title: Cryoballoon pulmonary vein isolation with real-time recordings from the pulmonary veins.
abstract: BACKGROUND
  Cryoballoon (CB) ablation represents a novel technology for pulmonary vein isolation (PVI). We investigated feasibility and safety of CB-PVI, utilizing a novel spiral catheter (SC), thereby obtaining real-time PV potential registration.
  
  
  METHODS
  Following double transseptal puncture, a Lasso catheter (Biosense Webster, Diamond Bar, CA, USA) and the 28 mm CB were positioned within the left atrium. A novel SC (Promap, ProRhythm Inc., Ronkonkoma, NY, USA) was inserted through the lumen of the CB allowing PV signal registration during treatment. Time to PV conduction block was analyzed. If no stable balloon position was obtained, the SC was exchanged for a regular guide wire and PV conduction was assessed after treatment by Lasso catheter.
  
  
  RESULTS
  In 18 patients, 39 of 72 PVs (54%) were successfully isolated using the SC. The remaining 33 PVs were isolated switching to the regular guide wire. Time to PV conduction block was significantly shorter in PVs in which sustained PVI was achieved as compared to PVs in which PV conduction recovered within 30 minutes (33 +/- 21 seconds vs 99 +/- 65 seconds). In 40 PVs, time to PV conduction block was not obtained because of: (1) PVI not being achieved during initial treatment; (2) a distal position of the SC; or (3) isolation with regular guide wire. No procedural complications occurred.
  
  
  CONCLUSIONS
  Visualization of real-time PV conduction during CB PVI is safe, feasible, and allows accurate timing of PVI onset in a subset of PVs. Time to PV conduction block predicts sustained PVI. However, mechanical properties of the SC need to be improved to further simplify CB PVI.
authors: From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. jongichun@t-online.de
authors: K R Julian
authors: KR
authors: Chun
authors: Alexander
authors: A
authors: Fürnkranz
authors: Andreas
authors: A
authors: Metzner
authors: Boris
authors: B
authors: Schmidt
authors: Roland
authors: R
authors: Tilz
authors: Thomas
authors: T
authors: Zerm
authors: Ilka
authors: I
authors: Köster
authors: Dieter
authors: D
authors: Nuyens
authors: Erik
authors: E
authors: Wissner
authors: Feifan
authors: F
authors: Ouyang
authors: Karl Heinz
authors: KH
authors: Kuck
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D002404:Catheterization / Q000379:methods* / Q000639:trends; D003452:Cryosurgery / Q000379:methods* / Q000639:trends; 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