Document Detail

The anatomic impact of sequential, additional, ostial radiofrequency ablation following pulmonary vein cryo-isolation.
MedLine Citation:
PMID:  23020755     Owner:  NLM     Status:  MEDLINE    
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.
Sarah Traullé; Shinsuke Miyazaki; Vincent Mouquet; Maciej Kubala; Jean-Sylvain Hermida
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Publication Detail:
Type:  Journal Article     Date:  2012-09-28
Journal Detail:
Title:  Pacing and clinical electrophysiology : PACE     Volume:  35     ISSN:  1540-8159     ISO Abbreviation:  Pacing Clin Electrophysiol     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-12-11     Completed Date:  2013-05-27     Revised Date:  2013-11-07    
Medline Journal Info:
Nlm Unique ID:  7803944     Medline TA:  Pacing Clin Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1420-7     Citation Subset:  IM    
Copyright Information:
©2012, The Authors. Journal compilation ©2012 Wiley Periodicals, Inc.
Amiens-Picardie University Medical Center and Picardie Jules Verne University, Amiens, France.
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MeSH Terms
Anticoagulants / therapeutic use
Atrial Fibrillation / physiopathology,  radiography,  surgery*
Catheter Ablation / methods*
Contrast Media / diagnostic use
Imaging, Three-Dimensional
Middle Aged
Postoperative Complications / diagnosis
Pulmonary Veins / physiopathology,  radiography,  surgery*
Pulmonary Veno-Occlusive Disease / diagnosis
Statistics, Nonparametric
Tomography, X-Ray Computed
Treatment Outcome
Reg. No./Substance:
0/Anticoagulants; 0/Contrast Media

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