Limits...
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.

Show MeSH

Related in: MedlinePlus

The big loop technique: (A) right inferior pulmonary vein (RIPV) with a large inferior gap (arrows) lacking an early PV branch. (B) The sheath is directed towards the lateral posterior left atrium, allowing the guide wire to be advanced until the distal part of the RIPV is reached. The balloon is placed over the wire at the RIPV ostium. (C) Schematic drawing of the big loop technique. CS, coronary sinus catheter; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; *Dislodged multipolar catheter. **Repositioned multipolar catheter for phrenic nerve stimulation.
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC2655313&req=5

EHN570F4: The big loop technique: (A) right inferior pulmonary vein (RIPV) with a large inferior gap (arrows) lacking an early PV branch. (B) The sheath is directed towards the lateral posterior left atrium, allowing the guide wire to be advanced until the distal part of the RIPV is reached. The balloon is placed over the wire at the RIPV ostium. (C) Schematic drawing of the big loop technique. CS, coronary sinus catheter; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; *Dislodged multipolar catheter. **Repositioned multipolar catheter for phrenic nerve stimulation.

Mentions: This technique was used in a case with an inferior RIPV ostium, when an early branch required for the hockey stick technique was lacking and the pull-down technique could not be used because of a larger inferior gap (>1 cm) (Figure 4A). To reach the PV ostium with the balloon, the sheath was bent and directed towards the lateral posterior LA, allowing the guide wire to be advanced along the posterior mitral annulus until the distal part of the RIPV was reached. Then, the sheath was further advanced to guide the balloon over the wire into the RIPV ostium (Figure 4B).


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 big loop technique: (A) right inferior pulmonary vein (RIPV) with a large inferior gap (arrows) lacking an early PV branch. (B) The sheath is directed towards the lateral posterior left atrium, allowing the guide wire to be advanced until the distal part of the RIPV is reached. The balloon is placed over the wire at the RIPV ostium. (C) Schematic drawing of the big loop technique. CS, coronary sinus catheter; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; *Dislodged multipolar catheter. **Repositioned multipolar catheter for phrenic nerve stimulation.
© Copyright Policy
Related In: Results  -  Collection

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

EHN570F4: The big loop technique: (A) right inferior pulmonary vein (RIPV) with a large inferior gap (arrows) lacking an early PV branch. (B) The sheath is directed towards the lateral posterior left atrium, allowing the guide wire to be advanced until the distal part of the RIPV is reached. The balloon is placed over the wire at the RIPV ostium. (C) Schematic drawing of the big loop technique. CS, coronary sinus catheter; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; RAO, right anterior oblique; RIPV, right inferior pulmonary vein; RSPV, right superior pulmonary vein; *Dislodged multipolar catheter. **Repositioned multipolar catheter for phrenic nerve stimulation.
Mentions: This technique was used in a case with an inferior RIPV ostium, when an early branch required for the hockey stick technique was lacking and the pull-down technique could not be used because of a larger inferior gap (>1 cm) (Figure 4A). To reach the PV ostium with the balloon, the sheath was bent and directed towards the lateral posterior LA, allowing the guide wire to be advanced along the posterior mitral annulus until the distal part of the RIPV was reached. Then, the sheath was further advanced to guide the balloon over the wire into the RIPV ostium (Figure 4B).

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