Cryoballoon pulmonary vein isolation with real-time recordings from the pulmonary veins.
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.
Chun
K R Julian
KR
From the Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. jongichun@t-online.de
Fürnkranz
Alexander
A
Metzner
Andreas
A
Schmidt
Boris
B
Tilz
Roland
R
Zerm
Thomas
T
Köster
Ilka
I
Nuyens
Dieter
D
Wissner
Erik
E
Ouyang
Feifan
F
Kuck
Karl Heinz
KH
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