title: Pulmonary vein electrophysiology during cryoballoon ablation as a predictor for procedural success.
abstract: BACKGROUND
  Cryoballoon technique is an innovative alternative to radiofrequency ablation for atrial fibrillation (AF). However, with current cryoballoon application techniques, the operator has no access to electrical information for 300 s during the freezing cycle.
  
  
  OBJECTIVE
  The objective of this study is to investigate the novel approach of real-time monitoring of pulmonary vein (PV) potentials throughout freezing using a circular mapping catheter introduced into the central lumen of the cryoballoon catheter.
  
  
  METHODS
  Patients had paroxysmal or persistent AF. Standard balloon catheters (23 or 28 mm diameter, 10.5 F shaft) were used. A coaxial mapping catheter (shaft diameter 0.9 mm; 15 mm loop with six electrodes) was advanced through the lumen of the cryoballoon catheter, replacing the guide wire. The primary procedural end point was successful PV isolation and real-time PV potential recording. Secondary end points were procedural data, complications, and the time to successful PV isolation.
  
  
  RESULTS
  In 141 consecutively enrolled patients, balloon positioning and ablation were successful in 439/568 veins (77%). Real-time recording of PV conduction during the freeze cycle was possible in 235/568 PVs (41%). Main reasons for failure to obtain real-time PV recordings were a distal position of the circular mapping catheter or insufficient catheter-vessel wall contact during ablation. A cutoff value of 83 s to PV isolation was predictive of stable procedural PV isolation without reconduction. One minor hemoptysis was observed possibly related to the mapping catheter.
  
  
  CONCLUSIONS
  This study, the largest to date, showed that real-time monitoring of PV conduction during cryoballoon freezing can be safely performed with a circular mapping catheter. A cutoff time of 83 s to PV isolation was predictive of sustained procedural PV isolation success without reconduction.
authors: Department of Cardiology an Intensive Care Medicine, Heart Center Munich-Bogenhausen, Klinikum Bogenhausen, Englschalkinger Strasse 77, 81925, Munich, Germany. uwe.dorwarth@klinikum-muenchen.de
authors: Uwe
authors: U
authors: Dorwarth
authors: Martin
authors: M
authors: Schmidt
authors: Michael
authors: M
authors: Wankerl
authors: Juergen
authors: J
authors: Krieg
authors: Florian
authors: F
authors: Straube
authors: Ellen
authors: E
authors: Hoffmann
references: J Cardiovasc Electrophysiol. 2010 Jul;21(7):731-7
references: 20132391
references: Europace. 2008 Nov;10(11):1277-80
references: 18955410
references: Europace. 2009 Oct;11(10):1281-8
references: 19654125
references: J Cardiovasc Electrophysiol. 2010 Jun 1;21(6):626-31
references: 20021514
references: J Am Coll Cardiol. 2005 Nov 15;46(10):1902-12
references: 16286179
references: Circulation. 2003 Apr 22;107(15):2045-50
references: 12668527
references: Circulation. 2000 Oct 17;102(16):1879-82
references: 11034932
references: J Am Coll Cardiol. 2006 Jun 20;47(12):2498-503
references: 16781380
references: J Cardiovasc Electrophysiol. 2009 Nov;20(11):1203-10
references: 19602018
references: Pacing Clin Electrophysiol. 1991 Nov;14(11 Pt 2):2042-8
references: 1721221
references: Eur Heart J. 2007 Sep;28(18):2231-7
references: 17569680
references: J Am Coll Cardiol. 2008 Jul 22;52(4):273-8
references: 18634982
references: Eur Heart J. 2009 Mar;30(6):699-709
references: 19109353
references: J Interv Card Electrophysiol. 2004 Oct;11(2):117-26
references: 15383774
references: Heart Rhythm. 2008 Mar;5(3):353-60
references: 18313591
references: Circulation. 2005 Feb 8;111(5):546-54
references: 15699274
references: Heart Rhythm. 2007 May;4(5):575-84
references: 17467623
references: Eur Heart J. 2009 Mar;30(6):636-7
references: 19223319