Document Detail

Right ventricular rapid pacing in catheter ablation of atrial fibrillation: a novel application for cryoballoon pulmonary vein isolation.
MedLine Citation:
PMID:  19513775     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Cryoballoon ablation (Arctic Front, Cryocath) represents a novel technology for pulmonary vein isolation (PVI). The initial phase of a freeze is crucial for cryolesion formation which is determined by local temperature depending on blood flow. We investigated the impact of right ventricular rapid pacing (RVRP) on temperature kinetics in patients (pts) with paroxysmal atrial fibrillation (PAF). METHODS AND RESULTS: Right ventricular rapid pacing was performed from the RV apex. Absolute minimal temperature (MT, degrees C), temperature slopes [time (s) to 80% MT; dT/dt), area under the curve (AUC) and arterial blood pressure (ABP, mmHg) were compared (group I: with RVRP vs. group II: without RVRP). RVRP (mean duration 55 +/- 7 s) was performed in 11 consecutive PAF pts (41 PVs, age 58 +/- 9 years, LA size 44 +/- 6 mm, normal ejection fraction). Only freezes with identical balloon positions were analyzed (11/41 PVs). RVRP (cycle length 333 +/- 3 ms) induced a significant drop in ABP (group I: 45 +/- 3 mmHg vs. group II: 100 +/- 18 mmHg, p < 0.001). MT was not different between group I and group II (-45.0 +/- 4.4 vs. -44.3 +/- 3.4 degrees C, p = 0.46), whereas slope (38.0 +/- 4.6 s vs. 51.6 +/- 14.4 s, p = 0.0034) and AUC (1090 +/- 4.6 vs. 1181 +/- 111.2, p = 0.02) was significantly changed. In one pt, a ventricular tachycardia was induced. PVI was achieved in 41/41 PVs. CONCLUSION: Right ventricular rapid pacing significantly accelerates cryoballoon cooling during the initial phase of a freeze possibly suggesting improved cryolesions.
K R Julian Chun; Alexander Fürnkranz; Boris Schmidt; Andreas Metzner; Roland Tilz; Thomas Zerm; Ilka Köster; Buelent Koektuerk; Melanie Konstantinidou; Feifan Ouyang; Karl Heinz Kuck
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2009-06-10
Journal Detail:
Title:  Clinical research in cardiology : official journal of the German Cardiac Society     Volume:  98     ISSN:  1861-0692     ISO Abbreviation:  -     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-07-30     Completed Date:  2009-10-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101264123     Medline TA:  Clin Res Cardiol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  493-500     Citation Subset:  IM    
Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany.
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MeSH Terms
Atrial Fibrillation / diagnosis,  physiopathology*,  therapy*
Balloon Dilatation / methods*
Cardiac Pacing, Artificial
Combined Modality Therapy
Cryosurgery / methods*
Heart Conduction System / physiopathology,  surgery*
Heart Rate
Heart Ventricles / physiopathology*
Middle Aged
Pulmonary Veins / physiopathology,  surgery*
Treatment Outcome

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