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Offering patients a higher safety profile and less discomfort than radio-frequency ablation, catheter cryoablation is a safe, effective and efficient alternative for clinicians treating atrial fibrillation and other arrhythmias. In The Practice of Catheter Cryoablation for Cardiac Arrhythmias, cardiac electrophysiologists, cardiologists and cardiology fellows will be able to gain an in-depth update in this rapidly advancing field. Those who wish to offer their patients this treatment option will learn how to master various procedural techniques related to catheter cryoablation. Edited by the pioneer of cryoablation therapy in Asia, with chapters written by expert cardiac electrophysiologists from centers in Asia, Europe and the US who have extensive experience using cryoablation to treat patients, this new book: * Provides comprehensive, clinically-focused guidance on all applications of catheter cryoablation for the treatment of arrhythmias * Focuses on catheter-based techniques that can be performed in the EP laboratory * Reflects global best practices form centers with extensive experience in cryoablation techniques * Covers the use of catheter cryoablation in both adult and pediatric arrhythmias To further enhance reader's understanding of the emergent techniques covered in the text, the book's companion website features video clips of live cryoablation procedures, plus case-based self-assessment questions for selected chapters.
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Seitenzahl: 313
Veröffentlichungsjahr: 2013
Table of Contents
Dedication
Title page
Copyright page
List of Contributors
Preface
Acknowledgments
About the Companion Website
CHAPTER 1: Biophysical Principles and Properties of Cryoablation
Background
Thermodynamics of the cryoablation system
Mechanisms of injury
Lesion characteristics
Factors affecting cryoablation efficacy
Conclusion
CHAPTER 2: Catheter Cryoablation for Pediatric Arrhythmias
Introduction
Cryoablation in immature myocardium – animal studies
Transcatheter cryoablation technique for the treatment of tachyarrhythmias in pediatrics
Outcomes of cryoablation in pediatrics
Cryoablation for other substrates
Cryoablation in congenital heart disease
Practice trends in pediatric cryoablation
CHAPTER 3: Atrioventricular Nodal Reentrant Tachycardia: What Have We Learned from Radiofrequency Catheter Ablation?
Introduction
Basis of catheter ablation for AVNRT
Techniques of radiofrequency catheter ablation
Safety and efficacy of RFCA
Lessons learned from RFCA
Conclusion
Acknowledgements
CHAPTER 4: Catheter Cryoablation for Atrioventricular Nodal Reentrant Tachycardia
Atrioventricular block after radiofrequency catheter ablation for atrioventricular nodal reentrant tachycardia
Is cryoablation free of the complication of permanent inadvertent AVB in the treatment of AVNRT?
Other advantages of using cryoablation to treat AVNRT
Recurrence rates: The Achilles' Heel of cryoablation in treating AVNRT
Procedural techniques of cryoablation for AVNRT
Strategies to decrease the recurrence rate after cryoablation for AVNRT
Conclusions
CHAPTER 5: Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation
Introduction
Function of the Arctic Front cryoballoon
Ablation of the pulmonary vein antrum – technique
Significance of measuring the proximal balloon temperature
Factors determining lesion size and homogeneity
Confirming adequate balloon occlusion
Impact of pulmonary vein anatomy
Impact of balloon characteristics
Imaging
Special isolation techniques
Confirming isolation
Monitoring pulmonary vein signals
Risk of phrenic nerve palsy
Other adverse events
Anticoagulation
Results of cryoballoon ablation
Outlook and future development
Acknowledgments
CHAPTER 6: Prevention of Phrenic Nerve Palsy during Cryoballoon Ablation for Atrial Fibrillation
Introduction
Anatomy
Mechanisms of phrenic nerve injury
Pacing the phrenic nerve
Monitoring of the phrenic nerve function
Recommendations
See it, hear it, feel it, and measure it
What to do when phrenic nerve injury occurs
Summary
CHAPTER 7: Linear Isthmus Ablation for Atrial Flutter: Catheter Cryoablation versus Radiofrequency Catheter Ablation
Introduction
Atrial flutter terminology
Pathophysiologic mechanisms of AFL
Electrocardiogram diagnosis of AFL
Mapping of AFL
Radiofrequency catheter ablation of AFL
Procedure endpoints for ablation of AFL
Outcomes of radiofrequency catheter ablation of typical AFL
Cryocatheter ablation of typical AFL
Summary
CHAPTER 8: Catheter Cryoablation for the Treatment of Accessory Pathways
Performance of RFCA of APs
Uncommon complications of RFCA for APs
Potential advantages of using cryoablation instead of RFCA in the treatment of APs
Procedural techniques of cryoablation for accessory pathways
Performance of catheter cryoablation of APs
Conclusions
CHAPTER 9: Catheter Cryoablation for the Treatment of Ventricular Arrhythmias
Introduction
History of cryoablation
Cryoablation technology
Conclusions
CHAPTER 10: Catheter Cryoablation for the Treatment of Miscellaneous Arrhythmias
Electrophysiological characteristics and anatomical locations of focal atrial tachycardia
Efficacy and safety of radiofrequency catheter ablation of FAT
Catheter cryoablation treatment for “high-risk” FAT
Radiofrequency and cryothermal ablation for inappropriate sinus tachycardia
Radiofrequency and cryothermal ablation for atrioventricular nodal ablation in atrial fibrillation
Conclusions
Index
To my wife, Lillian, and my little daughter, Nam Nam, for bringing me a new page of life.
– NY
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Library of Congress Cataloging-in-Publication Data
The practice of catheter cryoablation for cardiac arrhythmias / edited by Ngai-Yin Chan.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-118-45183-0 (cloth : alk. paper) – ISBN 978-1-118-45179-3 – ISBN 978-1-118-45180-9 (Mobi) – ISBN 978-1-118-45181-6 (Pdf) – ISBN 978-1-118-45182-3 (ePub) – ISBN 978-1-118-75776-5 – ISBN 978-1-118-75777-2
I. Chan, Ngai-Yin, editor of compilation.
[DNLM: 1. Arrhythmias, Cardiac–surgery. 2. Catheter Ablation–methods. 3. Cryosurgery–methods. WG 330]
RC685.A65
616.1'28–dc23
2013017939
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books.
Cover image: courtesy of the editor
Cover design by Rob Sawkins for Opta Design Ltd.
List of Contributors
Amin Al-Ahmad, MD
Division of Cardiovascular Medicine
Stanford University School of Medicine
Palo Alto, CA
USA
David J. Burkhardt, MD
Texas Cardiac Arrhythmia Institute
St. David's Medical Center
Austin, TX
USA
Ngai-Yin Chan, MBBS, FRCP, FACC, FHRS
Department of Medicine and Geriatrics
Princess Margaret Hospital
Hong Kong
China
Kathryn K. Collins, MD
University of Colorado and
Children's Hospital Colorado
Aurora, CO
USA
Luigi Di Biase, MD, PhD, FHRS
Texas Cardiac Arrhythmia Institute
St. David's Medical Center;
Department of Biomedical Engineering
University of Texas
Austin, TX
USA;
Department of Cardiology
University of Foggia
Foggia
Italy;
Albert Einstein College of Medicine
Montefiore Hospital
New York, NY
USA
Gregory K. Feld, MD
Clinical Cardiac Electrophysiology Program
Division of Cardiology
University of California, San Diego
San Diego, CA;
Sulpizio Family Cardiovascular Center
La Jolla, CA
USA
Jo Jo Hai, MBBS
Cardiology Division
Department of Medicine
Queen Mary Hospital
The University of Hong Kong
Hong Kong
China
Henry H. Hsia, MD
Division of Cardiovascular Medicine
Stanford University School of Medicine
Palo Alto, CA
USA
Marcin Kowalski, MD, FHRS
Department of Clinical Cardiac Electrophysiology
Staten Island University Hospital
Staten Island, NY
USA
Michael R. Lauer, MD
Permanente Medical Group
Cardiac Electrophysiology Laboratory
Kaiser-Permanente Medical Center
San Jose, CA
USA
Andrea Natale, MD, FACC, FHRS
Texas Cardiac Arrhythmia Institute
St. David's Medical Center;
Department of Biomedical Engineering
University of Texas
Austin, TX;
Division of Cardiovascular Medicine
Stanford University School of Medicine
Palo Alto, CA;
Sutter Pacific Medical Center
San Francisco, CA
USA
Pasquale Santangeli, MD
Texas Cardiac Arrhythmia Institute
St. David's Medical Center
Austin, TX
USA;
Department of Cardiology
University of Foggia
Foggia
Italy;
Division of Cardiovascular Medicine
Stanford University School of Medicine
Palo Alto, CA
USA
Navinder Sawhney, MD
Cardiac Electrophysiology Program
Division of Cardiology
University of California, San Diego
San Diego, CA;
Sulpizio Family Cardiovascular Center
La Jolla, CA
USA
Ruey J. Sung, MD
Division of Cardiovascular Medicine (Emeritus)
Stanford University School of Medicine
Stanford, CA
USA
Hung-Fat Tse, MD, PhD
Cardiology Division
Department of Medicine
Queen Mary Hospital
The University of Hong Kong
Hong Kong
China
George F. Van Hare, MD
Division of Pediatric Cardiology
Washington University School of Medicine and
St. Louis Children's Hospital
St. Louis, MO
USA
Jürgen Vogt, MD
Department of Cardiology
Heart and Diabetes Center North Rhine-Westphalia
Ruhr University Bochum
Bad Oeynhausen
Germany
Xue Yan
Department of Biomedical Engineering
Texas Cardiac Arrhythmia Institute
St. David's Medical Center;
University of Texas
Austin, TX
USA
Charlie Young, MD
Permanente Medical Group
Cardiac Electrophysiology Laboratory
Kaiser-Permanente Medical Center
San Jose, CA
USA
Preface
I was trained to use radiofrequency as the energy source in the ablation of various cardiac arrhythmias more than 20 years ago. This time-honored energy source has been shown to perform well in terms of both efficacy and safety profile. It was not until I encountered my first complication of inadvertent permanent atrioventricular block, in a young patient who underwent catheter ablation for atrioventricular nodal reentrant tachycardia, that I recognized we might need an even better source of energy.
Certainly, catheter cryoablation is not a substitute for radiofrequency ablation. However, in many of the arrhythmic substrates (notably the perinodal area, Koch's triangle, pulmonary vein, coronary sinus, cavotricuspid isthmus, etc.), cryothermy may be considered as the energy source of choice. Unfortunately, there has been a shortage of educational materials in this area. This work thus represents the first book dedicated to the science and practice of catheter cryoablation.
The Practice of Catheter Cryoablation for Cardiac Arrhythmias is purposefully written and organized to update the knowledge base in catheter cryoablation, with the emphasis on “how to perform.” We compare cryothermy with radiofrequency energy source in different arrhythmic substrates, and we have also supplemented the textual content with a companion website (www.chancryoablation.com) providing interactive cases and real case videos for selected chapters.
I am sure that this book can benefit all those who are interested in better understanding this relatively new technology and the science behind it. More importantly, this book will serve as an indispensable reference for those who would like to adopt catheter cryoablation in treating patients with different cardiac arrhythmias.
Ngai-Yin Chan, MBBS, FRCP, FACC, FHRS
Acknowledgments
This book is the product of the collective effort of many dedicated people. I would like to thank all the contributing authors, who are all prominent leaders in the field of catheter cryoablation and have found time out of their busy schedules to write the various chapters of the book. I also thank my great colleagues Stephen Choy and Johnny Yuen, who were excellent assistants during my cryoablation procedures. Stephen Cheung, an expert radiologist and a good friend of mine, has to be acknowledged for his contribution of the beautiful reconstructed cardiac CT image that is used on the book cover. Lastly, I have to thank Adam Wang and Perry Tang for their technical support in the preparation of the live cryoablation procedures videos for the companion website.
About the Companion Website
This book is accompanied by a companion website:
www.chancryoablation.com
The website includes:
Interactive Case Studies to accompany Chapters 2, 4, 5, 6, 7, 8 and 10Video clips to illustrate various cryoablation proceduresCHAPTER 1
Biophysical Principles and Properties of Cryoablation
Jo Jo Hai and Hung-Fat Tse
Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
More than 4000 years have passed since the first documented medical use of cooling therapy, when the ancient Egyptian Edwin Smith Papyrus described applying cold compresses made up of figs, honey, and grease to battlefield injuries.1 Not until 1947 did Hass and Taylor first describe the creation of myocardial lesions using cold energy generated by carbon dioxide as a refrigerant.2 In contrast to the destructive nature of heat energy, which produces diffuse areas of hemorrhage and necrosis with thrombus formation and aneurysmal dilation, cryoablation involves a unique biophysical process that gives it the distinctive safety and efficacy profile.3 Cryoablation induces cellular damage mainly via disruption of membranous organelles, such that destruction to the gross myocardial architectures is reduced. Furthermore, cryomapping is feasible as lesions created at a less cool temperature (>−30 °C) are reversible. These potential advantages nurtured the extensive clinical applications of cryoablation in the treatment of cardiac arrhythmias, such as atrioventricular nodal reentrant tachycardia, septal accessory pathways, atrial fibrillation, and ventricular tachycardia, where a high degree of precision is desirable.
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