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Improved real-time recordings using the fourth-generation cryoballoon technology—detection of dual fascicle electrograms

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

We aimed to analyze the rate of visualization of real-time (RT) recordings and dual fascicle electrograms in our first series of patients treated with the fourth-generation cryoballoon (CB) device.

Methods

All consecutive patients who underwent CB ablation using the fourth-generation technology were included in the analysis. In all procedures, we used a 28-mm CB placed via a single transseptal puncture guided by intracardiac ultrasound. A 20-mm octapolar intraluminal circular catheter was used for intracardiac recordings. A single 180-s freeze strategy was employed.

Results

A total of 129 patients (72.9% male, mean age 60.1 ± 10.9 years) were enrolled in the study. RT recordings were detected in 445 (86.2%) pulmonary veins (PVs). Specifically, RT recordings were visualized in 115 left superior PVs (89.2%), 107 left inferior PVs (82.9%), 118 right superior PVs (91.4%), and 105 right inferior PVs (81.3%). Dual fascicle electrograms could be observed only in patients in sinus rhythm, in 23 of 396 PVs (5.8%). They were most commonly observed in the left superior PV (8.1%), somewhat less in both inferior veins (6.1%), while this phenomenon was least frequent in the right superior PV (3.0%).

Conclusions

By using the fourth-generation CB, we report a specific pattern of isolation represented by a sequential isolation of two apparently distinct PV fascicles during a single CB freeze delivery. This phenomenon occurred in 5.8% of PV ablations. Of note, the rate of visualization of RT isolation with this novel CB was very high and could be documented in 86.2% of PVs.

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Authors and Affiliations

  1. Department of Cardiovascular Diseases, University of Zagreb School of Medicine, University Hospital Centre Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia

    Vedran Velagic, Vedran Pasara, Ivan Prepolec, Mislav Puljevic, Borka Pezo-Nikolic, Davor Puljević, Jure Samardzic, Maja Cikes & Davor Milicic

  2. Electrophysiology and Cardiac Pacing Unit, Division of Cardiology, West Vicenza General Hospitals, Vicenza, Italy

    Giacomo Mugnai

Authors
  1. Vedran Velagic
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  2. Giacomo Mugnai
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  3. Vedran Pasara
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  4. Ivan Prepolec
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  5. Mislav Puljevic
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  6. Borka Pezo-Nikolic
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  7. Davor Puljević
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  8. Jure Samardzic
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  9. Maja Cikes
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  10. Davor Milicic
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Contributions

VV and GM were responsible for conception of the study and drafting of the manuscript. VP, IP, BPN, and MP were responsible for acquisition and analysis of the data. JS, MC, DP, and DM were responsible for critical revision of the manuscript and important intellectual content.

Corresponding author

Correspondence to Vedran Velagic.

Ethics declarations

All patients underwent de novo pulmonary vein isolation procedures and provided written informed consent for the ablation. The research was conducted in accordance with the principles of the Declaration of Helsinki.

Conflict of interest

VV received educational grants by St Jude Medical and travel grants and lecture fees from Medtronic and Biosense-Webster. MC received lecture fees from Medtronic. MP and BPN received educational and travel grants from Medtronic and Biosense-Webster.

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Velagic, V., Mugnai, G., Pasara, V. et al. Improved real-time recordings using the fourth-generation cryoballoon technology—detection of dual fascicle electrograms. J Interv Card Electrophysiol 61, 261–268 (2021). https://doi.org/10.1007/s10840-020-00809-8

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  • DOI: https://doi.org/10.1007/s10840-020-00809-8

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