Cryoballoon pulmonary vein isolation guided by transesophageal echocardiography: novel aspects on an emerging ablation technique.
BACKGROUND
Pulmonary vein (PV) isolation using a balloon-mounted cryoablation system is a new technology for the percutaneous treatment of atrial fibrillation (AF). Transesophageal echocardiography (TEE) allows real-time visualization of cryoballoon positioning and successful vein occlusion via color Doppler. We hypothesized that PV mechanical occlusion monitored with TEE could predict effective electrical isolation.


METHODS
We studied 124 PVs in 30 patients. Under continuous TEE assessment, a cryoballoon was placed in the antrum of each PV aiming for complete PV occlusion as documented by color Doppler. At the end of the procedure, PV electrical isolation was evaluated using a circumferential mapping catheter.


RESULTS
Of the 124 PVs studied, 123 (99.2%) could be visualized by TEE: the antrum was completely visualized in 80 of them (64.5%), partially in 36 (29.0%), and only disappearance of proximal flow could be observed in the remaining 7 PVs (5.7%). Vein occlusion could be achieved in 111 of the 123 (90.2%) visualized PVs. Postinterventional mapping demonstrated electrical isolation in 109 of 111 occluded PVs (positive predictive value 98.2%) and only in 1 of 12 nonoccluded PVs (negative predictive value 91.7%, P < 0.001). After a mean follow-up of 7.4 +/- 3.7 months, 73.3% of patients remained in sinus rhythm without antiarrhythmic drugs.


CONCLUSIONS
Color Doppler documented PV occlusion during cryoballoon ablation can predict effective electrical isolation.
Siklódy
Claudia Herrera
CH
Department of Electrophysiology, Herz-Zentrum, Bad Krozingen, Germany. claudia.h.siklody@gmail.com
Minners
Jan
J
Allgeier
Martin
M
Allgeier
Hans-Jürgen
HJ
Jander
Nikolaus
N
Weber
Reinhold
R
Schiebeling-Römer
Jochen
J
Neumann
Franz-Josef
FJ
Kalusche
Dietrich
D
Arentz
Thomas
T
D001281:Atrial Fibrillation / Q000601:surgery*; D002404:Catheterization / Q000379:methods* / Q000639:trends; D003452:Cryosurgery / Q000379:methods* / Q000639:trends; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011667:Pulmonary Veins / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome