The role of cryosurgery in the management of cardiac arrhythmias

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Abstract
In the late 1970s, cryoablation of the AV node, accessory pathways, and ventricular tachycardia was first demonstrated and the technique was thought likely to assume an increasing importance in the surgical management of cardiac arrhythmias. However, more than 10 years later, cryotherapy is relatively sparingly used in these situations, and is at best an adjunctive means of therapy. The principal reason for this may lie in what was thought to be its major advantage: the fact that it is a highly selective, precise means of ablating myocardial tissue. Whereas electrophysiological mapping of tachycardia is able to identify apparently localized areas of arrhythmia substrate, relatively wide surgical destruction of myocardial tissue is frequently required to ensure successful tachycardia abolition: discrete, precise means of ablation are at a disadvantage. The future role for cryosurgery would seem to lie in those areas of arrhythmia management where selective ablation of substrate is essential. The ability of cryosurgery to modify (rather than simply ablate) AV nodal physiology in patients with AV nodal re-entrant tachycardia is such that it is likely to rival the recently reported catheter techniques for modification of the AV node.