Successful treatment of anteroseptal accessory pathways by transvenous cryomapping and cryoablation

Radiofrequency is the most commonly used energy source for the treatment of cardiac arrhythmias. Despite its high success rate, radiofrequency energy may sometimes present limitations, especially in case of anteroseptal atrioventricular accessory pathways. In these patients, inadvertent atrioventricular block may occur during or after the procedure and a high recurrence rate of conduction over the accessory pathway is observed. Since the late 1970s, cryosurgery has been an integral part of the management of cardiac arrhythmias, and recently, animal and clinical studies demonstrated the feasibility and safety of applying percutaneous catheter cryoablation technology. These studies also showed that reversible cryomapping of high-risk arrhythmogenic sites can be performed before creating permanent lesions. In this preliminary report, we describe the successful use of percutaneous cryoablation for the permanent interruption of conduction over anteroseptal accessory pathways.