title: Right ventricular rapid pacing in catheter ablation of atrial fibrillation: a novel application for cryoballoon pulmonary vein isolation.
abstract: 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).
  
  
  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.
  
  
  CONCLUSIONS
  Right ventricular rapid pacing significantly accelerates cryoballoon cooling during the initial phase of a freeze possibly suggesting improved cryolesions.
authors.affiliation: Department of Cardiology, Asklepios Klinik St Georg, Hamburg, Germany. jongichun@t-online.de
authors.forename: K R Julian
authors.initials: KR
authors.lastname: Chun
authors.forename: Alexander
authors.initials: A
authors.lastname: Fürnkranz
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
authors.forename: Andreas
authors.initials: A
authors.lastname: Metzner
authors.forename: Roland
authors.initials: R
authors.lastname: Tilz
authors.forename: Thomas
authors.initials: T
authors.lastname: Zerm
authors.forename: Ilka
authors.initials: I
authors.lastname: Köster
authors.forename: Buelent
authors.initials: B
authors.lastname: Koektuerk
authors.forename: Melanie
authors.initials: M
authors.lastname: Konstantinidou
authors.forename: Feifan
authors.initials: F
authors.lastname: Ouyang
authors.forename: Karl Heinz
authors.initials: KH
authors.lastname: Kuck
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D002304:Cardiac Pacing, Artificial; D002404:Catheterization / Q000379:methods*; D003131:Combined Modality Therapy; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006339:Heart Rate; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome