Kr Julian Chun and Stefano Bordignon contributed equally to the manuscript.
Single Transseptal Big Cryoballoon Pulmonary Vein Isolation using an Inner Lumen Mapping Catheter
Article first published online: 6 AUG 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 35, Issue 11, pages 1304–1311, November 2012
How to Cite
CHUN, K. J., BORDIGNON, S., GUNAWARDENE, M., URBAN, V., KULIKOGLU, M., SCHULTE-HAHN, B., NOWAK, B. and SCHMIDT, B. (2012), Single Transseptal Big Cryoballoon Pulmonary Vein Isolation using an Inner Lumen Mapping Catheter. Pacing and Clinical Electrophysiology, 35: 1304–1311. doi: 10.1111/j.1540-8159.2012.03475.x
Conflicts of Interest: KRJC and BS have both received speaking honoraria from Medtronic and Cardiofocus.
- Issue published online: 7 NOV 2012
- Article first published online: 6 AUG 2012
- Received March 26, 2012; revised April 22, 2012; accepted May 19, 2012.
- catheter ablation ;
- atrial fibrillation ;
Background: The single big cryoballon technique for pulmonary vein isolation (PVI) has been limited by the need for two transseptal punctures (TP). We therefore investigated feasibility and safety of a simplified approach using a single TP and a novel circumferential mapping catheter (CMC).
Methods: Patients underwent 28-mm cryoballoon PVI using a single TP. The CMC (Achieve© Medtronic Inc., Minneapolis, MN, USA) served as (1) guidewire and (2) as a PV mapping tool. Primary endpoint was PVI without switching to a regular guidewire. Secondary endpoints included: (1) PV signal quality during freezing, (2) time to PVI, (3) classification of successful ablation technique, (4) complications, and (5) procedural data.
Results: A total of 32 patients (126 PVs) were studied (mean age: 62 ± 11 years, 24 males, left atrium: 40 ± 4 mm). The primary endpoint was achieved in 29/32 patients (91%) and 123/126 PVs (98%) with a procedure and fluoroscopy time of 126 ± 26 minutes and 18.9 ± 7.5 minutes, respectively. Real-time visualization of PVI could be observed in 61/126 (48%) PVs. Time to sustained PVI versus nonsustained PVI was 66 ± 56 seconds versus 129 ± 76 seconds (P < 0.001). One phrenic nerve palsy was observed. After a follow-up of 250 ± 84 days 23/32 patients (72%) remained in sinus rhythm.
Conclusion: The “simplified single big cryoballoon” PVI strategy appears to be safe and feasible. However, real-time PV recording was achieved in <50% of PVs. Therefore, further catheter refinements are warranted. (PACE 2012; 35:1304–1311)