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The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study.

Chun KR, Schmidt B, Metzner A, Tilz R, Zerm T, Köster I, Fürnkranz A, Koektuerk B, Konstantinidou M, Antz M, Ouyang F, Kuck KH - Eur. Heart J. (2008)

Bottom Line: No PV stenosis occurred.Total median (Q(1); Q(3)) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).Using the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.

ABSTRACT

Aims: Cryothermal energy (CTE) ablation via a balloon catheter (Arctic Front, Cryocath) represents a novel technology for pulmonary vein isolation (PVI). However, balloon-based PVI approaches are associated with phrenic nerve palsy (PNP). We investigated whether 'single big cryoballoon'-deployed CTE lesions can (i) achieve acute electrical PVI without left atrium (LA) imaging and (ii) avoid PNP in patients with paroxysmal atrial fibrillation (PAF).

Methods and results: After double transseptal punctures, one Lasso catheter and a big 28 mm cryoballoon catheter using a steerable sheath were inserted into the LA. PV angiography and ostial Lasso recordings from all PVs were obtained. Selective PV angiography was used to evaluate balloon to LA-PV junction contact. CTE ablation lasted 300 s, and the PN was paced during freezing at right-sided PVs. Twenty-seven patients (19 males, mean age: 56 +/- 9 years, LA size: 42 +/- 5 mm) with PAF (mean duration: 6.6 +/- 5.7 years) were included. PVI was achieved in 97/99 PVs (98%). Median (Q(1); Q(3)) procedural, balloon, and fluoroscopy times were 220 min (190; 245), 130 min (90; 170), and 50 min (42; 69), respectively. Three transient PNP occurred after distal PV ablations. No PV stenosis occurred. Total median (Q(1); Q(3)) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).

Conclusion: Using the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.

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Related in: MedlinePlus

The crosstalk technique: (A) big balloon ablation after occlusion of the left superior pulmonary vein (PV); the Lasso catheter is placed in the left inferior PV. (B) Left inferior PV ablation after exchanging balloon and Lasso positions. (C) Left superior PV Lasso recordings demonstrate remaining LA–PV conduction (arrow: PV spike, dotted line: earliest activation LSPV 15/16 indicating inferior conduction gap) and subsequent elimination of PV spike. A, atrium; CS, coronary sinus catheter; V, ventricle; LA, left atrium; LAO, left anterior oblique; PV, pulmonary vein. *Far field atrium.
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EHN570F1: The crosstalk technique: (A) big balloon ablation after occlusion of the left superior pulmonary vein (PV); the Lasso catheter is placed in the left inferior PV. (B) Left inferior PV ablation after exchanging balloon and Lasso positions. (C) Left superior PV Lasso recordings demonstrate remaining LA–PV conduction (arrow: PV spike, dotted line: earliest activation LSPV 15/16 indicating inferior conduction gap) and subsequent elimination of PV spike. A, atrium; CS, coronary sinus catheter; V, ventricle; LA, left atrium; LAO, left anterior oblique; PV, pulmonary vein. *Far field atrium.

Mentions: For the left-sided PVs, cryoablation was first deployed at the left superior PV (LSPV) with a Lasso catheter located in the left inferior PV (LIPV). After angiographic evaluation of PV occlusion by the balloon, CTE was applied. Thereafter, the Lasso was placed in the LSPV to check whether the PV was isolated or not. In the case of a gap along the inferior aspect of the LSPV, the cryoballoon was placed at the LIPV. After angiographic verification of the balloon position at the ostium of the LIPV, CTE was delivered (Figure 1A–C). During CTE application to the LIPV, simultaneous PV recordings from the Lasso catheter in the LSPV were obtained to assess either LSPV spike sequence changes or LSPV isolation (Figure 1C). Because of the interaction between the two veins, this approach has been termed as crosstalk ablation technique. Subsequent Lasso recordings from the LIPV documented either simultaneous PVI or guided closure of remaining conduction gaps by further balloon applications.


The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study.

Chun KR, Schmidt B, Metzner A, Tilz R, Zerm T, Köster I, Fürnkranz A, Koektuerk B, Konstantinidou M, Antz M, Ouyang F, Kuck KH - Eur. Heart J. (2008)

The crosstalk technique: (A) big balloon ablation after occlusion of the left superior pulmonary vein (PV); the Lasso catheter is placed in the left inferior PV. (B) Left inferior PV ablation after exchanging balloon and Lasso positions. (C) Left superior PV Lasso recordings demonstrate remaining LA–PV conduction (arrow: PV spike, dotted line: earliest activation LSPV 15/16 indicating inferior conduction gap) and subsequent elimination of PV spike. A, atrium; CS, coronary sinus catheter; V, ventricle; LA, left atrium; LAO, left anterior oblique; PV, pulmonary vein. *Far field atrium.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2655313&req=5

EHN570F1: The crosstalk technique: (A) big balloon ablation after occlusion of the left superior pulmonary vein (PV); the Lasso catheter is placed in the left inferior PV. (B) Left inferior PV ablation after exchanging balloon and Lasso positions. (C) Left superior PV Lasso recordings demonstrate remaining LA–PV conduction (arrow: PV spike, dotted line: earliest activation LSPV 15/16 indicating inferior conduction gap) and subsequent elimination of PV spike. A, atrium; CS, coronary sinus catheter; V, ventricle; LA, left atrium; LAO, left anterior oblique; PV, pulmonary vein. *Far field atrium.
Mentions: For the left-sided PVs, cryoablation was first deployed at the left superior PV (LSPV) with a Lasso catheter located in the left inferior PV (LIPV). After angiographic evaluation of PV occlusion by the balloon, CTE was applied. Thereafter, the Lasso was placed in the LSPV to check whether the PV was isolated or not. In the case of a gap along the inferior aspect of the LSPV, the cryoballoon was placed at the LIPV. After angiographic verification of the balloon position at the ostium of the LIPV, CTE was delivered (Figure 1A–C). During CTE application to the LIPV, simultaneous PV recordings from the Lasso catheter in the LSPV were obtained to assess either LSPV spike sequence changes or LSPV isolation (Figure 1C). Because of the interaction between the two veins, this approach has been termed as crosstalk ablation technique. Subsequent Lasso recordings from the LIPV documented either simultaneous PVI or guided closure of remaining conduction gaps by further balloon applications.

Bottom Line: No PV stenosis occurred.Total median (Q(1); Q(3)) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).Using the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiology, Asklepios Klinik St Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany.

ABSTRACT

Aims: Cryothermal energy (CTE) ablation via a balloon catheter (Arctic Front, Cryocath) represents a novel technology for pulmonary vein isolation (PVI). However, balloon-based PVI approaches are associated with phrenic nerve palsy (PNP). We investigated whether 'single big cryoballoon'-deployed CTE lesions can (i) achieve acute electrical PVI without left atrium (LA) imaging and (ii) avoid PNP in patients with paroxysmal atrial fibrillation (PAF).

Methods and results: After double transseptal punctures, one Lasso catheter and a big 28 mm cryoballoon catheter using a steerable sheath were inserted into the LA. PV angiography and ostial Lasso recordings from all PVs were obtained. Selective PV angiography was used to evaluate balloon to LA-PV junction contact. CTE ablation lasted 300 s, and the PN was paced during freezing at right-sided PVs. Twenty-seven patients (19 males, mean age: 56 +/- 9 years, LA size: 42 +/- 5 mm) with PAF (mean duration: 6.6 +/- 5.7 years) were included. PVI was achieved in 97/99 PVs (98%). Median (Q(1); Q(3)) procedural, balloon, and fluoroscopy times were 220 min (190; 245), 130 min (90; 170), and 50 min (42; 69), respectively. Three transient PNP occurred after distal PV ablations. No PV stenosis occurred. Total median (Q(1); Q(3)) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).

Conclusion: Using the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.

Show MeSH
Related in: MedlinePlus