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Cryoablation versus radiofrequency ablation in AVNRT: same goal, different strategy

Atrioventricular nodal re-entry tachycardia (AVNRT) is the most common benign supraventricular tachycardia{Kastor, 1975 #14}. The underlying substrate for the arrhythmia was first proven by Denes et al. in 1973 as being the presence of dual atrioventricular (AV) pathways {Denes, 1973 #3}. Although present in about 20 to 30% of people, AV nodal duality only gives rise to symptomatic tachycardia in about 3% of this subgroup {McCanta,  #18}. Therapeutic options for symptomatic patients consist of both medical therapy and ablation. Several class I, II and IV anti-arrhythmic drugs are used to treat AVNRT. However, since the majority of patients suffering from AVNRT are in their second and third decade of life, a long-lasting drug therapy is not the most preferred option. Therefore radiofrequency (RF) ablation for AVNRT was introduced in 1982 by Gallagher et al {Gallagher, 1982 #7}. The initial target for ablation was the fast pathway {Langberg, 1989 #16}. This approach soon proved to have some deleterious side effects such as complete atrioventricular block in 10%-20% {Epstein, 1989 #6} and so the target for ablation was moved to the slow pathway in most patients.  Nowadays two options are available to ablate the slow pathway: focal cryoablation or RF ablation. Both techniques come with different advantages and disadvantages. This paper is dedicated to make a historical comparison between both techniques, evaluate results published in literature and comment on possible pitfalls in using cryo- and RF ablation.

Credits: Riahi Leila; Prisecaru Raluca; De Greef Yves; Stockman Dirk; Schwagten Bruno

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