title: Cryoballoon pulmonary vein isolation supported by intracardiac echocardiography: integration of a nonfluoroscopic imaging technique in atrial fibrillation ablation.
abstract: BACKGROUND
  cryoballoon ablation has been adopted for pulmonary vein (PV) isolation (PVI) in many centers. Complete occlusion of PV by an adequately sized balloon is crucial for effectiveness of cryoenergy delivery. The aim of this study was to evaluate intracardiac echocardiography (ICE) as an alternative imaging technique compared to angiographic imaging in cryoballoon PVI.
  
  
  RESULTS
  a total of 75 PVs were treated in 22 patients (61 ± 13 years, 17 male) undergoing PV cryoballoon ablation for drug refractory paroxysmal atrial fibrillation. Decision for an adequate balloon size was based on diameters of the PV antra assessed by ICE and PV angiography. Per PV 2.4 ± 0.4 cryoenergy pulses were applied. Decision for the balloon size was similar either based upon angiography or on ICE. A single 23 or 28 mm balloon was chosen in 10 and 3 patients, respectively. Two different sized balloons were used in 9 patients. PVI was evaluated after 2 cryoenergy applications. Total occlusion of the PV confirmed by ICE color flow Doppler (CFD) during ablation predicted successful PVI in 70 of 75 (93%) and unsuccessful PVI in 8 of 8 (100%). PV flow registered by pulsed wave Doppler at the PV ostium pre- and postablation was 0.48 ± 0.10 and 0.51 ± 0.12 m/s, respectively (n.s.). PVI was finally confirmed by entrance block in all PVs. No procedural complications occurred.
  
  
  CONCLUSIONS
  ICE is a feasible novel imaging technique in cryoballoon ablation procedures. It allows decision for adequate balloon size, exact balloon placement, prediction of acute ablation success, and excludes acute narrowing of PV ostia.
authors.affiliation: Department of Cardiology, Heart and Diabetes Center North Rhine-Westfalia, Ruhr University Bochum, Bad Oeynhausen, Germany. georgnoelker@yahoo.com
authors.forename: Georg
authors.initials: G
authors.lastname: Nölker
authors.forename: Johannes
authors.initials: J
authors.lastname: Heintze
authors.forename: Klaus-Jürgen
authors.initials: KJ
authors.lastname: Gutleben
authors.forename: Bogdan
authors.initials: B
authors.lastname: Muntean
authors.forename: Vanessa
authors.initials: V
authors.lastname: Pütz
authors.forename: Ameera
authors.initials: A
authors.lastname: Yalda
authors.forename: Jürgen
authors.initials: J
authors.lastname: Vogt
authors.forename: Dieter
authors.initials: D
authors.lastname: Horstkotte
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods; D002404:Catheterization / Q000379:methods*; D003452:Cryosurgery / Q000379:methods*; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery