title: [Catheter ablation of paroxysmal atrial fibrillation: extended recommendations considering safety improvements of pulmonary vein isolation with a cryoballoon--Case 11/2011].
abstract: METHODS
  A 71-year-old, male patient was referred to our clinic for paroxysmal palpitations with dyspnoe and fatigue since four years despite pharmacological treatment with flecainide and bisoprolol.
  
  
  METHODS
  A paroxysmal atrial fibrillation was documented in a 24-hour Holter recording. A bicycle ergometry showed a hypertensive reaction during exercise without any sign of coronary insufficiency. Intracardiac thrombi could by excluded by transesophageal echocardiography.
  
  
  METHODS
  The diagnosos of a drug-refractory paroxysmal atrial fibrillation was made and cryoballoon pulmonary vein isolation was performed. A follow-up 3 months after the ablation disclosed a freedom from atrial fibrillation documented in 7-day Holter recording.
  
  
  CONCLUSIONS
  Compared to pharmacological rhythm control, interventional treatment has been established as more effective therapy for paroxysmal atrial fibrillation. However, patients should be referred to the ablation early enough to avoid structural atrial remodeling and thus transition into persistent or permanent atrial fibrillation. New technical developments e.g. cryoballoon catheter-system simplifies the procedure and has been reported to be effective and safe to use for circumferential pulmonary vein isolation. Should the very promising preclinical data on efficacy and safety of cryothermal energy ablation be confirmed by results of ongoing, controlled trials, the catheter ablation may become the fist-line treatment for all patients with paroxysmal atrial fibrillation.
authors.affiliation: Medizinische Klinik III, Universitätsklinikum Tübingen. slawomir.weretka@med.uni-tuebingen.de
authors.forename: S
authors.initials: S
authors.lastname: Weretka
authors.forename: H-J
authors.initials: HJ
authors.lastname: Weig
authors.forename: N
authors.initials: N
authors.lastname: Rüb
authors.forename: U
authors.initials: U
authors.lastname: Parade
authors.forename: G
authors.initials: G
authors.lastname: Kerst
authors.forename: R
authors.initials: R
authors.lastname: Laszlo
authors.forename: M
authors.initials: M
authors.lastname: Gawaz
authors.forename: J
authors.initials: J
authors.lastname: Schreieck
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D003452:Cryosurgery / Q000295:instrumentation*; D004452:Echocardiography; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D012815:Signal Processing, Computer-Assisted
chemical_list: D000889:Anti-Arrhythmia Agents