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Evaluation of cryoballoon pulmonary vein isolation lesions during the acute and chronic phases using a high-resolution mapping system

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Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Background

An acute cryothermal ablation lesion contains both reversible and irreversible elements. However, differences in lesions created with cryoballoon pulmonary vein isolation (PVI) between the acute and chronic phases have not been fully elucidated.

Methods

We retrospectively analyzed 23 consecutive patients with atrial fibrillation who underwent cryoballoon PVI during the initial procedure followed by a second ablation procedure. In all patients, cryoballoon PVI lesions were evaluated with high-resolution voltage mapping just after PVI (acute phase) and during the second session (chronic phase). We compared the area and width of the non-isolated left atrial posterior wall (NI-LAPW) with voltage ≥ 0.5 mV during both sessions.

Results

PVI was successfully achieved in all patients. Cryoballoon PVI lesions were re-evaluated at 11 [2–17] months post-procedure. During the chronic phase, NI-LAPW width became significantly larger at the level of the roof (change, 5.8 ± 5.5 mm; p < 0.001) and at the level of the carina (change, 3.3 ± 7.0 mm; p < 0.05), and NI-LAPW area became significantly larger (change, 1.5 ± 1.9 cm2; p < 0.001) compared with the acute phase. Eight patients without any PV reconnections also had larger NI-LAPW areas (change, 1.3 ± 1.2 cm2; p < 0.05) during the chronic phase. Conduction resumption confined to the right carina was observed in 1 (4.3%) patient who presented with circumferential PVI that included the carina during the first session.

Conclusion

Acute cryoballoon PVI lesions significantly regressed during the chronic phase. PV reconnections and the isolation area should be carefully re-evaluated during the second procedure.

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Acknowledgements

We greatly appreciate our hospital’s clinical engineers.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan

    Takayuki Sekihara, Shinsuke Miyazaki, Daisetsu Aoyama, Moeko Nagao, Toshihiko Tsuji, Shota Kakehashi, Moe Mukai, Tomoya Eguchi, Kanae Hasegawa, Hiroyasu Uzui & Hiroshi Tada

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  1. Takayuki Sekihara
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  2. Shinsuke Miyazaki
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  3. Daisetsu Aoyama
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  4. Moeko Nagao
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  6. Shota Kakehashi
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  7. Moe Mukai
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  8. Tomoya Eguchi
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  10. Hiroyasu Uzui
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  11. Hiroshi Tada
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Corresponding author

Correspondence to Takayuki Sekihara.

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Ethics approval

The study protocol was approved by the hospital’s institutional review board (approval number 20180040). The study complied with the Declaration of Helsinki.

Conflict of interest

Dr. Miyazaki belonged to a department endowed by Medtronic, Boston, Abbott, and Japan Lifeline.

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Sekihara, T., Miyazaki, S., Aoyama, D. et al. Evaluation of cryoballoon pulmonary vein isolation lesions during the acute and chronic phases using a high-resolution mapping system. J Interv Card Electrophysiol 65, 123–131 (2022). https://doi.org/10.1007/s10840-022-01225-w

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  • DOI: https://doi.org/10.1007/s10840-022-01225-w

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