Both authors contributed equally to this manuscript.
Cryoballoon Pulmonary Vein Isolation with Real-Time Recordings from the Pulmonary Veins
Article first published online: 13 JUL 2009
© 2009 Wiley Periodicals, Inc.
Journal of Cardiovascular Electrophysiology
Volume 20, Issue 11, pages 1203–1210, November 2009
How to Cite
CHUN, K. R. J., FÜRNKRANZ, A., METZNER, A., SCHMIDT, B., TILZ, R., ZERM, T., KÖSTER, I., NUYENS, D., WISSNER, E., OUYANG, F. and KUCK, K. H. (2009), Cryoballoon Pulmonary Vein Isolation with Real-Time Recordings from the Pulmonary Veins. Journal of Cardiovascular Electrophysiology, 20: 1203–1210. doi: 10.1111/j.1540-8167.2009.01549.x
Dr. Kuck reports serving as consultant for European Advisory Board Cryocath, Montreal, Canada. Dr. Chun reports honoraria relevant to this topic.
- Issue published online: 30 OCT 2009
- Article first published online: 13 JUL 2009
- Manuscript received 25 March 2009; Revised manuscript received 21 April 2009; Accepted for publication 6 May 2009.
- atrial fibrillation;
- pulmonary vein isolation;
- catheter ablation;
Introduction: Cryoballoon (CB) ablation represents a novel technology for pulmonary vein isolation (PVI). We investigated feasibility and safety of CB-PVI, utilizing a novel spiral catheter (SC), thereby obtaining real-time PV potential registration.
Methods: Following double transseptal puncture, a Lasso catheter (Biosense Webster, Diamond Bar, CA, USA) and the 28 mm CB were positioned within the left atrium. A novel SC (Promap, ProRhythm Inc., Ronkonkoma, NY, USA) was inserted through the lumen of the CB allowing PV signal registration during treatment. Time to PV conduction block was analyzed. If no stable balloon position was obtained, the SC was exchanged for a regular guide wire and PV conduction was assessed after treatment by Lasso catheter.
Results: In 18 patients, 39 of 72 PVs (54%) were successfully isolated using the SC. The remaining 33 PVs were isolated switching to the regular guide wire. Time to PV conduction block was significantly shorter in PVs in which sustained PVI was achieved as compared to PVs in which PV conduction recovered within 30 minutes (33 ± 21 seconds vs 99 ± 65 seconds). In 40 PVs, time to PV conduction block was not obtained because of: (1) PVI not being achieved during initial treatment; (2) a distal position of the SC; or (3) isolation with regular guide wire. No procedural complications occurred.
Conclusion: Visualization of real-time PV conduction during CB PVI is safe, feasible, and allows accurate timing of PVI onset in a subset of PVs. Time to PV conduction block predicts sustained PVI. However, mechanical properties of the SC need to be improved to further simplify CB PVI.