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Balloon Occlusion Of The Distal Coronary Sinus Facilitates Mitral Isthmus Ablation.
MedLine Citation:
PMID:  21315835     Owner:  NLM     Status:  Publisher    
BACKGROUND: Mitral Isthmus ablation is challenging. Blood flow in the coronary sinus (CS) may act as a "heat sink" and reduce the efficacy of radiofrequency ablation. OBJECTIVE: This study investigates if balloon occlusion of CS facilitates mitral isthmus ablation. METHODS: This single-centre, prospective, randomized controlled trial included patients undergoing ablation for atrial fibrillation. After circumferential pulmonary vein isolation and roof line ablation, mitral isthmus ablation was performed during left atrial appendage pacing using an irrigated ablation catheter (Endocardium: max power: 40/50W, max temp: 48°C; CS: max power: 25/30W, max temp: 48°C). An air-filled 40 × 10 mm percutaneous transluminal angioplasty balloon (Opta®Pro, Cordis) was used to occlude the CS on the epicardial aspect of the ablation line. Left coronary and CS angiography were performed pre- and post-procedure. RESULTS: Forty six patients were studied. The balloon was successfully positioned in the distal CS in 20/23 patients (87%). Mitral isthmus block was achieved in 41/46 patients (91%). According to "intention-to-treat" analysis, there was significant reduction in the need for epicardial CS ablation (48% vs 83%, p=0.01) in the CS occlusion group but no difference in acute success rate. Secondary analysis showed reduction in mean total ablation time (9.4±.5.5 vs 13.3±4.6 min, p<0.02) and mean CS ablation time (1.5±2.8 vs 3.4±2.7 min, p<0.05) in patients who had CS occlusion. CONCLUSION: Balloon occlusion of the CS during mitral isthmus ablation is feasible and safe. It significantly reduces ablation time and the need for CS ablation to achieve mitral isthmus block. The results support the hypothesis that "heat-sink" is one of the obstacles to successful mitral isthmus ablation.
Kelvin C K Wong; Michael Jones; Norman Qureshi; Praveen P Sadarmin; Joe De Bono; Kim Rajappan; Yaver Bashir; Timothy R Betts
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-2-9
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  -     ISSN:  1556-3871     ISO Abbreviation:  -     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-2-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011. Published by Elsevier Inc.
Oxford Heart Centre, John Radcliffe Hospital, Oxford, United Kingdom.
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