Conflicts of interest and disclosures: None.
The Anatomic Impact of Sequential, Additional, Ostial Radiofrequency Ablation Following Pulmonary Vein Cryo-Isolation
Article first published online: 28 SEP 2012
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Pacing and Clinical Electrophysiology
Volume 35, Issue 12, pages 1420–1427, December 2012
How to Cite
TRAULLÉ, S., MIYAZAKI, S., MOUQUET, V., KUBALA, M. and HERMIDA, J.-S. (2012), The Anatomic Impact of Sequential, Additional, Ostial Radiofrequency Ablation Following Pulmonary Vein Cryo-Isolation. Pacing and Clinical Electrophysiology, 35: 1420–1427. doi: 10.1111/j.1540-8159.2012.03521.x
- Issue published online: 7 DEC 2012
- Article first published online: 28 SEP 2012
- Received September 19, 2011; revised June 18, 2012; accepted June 18, 2012.
- atrial fibrillation;
- pulmonary vein isolation;
Background : Although pulmonary vein (PV) stenosis is a serious complication of radiofrequency PV isolation, the anatomical impact of a combination of two energy sources on PV diameter has not been evaluated. The aim of this study was to evaluate the impact of supplementary point-by-point radiofrequency applications (following PV cryoablation) on the PV orifice diameter.
Methods : Forty-nine patients having undergone PV isolation for drug-refractory atrial fibrillation were included. All had undergone cardiac computed tomography before ablation and again at least 3 months afterwards. When isolation with the cryoballoon was not complete, a conventional irrigated-tip radiofrequency catheter was used for point-by-point applications.
Results : Of the 189 target PVs, 117 were isolated with cryotherapy alone (cryo PVs) and 72 required additional radiofrequency (hybrid PVs). The second scan (performed an average of 11.4 ± 5.4 months after) showed a decrease in diameter for all the hybrid PVs (17.2 ± 2.6 to 16.3 ± 3.4 mm; P = 0.037) but no change for the cryo PVs. This change was associated with a decrease in left superior pulmonary vein (LSPV) diameter (19.2 ± 3.0 to 17.8 ± 4.9 mm, P = 0.014). There were no changes in other veins. A subgroup analysis for the LSPV revealed a decrease for the hybrid PVs (18.8 ± 3.6 to 15.9 ± 7.1 mm, P = 0.046) but not for the cryo PVs. Significant PV stenosis was observed in three hybrid PVs (two severe stenosis of the LSPV and one moderate stenosis of the right inferior pulmonary vein) but not in cryo PVs (4.1% vs 0%, respectively; P = 0.023).
Conclusions : Cryoballoon ablation of the PV with adjunct, focal, irrigated ostial RF applications may be associated with a higher risk of PV stenosis. (PACE 2012;35:1420–1427)