title: The anatomic impact of sequential, additional, ostial radiofrequency ablation following pulmonary vein cryo-isolation.
abstract: BACKGROUND
  Although pulmonary vein (PV) stenosis is a serious complication of radiofrequency PV isolation, the anatomical impact of a combination of two energy sources on PV diameter has not been evaluated. The aim of this study was to evaluate the impact of supplementary point-by-point radiofrequency applications (following PV cryoablation) on the PV orifice diameter.
  
  
  METHODS
  Forty-nine patients having undergone PV isolation for drug-refractory atrial fibrillation were included. All had undergone cardiac computed tomography before ablation and again at least 3 months afterwards. When isolation with the cryoballoon was not complete, a conventional irrigated-tip radiofrequency catheter was used for point-by-point applications.
  
  
  RESULTS
  Of the 189 target PVs, 117 were isolated with cryotherapy alone (cryo PVs) and 72 required additional radiofrequency (hybrid PVs). The second scan (performed an average of 11.4 ± 5.4 months after) showed a decrease in diameter for all the hybrid PVs (17.2 ± 2.6 to 16.3 ± 3.4 mm; P = 0.037) but no change for the cryo PVs. This change was associated with a decrease in left superior pulmonary vein (LSPV) diameter (19.2 ± 3.0 to 17.8 ± 4.9 mm, P = 0.014). There were no changes in other veins. A subgroup analysis for the LSPV revealed a decrease for the hybrid PVs (18.8 ± 3.6 to 15.9 ± 7.1 mm, P = 0.046) but not for the cryo PVs. Significant PV stenosis was observed in three hybrid PVs (two severe stenosis of the LSPV and one moderate stenosis of the right inferior pulmonary vein) but not in cryo PVs (4.1% vs 0%, respectively; P = 0.023).
  
  
  CONCLUSIONS
  Cryoballoon ablation of the PV with adjunct, focal, irrigated ostial RF applications may be associated with a higher risk of PV stenosis.
authors.affiliation: Amiens-Picardie University Medical Center and Picardie Jules Verne University, Amiens, France. traulle.sarah@chu-amiens.fr
authors.forename: Sarah
authors.initials: S
authors.lastname: Traullé
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Vincent
authors.initials: V
authors.lastname: Mouquet
authors.forename: Maciej
authors.initials: M
authors.lastname: Kubala
authors.forename: Jean-Sylvain
authors.initials: JS
authors.lastname: Hermida
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D003287:Contrast Media; D003452:Cryosurgery; D004562:Electrocardiography; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011667:Pulmonary Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011668:Pulmonary Veno-Occlusive Disease / Q000175:diagnosis; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D003287:Contrast Media