Document Detail


Characterization of conduction recovery after pulmonary vein isolation using the "single big cryoballoon" technique.
MedLine Citation:
PMID:  20129295     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary vein isolation using the cryoballoon technique (CB-PVI) has evolved into a simple and safe alternative for point-by-point radiofrequency ablation. Systematic analysis of conduction recovery occurring after CB-PVI and causing recurrent atrial fibrillation has not yet been performed. OBJECTIVE: The purpose of this study was to analyze conduction recovery after PVI using the single big (28-mm) cryoballoon technique. METHODS: Twenty-six patients with recurrent atrial tachyarrhythmia after previous CB-PVI underwent repeat ablation. Pulmonary vein (PV) reisolation was performed by antral irrigated radiofrequency ablation using electroanatomic mapping. For analysis of the location of conduction gaps, the ipsilateral LA-PV junction was divided into six equally distributed segments. RESULTS: PV reconduction frequently occurred into multiple (>2) PVs (54% patients). Conduction gaps could be abolished by single point ablation in 63% (lateral) and 41% (septal) of patients or by incomplete circular lesions in the remaining patients. A significantly higher number of patients exhibited conduction recovery at inferior segments (85% lateral, 77% septal) compared with superior segments (42% lateral, 31% septal). Furthermore, the ridge between PV ostia and left atrial appendage (LAA) was highly associated with reconduction into lateral PVs (81% of patients). Retrospective analysis of the initial CB-PVI-procedure revealed lower freezing temperatures at superior than inferior PVs as well as sharp catheter angulations with loss of central cryoballoon alignment to reach inferior PVs. CONCLUSION: Conduction recovery after CB-PVI occurs at a high incidence at inferior sites around ipsilateral PV ostia and the LAA-PV ridge. Modifications of the technique to ensure optimal balloon-tissue contact at predilection sites may improve long-term success rates.
Authors:
Alexander F?rnkranz; K R Julian Chun; Dieter Nuyens; Andreas Metzner; Ilka K?ster; Boris Schmidt; Feifan Ouyang; Karl-Heinz Kuck
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Publication Detail:
Type:  Journal Article     Date:  2009-11-10
Journal Detail:
Title:  Heart rhythm : the official journal of the Heart Rhythm Society     Volume:  7     ISSN:  1556-3871     ISO Abbreviation:  Heart Rhythm     Publication Date:  2010  
Date Detail:
Created Date:  2010-02-04     Completed Date:  2010-05-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101200317     Medline TA:  Heart Rhythm     Country:  United States    
Other Details:
Languages:  eng     Pagination:  184-90     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. a.fuernkranz@gmail.com
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Balloon / methods*
Atrial Fibrillation / physiopathology,  radiography,  surgery*
Catheter Ablation / methods*
Coronary Angiography
Cryosurgery / methods*
Electrocardiography
Electrophysiologic Techniques, Cardiac
Female
Humans
Male
Middle Aged
Pulmonary Veins / physiopathology,  surgery*
Recurrence
Reoperation
Treatment Outcome
Comments/Corrections
Comment In:
Heart Rhythm. 2010;7(2):191-2   [PMID:  20129296 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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