title: Single transseptal big Cryoballoon pulmonary vein isolation using an inner lumen mapping catheter.
abstract: BACKGROUND
  The single big cryoballon technique for pulmonary vein isolation (PVI) has been limited by the need for two transseptal punctures (TP). We therefore investigated feasibility and safety of a simplified approach using a single TP and a novel circumferential mapping catheter (CMC).
  
  
  METHODS
  Patients underwent 28-mm cryoballoon PVI using a single TP. The CMC (Achieve(©) Medtronic Inc., Minneapolis, MN, USA) served as (1) guidewire and (2) as a PV mapping tool. Primary endpoint was PVI without switching to a regular guidewire. Secondary endpoints included: (1) PV signal quality during freezing, (2) time to PVI, (3) classification of successful ablation technique, (4) complications, and (5) procedural data.
  
  
  RESULTS
  A total of 32 patients (126 PVs) were studied (mean age: 62 ± 11 years, 24 males, left atrium: 40 ± 4 mm). The primary endpoint was achieved in 29/32 patients (91%) and 123/126 PVs (98%) with a procedure and fluoroscopy time of 126 ± 26 minutes and 18.9 ± 7.5 minutes, respectively. Real-time visualization of PVI could be observed in 61/126 (48%) PVs. Time to sustained PVI versus nonsustained PVI was 66 ± 56 seconds versus 129 ± 76 seconds (P < 0.001). One phrenic nerve palsy was observed. After a follow-up of 250 ± 84 days 23/32 patients (72%) remained in sinus rhythm.
  
  
  CONCLUSIONS
  The "simplified single big cryoballoon" PVI strategy appears to be safe and feasible. However, real-time PV recording was achieved in <50% of PVs. Therefore, further catheter refinements are warranted. (PACE 2012; 35:1304-1311).
authors.affiliation: Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Frankfurt, Germany. j.chun@ccb.de
authors.forename: Kr Julian
authors.initials: KJ
authors.lastname: Chun
authors.forename: Stefano
authors.initials: S
authors.lastname: Bordignon
authors.forename: Melanie
authors.initials: M
authors.lastname: Gunawardene
authors.forename: Verena
authors.initials: V
authors.lastname: Urban
authors.forename: Mehmet
authors.initials: M
authors.lastname: Kulikoglu
authors.forename: Britta
authors.initials: B
authors.lastname: Schulte-Hahn
authors.forename: Bernd
authors.initials: B
authors.lastname: Nowak
authors.forename: Boris
authors.initials: B
authors.lastname: Schmidt
mesh_terms: D000800:Angioplasty, Balloon / Q000295:instrumentation*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D062906:Cardiac Catheters; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006329:Heart Conduction System / Q000601:surgery; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome