title: Real-time assessment of pulmonary vein disconnection during cryoablation of atrial fibrillation: can it be 'achieved' in almost all cases?
abstract: OBJECTIVE
  Real-time assessment of pulmonary vein (PV) disconnection is possible using an inner circular mapping catheter during cryoablation of atrial fibrillation (AF). However, it has been recently demonstrated that such continuous monitoring may only be possible in <50% of PVs. We hypothesized that a stepwise mapping approach, including pacing manoeuvres, could optimize monitoring of real-time PV disconnection during ablation.
  
  
  RESULTS
  Single-centre, prospective observational study (NCT01843465) including 34 consecutive eligible patients (128 PVs) undergoing a first procedure of cryoballoon ablation of AF using the Artic Front Advance(®) 28 mm catheter and a 20 mm diameter Achieve(®) catheter (AC) in all cases. Monitoring of real-time entrance block was possible, when AC was maintained in the standard position (distal to the tip of the Artic Front Advance(®) catheter) in 47 (36.7%) PVs. In an additional 63 cases (49.2%), such monitoring was possible after moving AC to a more proximal position and using different torqueing movements. Finally, using supplemental systematic pacing manoeuvres to test exit block, real-time assessment of PV disconnection was possible in 15 (11.7%) more PVs. Overall, real-time assessment of PV disconnection was possible in 97.7% of cases, after a mean duration of 48.6 ± 33.0 s.
  
  
  CONCLUSIONS
  Our results suggest that optimal use of the AC, with a systematic stepwise mapping approach, may dramatically improve the real-time monitoring of PV disconnection during AF cryoablation.
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France sboveda@clinique-pasteur.com.
authors.forename: Serge
authors.initials: S
authors.lastname: Boveda
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: Rui
authors.initials: R
authors.lastname: Providência
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Albenque
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Combes
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Combes
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: Hassiba
authors.initials: H
authors.lastname: Hireche
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Casteigt
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: Abdeslam
authors.initials: A
authors.lastname: Bouzeman
authors.affiliation: Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 ToulouseCedex 3, France.
authors.forename: François
authors.initials: F
authors.lastname: Jourda
authors.affiliation: Paris Cardiovascular Research Center, Paris, France.
authors.forename: Kumar
authors.initials: K
authors.lastname: Narayanan
authors.affiliation: Paris Cardiovascular Research Center, Paris, France.
authors.forename: Eloi
authors.initials: E
authors.lastname: Marijon
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000379:methods*; D003199:Computer Systems; D003452:Cryosurgery / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome
keywords: Achieve catheter; Atrial fibrillation; Cryoablation; Entrance block; Exit block