Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome.
OBJECTIVE
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.
Van Belle
Yves
Y
Clinical Electrophysiology Unit, Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Dr Molewaterplein 40, Room BD416, 3015 GD Rotterdam, The Netherlands. y.vanbelle@erasmusmc.nl
Janse
Petter
P
Rivero-Ayerza
Maximo J
MJ
Thornton
Andrew S
AS
Jessurun
Emile R
ER
Theuns
Dominic
D
Jordaens
Luc
L
D001281:Atrial Fibrillation / Q000473:pathology / Q000601:surgery*; D021721:Balloon Occlusion / Q000295:instrumentation*; D003452:Cryosurgery / Q000295:instrumentation*; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome