Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome.

Abstract:

AIMS:To assess safety, feasibility and short term outcome of pulmonary vein (PV) isolation in paroxysmal atrial fibrillation (AF) with a cryoballoon. METHODS:We consecutively treated 57 patients with a double lumen 23 or 28 mm cryoballoon. The acute results, complications and follow-up over the first three months were analysed, using a comprehensive and intensive follow-up period. RESULTS:During 57 procedures, 185 of 220 targeted PV's were successfully isolated using the cryoballoon (84%) (balloon group, 33 patients). In 33 veins (15%) an additional segmental isolation (hybrid group, 24 patients) was necessary with a standard cryocatheter to achieve isolation. The average procedure times were respectively 211 +/- 108 and 261 +/- 83 minutes (NS), the average fluoroscopy times 52 +/- 36 and 66 +/- 33 minutes (NS). The number of balloon applications did not differ between both groups: respectively a median 9 (4-18) and 10 (5-17) (NS). We observed four phrenic nerve paralysis after ablation of the right superior PV: two resolved immediately after cessation of the cryoenergy, one recovered after 3 months, one persisted up to 6 months. A daily transtelephonic rhythm recording showed a significant drop in mean AF burden from 24% to 10%, 8% and 5% during the three consecutive months of follow-up (p < 0.01 versus baseline). No differences were observed between the treatment groups. 34 patients (60%) were completely free from AF after a single procedure. CONCLUSIONS:Balloon cryoablation of the pulmonary veins with additional segmental isolation if necessary, is a good approach for patients presenting with paroxysmal AF, showing a significant reduction in AF burden after a single procedure. The major complication seems to be phrenic nerve paralysis after ablation of the right superior PV, but this is potentially reversible over several months.

journal_name

Eur Heart J

journal_title

European heart journal

authors

Van Belle Y,Janse P,Rivero-Ayerza MJ,Thornton AS,Jessurun ER,Theuns D,Jordaens L

doi

10.1093/eurheartj/ehm227

subject

Has Abstract

pub_date

2007-09-01 00:00:00

pages

2231-7

issue

18

eissn

0195-668X

issn

1522-9645

pii

ehm227

journal_volume

28

pub_type

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