Cryoballoon Pulmonary Vein Isolation Guided by Transesophageal Echocardiography: Novel Aspects on an Emerging Ablation Technique

  1. CLAUDIA HERRERA SIKLÓDY M.D.1,
  2. JAN MINNERS M.D., Ph.D.3,
  3. MARTIN ALLGEIER M.D.2,
  4. HANS-JÜRGEN ALLGEIER M.D.2,
  5. NIKOLAUS JANDER M.D.2,
  6. REINHOLD WEBER M.D.1,
  7. JOCHEN SCHIEBELING-RÖMER M.D.1,
  8. FRANZ-JOSEF NEUMANN M.D.3,
  9. DIETRICH KALUSCHE M.D.1,
  10. THOMAS ARENTZ M.D.1

Article first published online: 26 JUN 2009

DOI: 10.1111/j.1540-8167.2009.01524.x

Issue

Journal of Cardiovascular Electrophysiology

Journal of Cardiovascular Electrophysiology

Volume 20, Issue 11, pages 1197–1202, November 2009

Additional Information

How to Cite

SIKLÓDY, C. H., MINNERS, J., ALLGEIER, M., ALLGEIER, H.-J., JANDER, N., WEBER, R., SCHIEBELING-RÖMER, J., NEUMANN, F.-J., KALUSCHE, D. and ARENTZ, T. (2009), Cryoballoon Pulmonary Vein Isolation Guided by Transesophageal Echocardiography: Novel Aspects on an Emerging Ablation Technique. Journal of Cardiovascular Electrophysiology, 20: 1197–1202. doi: 10.1111/j.1540-8167.2009.01524.x

Author Information

  1. 1

    Department of Electrophysiology

  2. 2

    Department of Echocardiography

  3. 3

    Department of Cardiology, Herz-Zentrum, Bad Krozingen, Germany

*Address for correspondence: Dr. Claudia Herrera Siklódy, M.D., Herz-Zentrum, Department of Electrophysiology, D 79189 Bad Krozingen, Germany. Fax: +49-7633-402-2429; E-mail: claudia.h.siklody@gmail.com

Publication History

  1. Issue published online: 30 OCT 2009
  2. Article first published online: 26 JUN 2009
  3. Manuscript received 11 March 2009; Revised manuscript received 28 April 2009; Accepted for publication 29 April 2009.

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Keywords:

  • atrial fibrillation;
  • cryoablation;
  • catheter ablation;
  • transesophageal echocardiography;
  • pulmonary vein

Background: Pulmonary vein (PV) isolation using a balloon-mounted cryoablation system is a new technology for the percutaneous treatment of atrial fibrillation (AF). Transesophageal echocardiography (TEE) allows real-time visualization of cryoballoon positioning and successful vein occlusion via color Doppler. We hypothesized that PV mechanical occlusion monitored with TEE could predict effective electrical isolation.

Methods: We studied 124 PVs in 30 patients. Under continuous TEE assessment, a cryoballoon was placed in the antrum of each PV aiming for complete PV occlusion as documented by color Doppler. At the end of the procedure, PV electrical isolation was evaluated using a circumferential mapping catheter.

Results: Of the 124 PVs studied, 123 (99.2%) could be visualized by TEE: the antrum was completely visualized in 80 of them (64.5%), partially in 36 (29.0%), and only disappearance of proximal flow could be observed in the remaining 7 PVs (5.7%). Vein occlusion could be achieved in 111 of the 123 (90.2%) visualized PVs. Postinterventional mapping demonstrated electrical isolation in 109 of 111 occluded PVs (positive predictive value 98.2%) and only in 1 of 12 nonoccluded PVs (negative predictive value 91.7%, P < 0.001). After a mean follow-up of 7.4 ± 3.7 months, 73.3% of patients remained in sinus rhythm without antiarrhythmic drugs.

Conclusion: Color Doppler documented PV occlusion during cryoballoon ablation can predict effective electrical isolation.

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