title: Pulmonary vein isolation using a single size cryoballoon chosen according to transesophageal echocardiography information.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) using cryoballoon (CB) catheter is a new technique for atrial fibrillation (AF) ablation. Previous studies used computer tomography (CT) or magnetic resonance imaging (MRI) scan to determine the pulmonary vein (PV) diameter and anatomy for choosing the CB size. We evaluated pre-ablation transoesophageal-echocardiography (TEE) as an alternative to CT/MRI scan in patients undergoing AF ablation for determining the appropriate size of the CB.
  
  
  METHODS
  Fifty-five consecutive patients (men=43, women=12) with a mean age of 63 ± 12.5 years, and with drug-refractory paroxysmal AF (34 patients) or persistent AF (21 patients) were included in this prospective study. All patients underwent pre-ablation TEE.
  
  
  RESULTS
  Hypertension was present in 19 patients (34%). Mean anterior-posterior left atrium diameter was 45.1 ± 8.9 mm. In total, 217 PV were targeted using a single 23-mm (n=14) or 28-mm (n=40) CB catheter chosen according to TEE-obtained measurements. PVI was achieved in 195 PV (90%). Mean number of CB applications per patient was 9.8 ± 2.1 (range 8-14). Mean procedure duration and fluoroscopy times were 131 ± 27 min (90-190 min) and 36 ± 12 min (22-66 min) respectively. Phrenic nerve palsy occurred in 3 patients (5.4%) and was transient (<1 month) in all of them.
  
  
  CONCLUSIONS
  This study suggests that TEE is an easily available and effective tool to select the size of the CB for PVI according to evaluated PV diameters and anatomy.
authors.affiliation: Division of Cardiology, Hôpital Nord, Aix-Marseille Université, Marseille, France. michael.peyrol@ap-hm.fr
authors.forename: Michaël
authors.initials: M
authors.lastname: Peyrol
authors.forename: Pascal
authors.initials: P
authors.lastname: Sbragia
authors.forename: Amandine
authors.initials: A
authors.lastname: Quatre
authors.forename: Gilles
authors.initials: G
authors.lastname: Boccara
authors.forename: Zinedine
authors.initials: Z
authors.lastname: Zerrouk
authors.forename: Serge
authors.initials: S
authors.lastname: Yvorra
authors.forename: Maxime
authors.initials: M
authors.lastname: Guenoun
authors.forename: Samuel
authors.initials: S
authors.lastname: Lévy
authors.forename: Franck
authors.initials: F
authors.lastname: Paganelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000000981:diagnostic imaging* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D003452:Cryosurgery / Q000379:methods*; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000000981:diagnostic imaging* / Q000601:surgery*