Cryoablation inside the pulmonary vein after failure of radiofrequency antral isolation.
BACKGROUND
Antral pulmonary vein (PV) ablation with radiofrequency (RF) energy has become widely used as a curative approach for the treatment of atrial fibrillation. In some patients, despite antral ablation, PV entry and exit conduction block (BDB) cannot be achieved with RF energy. Cryoablation inside the PV may be an effective method to achieve BDB.


OBJECTIVE
This study sought to describe a strategy of cryoablation within the PV to produce BDB in patients in whom antral RF ablation has failed.


METHODS
In 15 of 148 consecutive patients (57 +/- 8.9 years old, 80% male) with atrial fibrillation (14 paroxysmal, 1 chronic) undergoing PV isolation cryoablation (CryoCath Technologies, Inc., Montreal, Canada) was performed 12 +/- 2 mm inside the PV after RF antral isolation failed. Nine patients were undergoing a repeat PV isolation procedure. Procedural and follow-up data were recorded and collected.


RESULTS
In these 15 patients, BDB could not be achieved in 23 veins (12 left superior PV) with antral or ostial ablation alone. After cryoablation inside the vein, all patients had documented PV BDB and were in normal sinus rhythm at the end of the procedure. The average PV diameter before and after the procedure was unchanged (1.77 +/- 0.18 vs 1.74 +/- 0.19, P = .641). The average fluoroscopic and procedure times were 57 +/- 16 min and 5.3 + 1.2 hours, respectively. At 1-year follow-up, 75% of patients remained in sinus rhythm off antiarrhythmic medication; 7 of 9 patients undergoing a repeat procedure were in sinus rhythm at 1 year off antiarrhythmics. None of the patients had clinical evidence of PV stenosis after cryoablation.


CONCLUSIONS
Cryoablation inside the PV after failed antral isolation with RF is a safe and effective method to achieve acute BDB.
Virginia Commonwealth University Medical Center, Richmond, Virginia, USA.
David N
DN
Kenigsberg
Mark A
MA
Wood
Jamshid
J
Alaeddini
Kenneth A
KA
Ellenbogen
D000368:Aged; D001281:Atrial Fibrillation / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000379:methods*; D004108:Dilatation, Pathologic; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D017211:Treatment Failure