Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation?
BACKGROUND
Unlike the initial balloon ablation catheters that were designed to deliver ablation lesions within the pulmonary veins (PVs), the current balloon prototypes are fashioned to deliver lesions at the PV ostia.


OBJECTIVE
Using electroanatomical mapping, this study evaluates the actual location of ablation lesions generated by cryo-based, laser-based, or ultrasound-based balloon catheters.


METHODS
In a total of 14 patients with paroxysmal atrial fibrillation, PV isolation was performed using either a cryoballoon catheter (8 patients), laser catheter (4 patients) or ultrasound balloon catheter (2 patients). Patients underwent preprocedural computed tomographic/magnetic resonance imaging. An intracardiac ultrasound catheter was used to aid in positioning the balloon catheter at the PV ostium/antrum. In all patients, sinus rhythm bipolar voltage amplitude maps (using either CARTO with computed tomographic/magnetic resonance image integration or NavX mapping) were generated at baseline and after electrical PV isolation as confirmed by use of a circular mapping catheter.


RESULTS
Electrical isolation was achieved in 100% of the PVs. Electroanatomical mapping revealed that after ablation with any of the 3 balloon catheters, the extent of isolation included the tubular portions of each PV to the level of the PV ostia. However, the PV antral portions were left largely unablated with all 3 balloon technologies.


CONCLUSIONS
Using the current generation of balloon ablation catheters, electrical isolation occurs at the level of the PV ostia, but the antral regions are largely unablated.
Reddy
Vivek Y
VY
Cardiology Department, Homolka Hospital, Prague, Czech Republic. vreddy@partners.org <vreddy@partners.org>
Neuzil
Petr
P
d'Avila
Andre
A
Laragy
Margaret
M
Malchano
Zachary J
ZJ
Kralovec
Stepan
S
Kim
Steven J
SJ
Ruskin
Jeremy N
JN
D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002404:Catheterization; D017679:Cryotherapy; D004452:Echocardiography; D022062:Electrophysiologic Techniques, Cardiac; D004724:Endoscopy; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D008279:Magnetic Resonance Imaging; D011667:Pulmonary Veins; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome