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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

Phrenic nerve lesion: (A) baseline angiography of right superior pulmonary vein (RSPV) in right anterior oblique. (B) Ostial balloon position at the start of the freeze. (C) Unanticipated cryoballoon ablation inside the RSPV. CS, coronary sinus catheter; PN stim, phrenic nerve stimulation; RAO, right anterior oblique; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein.
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EHN570F5: Phrenic nerve lesion: (A) baseline angiography of right superior pulmonary vein (RSPV) in right anterior oblique. (B) Ostial balloon position at the start of the freeze. (C) Unanticipated cryoballoon ablation inside the RSPV. CS, coronary sinus catheter; PN stim, phrenic nerve stimulation; RAO, right anterior oblique; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein.

Mentions: Complications as a secondary endpoint occurred in 3/27 patients (11%). Despite continuous right-sided PN stimulation during ablation of the septal PVs, one PNP occurred after an unanticipated freeze in a distal position inside the RSPV: during freezing, the balloon pressure decreased, which lead to a more distal balloon position (patient # 16, PV size: 18.2 mm) (Figure 5). Two additional PN lesions occurred: one during freezing from the RSPV (Patient 18, PV size: 26.0 mm) and the other from the RIPV (Patient 24, PV size: 26.0 mm). The ratio of PV size (26 mm) to balloon size (28 mm) with PN damage was 0.93. CTE application was immediately terminated if PN capture was lost (Patient 16, duration: 120 s; Patient 18, duration: 223 s; Patient 24, duration: 59 s). The PN function recovered in Patient 24 during the procedure after 3 min (freeze at RIPV). In the remaining patients, the PNP persisted until the end of the procedure. No further complications including PV stenosis were observed.


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)

Phrenic nerve lesion: (A) baseline angiography of right superior pulmonary vein (RSPV) in right anterior oblique. (B) Ostial balloon position at the start of the freeze. (C) Unanticipated cryoballoon ablation inside the RSPV. CS, coronary sinus catheter; PN stim, phrenic nerve stimulation; RAO, right anterior oblique; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein.
© Copyright Policy
Related In: Results  -  Collection

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

EHN570F5: Phrenic nerve lesion: (A) baseline angiography of right superior pulmonary vein (RSPV) in right anterior oblique. (B) Ostial balloon position at the start of the freeze. (C) Unanticipated cryoballoon ablation inside the RSPV. CS, coronary sinus catheter; PN stim, phrenic nerve stimulation; RAO, right anterior oblique; RSPV, right superior pulmonary vein; RIPV, right inferior pulmonary vein.
Mentions: Complications as a secondary endpoint occurred in 3/27 patients (11%). Despite continuous right-sided PN stimulation during ablation of the septal PVs, one PNP occurred after an unanticipated freeze in a distal position inside the RSPV: during freezing, the balloon pressure decreased, which lead to a more distal balloon position (patient # 16, PV size: 18.2 mm) (Figure 5). Two additional PN lesions occurred: one during freezing from the RSPV (Patient 18, PV size: 26.0 mm) and the other from the RIPV (Patient 24, PV size: 26.0 mm). The ratio of PV size (26 mm) to balloon size (28 mm) with PN damage was 0.93. CTE application was immediately terminated if PN capture was lost (Patient 16, duration: 120 s; Patient 18, duration: 223 s; Patient 24, duration: 59 s). The PN function recovered in Patient 24 during the procedure after 3 min (freeze at RIPV). In the remaining patients, the PNP persisted until the end of the procedure. No further complications including PV stenosis were observed.

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