abstract Full Text Full Text PDF PubMed Scopus (186) Google Scholar , 2 Camm A.J. Kirchhof P. Lip G.Y. et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J. 2010; 31: 2369-2429 Crossref PubMed Scopus (4116) Google Scholar While conceptually attractive and technical feasible with promising clinical efficacy, these catheter ablation procedures, mainly with radiofrequency energy, are limited by the risk of major complications, including PV stenosis, atrioesophageal fistula, and thromboembolism. 3 Cappato R. Calkins H. Chen S.A. et al. Prevalence and causes of fatal outcome in catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2009; 53: 1798-1803 Abstract Full Text Full Text PDF PubMed Scopus (469) Google Scholar , 4 Cappato R. Calkins H. Chen S.A. et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010; 3: 32-38 Crossref PubMed Scopus (1536) Google Scholar Tissue heating with radiofrequency energy can potentially lead to endocardial disruption, charring, PV stenosis, platelet activation, and thrombus formation. As a result, other alternative energy sources such as cryoablation, microwave, and laser 5 Tse H.F. Reek S. Timmermans C. et al. Pulmonary vein isolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis. J Am Coll Cardiol. 2003; 42: 752-758 Abstract Full Text Full Text PDF PubMed Scopus (181) Google Scholar , 6 Yiu K.H. Siu C.W. Lau C.P. et al. Transvenous catheter-based microwave ablation for atrial flutter. Heart Rhythm. 2007; 4: 221-223 Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar have been developed with the aim to reduce these complications. Among these alternative energy sources, cryoablation appears to have the best safety profile. Prior experimental studies have demonstrated that cryoablation creates minimal endocardial disruption with the reservation of underlying tissue architecture, reduce platelet and clotting activation, 7 Khairy P. Chauvet P. Lehmann J. et al. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation. 2003; 107: 2045-2050 Crossref PubMed Scopus (420) Google Scholar and is associated with a lower risk of thrombus formation 8 van Oeveren W. Crijns H.J. Korteling B.J. et al. Blood damage, platelet and clotting activation during application of radiofrequency or cryoablation catheters: a comparative in vitro study. J Med Eng Technol. 1999; 23: 20-25 Crossref PubMed Scopus (38) Google Scholar as well as atrioesophageal fistula 9 Ripley K.L. Gage A.A. Olsen D.B. et al. Time course of esophageal lesions after catheter ablation with cryothermal and radiofrequency ablation: implication for atrio-esophageal fistula formation after catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2007; 18: 642-646 Crossref PubMed Scopus (80) Google Scholar compared with radiofrequency energy. Cellular damage, platelet activation, and inflammatory response after pulmonary vein isolation: A randomized study comparing radiofrequency ablation with cryoablationHeart RhythmVol. 9Issue 2PreviewExperimental data suggest that use of cryoablation in pulmonary vein isolation (PVI) is associated with less cell damage and less thrombus formation compared to radiofrequency (RF) energy. Full-Text PDF