DGK Herztage 2025. Clin Res Cardiol (2025). https://doi.org/10.1007/s00392-025-02737-x
1RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie/Rhythmologie Bad Neustadt a. d. Saale, Deutschland; 2RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Kardiologie II / Interventionelle Elektrophysiologie Bad Neustadt a. d. Saale, Deutschland; 3RHÖN-KLINIKUM AG Campus Bad Neustadt Radiologie Bad Neustadt a. d. Saale, Deutschland; 4RHÖN-KLINIKUM AG Campus Bad Neustadt Klinik für Rhythmologie und Interventionelle Elektrophysiologie Bad Neustadt a. d. Saale, Deutschland
Introduction
Successful long term catheter ablation of recurrent ventricular arrhythmias in patients with complex scar remains a challenge despite increasing effectiveness of ablation technologies.
Purpose
The aim of this study was to investigate the acute and midterm success of ultra low temperature cryoablation (ULTC) as emerging catheter ablation technology in patients with ventricular arrhythmias after failed RF and/or complex substrate.
Methods
Consecutive patients were enrolled in this study after at least one failed endocardial RF ablation for VT or PVC focused on patients with documented complex substrate defined as extensive transmural respectively intramural and epicardial scar. Pre-procedurally, in all patients cardiac MRI/CT with late enhancement sequencies was performed for identification of scar localization and extension. The primary end point was the acute success - defined as elimination of clinical PVC and non-inducibility for clinical VT. Midterm success was defined as PVC burden < 10 %/ 24h holter monitoring and a VT free survival at least 3 months after ablation. Secondary end point was the safety profile of ULTC.
Results
A total number of 11 patients (mean age 63.9 ± 9.5 y/o; 9 men; mean LVEF 37.9 % ± 7.7 %; 9 with NICM) were enrolled. Four patients had PVCs (group 1, mean PVC burden 30% ± 5.2%) and 7 patients sustained recurrent VTs (group 2). Excepting one patient in group 1, all others had documented complex scar. Total procedure duration was 167 ± 25 min (145 min ± 20 min in group 1 respectively 180 ± 20 min group 2). A mean number of 15±3 freezing cycles were applied (freezing time 34 ±8 min). An acute success of 100 % was achieved in group 1 respectively 71 % in group 2. The midterm success was 75 % in group 1 respectively 57 % in group 2. No procedure related complications were recorded.
Conclusion
ULTC is an effective ablation technology of PVCs in patients with failed endocardial RF ablation and complex scar. ULTC has also a good acute success rate for VT, however the midterm results remain comparable to conventional RF ablation in patients with complex scar and failed RF ablation. ULTC has an excellent safety profile.