Cryothermal ablation: Mechanism of tissue injury and current experience in the treatment of tachyarrhythmias

Cryosurgery has been an integral part of the surgical management of cardiac arrhythmias since the late 1970s. With the recent development of intravenous cryocatheters, the use of cryothermy in the treatment of cardiac arrythmias will increase in the near future. The following discussion includes a detailed consideration of the mode of tissue injury associated with cryothermy and comprehensive review of cryosurgery in the management of a variety of cardiac arrhythmias. Cryosurgical management of supraventricular and ventricular tachycardias has proven to be both safe and effective. Cryothermal tissue injury is distinguished from hyperthermic injury by the preservation of basic underlying tissue architecture and minimal thrombus formation. Such differences will be particularly important in settings requiring extensive lesion formation, such as catheter-based maze procedures for the treatment of atrial fibrillation.