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Efficacy and safety of cryoablation of para-Hisian and mid-septal accessory pathways using a specific protocol: single-center experience in consecutive patients

Journal of Interventional Cardiac Electrophysiology
Jacopo Marazzato, Giuseppe Fonte, Raffaella Marazzi, Lorenzo A. Doni, Gianfranco Mitacchione, Manola Vilotta, Roberto De Ponti



Radiofrequency (RF) catheter ablation of para-Hisian (P-H) and mid-septal (M-S) accessory pathways (APs) is a potentially harmful procedure due to their close location to the A-V node. Conversely, cryoablation (CA) appears safer in this setting. The aim of this study was to assess the efficacy and safety of CA of these APs using a specific protocol.


Fifty-three patients undergoing CA for P-H (45) or M-S (8) APs were included. CA was performed with a 4-mm catheter at − 75 °C for 480 s in the site where conduction block over the AP was obtained by a specific cryomapping protocol. Optimal catheter-tissue contact was achieved by inferior or superior vena cava approach. In case of failure, a 6-mm catheter and/or trans-septal catheterization (TSC) were considered. Normal AV conduction was monitored throughout CA, which was interrupted in case of its inadvertent modifications.


In 46 patients (87%), CA was successful. Reasons for failure were as follows: lack of AP interruption (3 patients), intraprocedure AP conduction resumption (3), or transient A-H interval prolongation (1). Failure was associated with more aggressive approach including multiple procedures, greater use of 6-mm catheters, TSC, and longer CA applications. No major complications were observed. Three out of 46 patients (6.5%) experienced relapse of AP conduction during follow-up and were successfully re-treated by CA.


CA of P-H and M-S APs is highly safe and effective and a specific protocol for cryomapping and CA could lead to a low recurrence rate at follow-up.

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