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Pulmonary vein electrophysiology during cryoballoon ablation as a predictor for procedural success

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Abstract

Background

Cryoballoon technique is an innovative alternative to radiofrequency ablation for atrial fibrillation (AF). However, with current cryoballoon application techniques, the operator has no access to electrical information for 300 s during the freezing cycle.

Objective

The objective of this study is to investigate the novel approach of real-time monitoring of pulmonary vein (PV) potentials throughout freezing using a circular mapping catheter introduced into the central lumen of the cryoballoon catheter.

Methods

Patients had paroxysmal or persistent AF. Standard balloon catheters (23 or 28 mm diameter, 10.5 F shaft) were used. A coaxial mapping catheter (shaft diameter 0.9 mm; 15 mm loop with six electrodes) was advanced through the lumen of the cryoballoon catheter, replacing the guide wire. The primary procedural end point was successful PV isolation and real-time PV potential recording. Secondary end points were procedural data, complications, and the time to successful PV isolation.

Results

In 141 consecutively enrolled patients, balloon positioning and ablation were successful in 439/568 veins (77%). Real-time recording of PV conduction during the freeze cycle was possible in 235/568 PVs (41%). Main reasons for failure to obtain real-time PV recordings were a distal position of the circular mapping catheter or insufficient catheter-vessel wall contact during ablation. A cutoff value of 83 s to PV isolation was predictive of stable procedural PV isolation without reconduction. One minor hemoptysis was observed possibly related to the mapping catheter.

Conclusions

This study, the largest to date, showed that real-time monitoring of PV conduction during cryoballoon freezing can be safely performed with a circular mapping catheter. A cutoff time of 83 s to PV isolation was predictive of sustained procedural PV isolation success without reconduction.

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Abbreviations

PV:

Pulmonary vein

PVI:

PV isolation

ROC:

Receiver-operated curve

rPNP:

Right phrenic nerve palsy

References

  1. Reddy, V. Y., Neuzil, P., d’Avila, A., et al. (2008). Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation? Heart Rhythm, 5(3), 353–360.

    Article  PubMed  Google Scholar 

  2. Sarabanda, A. V., Bunch, T. J., Johnson, S. B., et al. (2005). Efficacy and safety of circumferential pulmonary vein isolation using a novel cryothermal balloon ablation system. Journal of the American College of Cardiology, 46, 1902–1912.

    Article  PubMed  Google Scholar 

  3. Khairy, P., Chauvet, P., Lehmann, J., et al. (2003). Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation, 107, 2045–2050.

    Article  PubMed  Google Scholar 

  4. Wong, T., Markides, V., Peters, N. S., & Davies, D. W. (2004). Percutaneous pulmonary vein cryoablation to treat atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 11, 117–126.

    Article  PubMed  Google Scholar 

  5. Packer, D. L., Keelan, P., Munger, T. M., et al. (2005). Clinical presentation, investigation, and management of pulmonary vein stenosis complicating ablation for atrial fibrillation. Circulation, 111, 546–554.

    Article  PubMed  Google Scholar 

  6. Chun, K. R., Fürnkranz, A., Metzner, A., et al. (2009). Cryoballoon pulmonary vein isolation with real-time recordings from the pulmonary veins. Journal of Cardiovascular Electrophysiology, 20, 1203–1210.

    Article  PubMed  Google Scholar 

  7. Tang, M., Kriatselis, C., Nedios, S., et al. (2010). A novel cryoballoon technique for mapping and isolating pulmonary veins: a feasibility and efficacy study. Journal of Cardiovascular Electrophysiology, 21, 626–631.

    Article  PubMed  Google Scholar 

  8. Schmidt, B., Chun, K. R. J., Metzner, A., et al. (2009). Pulmonary vein isolation with high-intensity focused ultrasound: results from the HIFU 12F study. Europace, 11, 1281–1288.

    Article  PubMed  Google Scholar 

  9. Neumann, T., Vogt, J., Schumacher, B., et al. (2008). Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. Journal of the American College of Cardiology, 52, 273–278.

    Article  PubMed  Google Scholar 

  10. Twidale, N., Wang, X. Z., Beckman, K. J., et al. (1991). Factors associated with recurrence of accessory pathway conduction after radiofrequency catheter ablation. Pacing and Clinical Electrophysiology, 14, 2042–2048.

    Article  PubMed  CAS  Google Scholar 

  11. Natale, A., Pisano, E., Shewchik, J., et al. (2000). First human experience with pulmonary vein isolation using a through-the-balloon circumferential ultrasound ablation system for recurrent atrial fibrillation. Circulation, 102, 1879–1982.

    PubMed  CAS  Google Scholar 

  12. Sacher, F., Monahan, K. H., Thomas, S. R., et al. (2006). Phrenic nerve injury after atrial fibrillation catheter ablation. Characterization and outcome in a multicenter study. Journal of the American College of Cardiology, 47, 2498–2503.

    Article  PubMed  Google Scholar 

  13. Schmidt, B., Antz, M., Ernst, S., et al. (2007). Pulmonary vein isolation by high-intensity focused ultrasound: first-in-man study with a steerable balloon catheter. Heart Rhythm, 4, 575–584.

    Article  PubMed  Google Scholar 

  14. Van Belle, Y., Janse, P., Rivero-Ayerza, M. J., et al. (2007). Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome. European Heart Journal, 28, 2231–2237.

    Article  PubMed  Google Scholar 

  15. Koller, M. L., & Schumacher, B. (2009). Cryoballoon ablation of paroxysmal atrial fibrillation: bigger is better and simpler is better. European Heart Journal, 30, 636–637.

    Article  PubMed  Google Scholar 

  16. Chun, K. R., Schmidt, B., Metzner, A., et al. (2009). The ‘single big cryoballoon’ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. European Heart Journal, 30, 699–709.

    Article  PubMed  Google Scholar 

  17. Malmborg, H., Lonnerholm, S., & Blomstrom-Lundqvist, C. (2008). Acute and clinical effects of cryoballoon pulmonary vein isolation in patients with symptomatic paroxysmal and persistent atrial fibrillation. Europace, 10, 1277–1280.

    Article  PubMed  Google Scholar 

  18. Ahmed, H., Neuzil, P., Skoda, J., et al. (2010). The permanency of pulmonary vein isolation using a balloon cryoablation catheter. Journal of Cardiovascular Electrophysiology, 21, 731–737.

    PubMed  Google Scholar 

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Conflicts of interest

The authors have received speaker honoraria from Medtronic and Biotronik.

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Authors and Affiliations

  1. Department of Cardiology an Intensive Care Medicine, Heart Center Munich-Bogenhausen, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany

    Uwe Dorwarth, Martin Schmidt, Michael Wankerl, Juergen Krieg, Florian Straube & Ellen Hoffmann

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  1. Uwe Dorwarth
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  2. Martin Schmidt
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  3. Michael Wankerl
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  4. Juergen Krieg
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  5. Florian Straube
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  6. Ellen Hoffmann
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Correspondence to Uwe Dorwarth.

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Dorwarth, U., Schmidt, M., Wankerl, M. et al. Pulmonary vein electrophysiology during cryoballoon ablation as a predictor for procedural success. J Interv Card Electrophysiol 32, 205–211 (2011). https://doi.org/10.1007/s10840-011-9585-x

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  • DOI: https://doi.org/10.1007/s10840-011-9585-x

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