title: Feasibility and efficacy of simultaneous pulmonary vein isolation and cavotricuspid isthmus ablation using cryotherapy.
abstract: BACKGROUND
  Pulmonary vein isolation (PVI) and cavotricuspid isthmus (CTI) ablation are often performed as part of the same procedure. In many cases, PVI is performed by cryotherapy and then CTI ablation by radiofrequency (RF) energy. We sought to determine whether it is more efficient to perform CTI ablation simultaneously with PVI using separate cryogenerators.
  
  
  RESULTS
  We performed cryoablation of the CTI during PVI with the Arctic Front cryoballoon in 25 consecutive patients with clinical indications for both (PVI/CTI-cryo group). Procedural data were compared to those of 25 matched patients who underwent PVI only by the same operator (PVI-only group), and 25 patients who underwent PVI by cryotherapy and CTI ablation using RF energy sequentially during the same procedure (PVI/CTI-mixed group). No complication occurred. All veins were isolated; bidirectional CTI block was demonstrated in all cases where it was attempted, except for 1 patient in the PVI/CTI-mixed group. Procedure and fluoroscopy duration were significantly shorter in the PVI/CTI-cryo group (162 ± 34 and 24 ± 5 minutes) than in the PVI/CTI-mixed group (209 ± 46 minutes, P < 0.001 and 59 ± 28 minutes, P < 0.001). Procedure and fluoroscopy duration in the PVI-only group (155 ± 32 and 22 ± 8 minutes) were similar to those in the PVI/CTI-cryo group (P = NS) but significantly shorter than in the PVI/CTI-mixed group (P < 0.001 for both). Clinical outcomes were similar in all groups.
  
  
  CONCLUSIONS
  When CTI ablation is performed with RF energy after PVI by cryoballoon, it adds significantly to the procedure and fluoroscopy durations; when performed contemporaneously using cryotherapy at both sites, the procedure and fluoroscopy durations are not prolonged.
authors.affiliation: Department of Cardiology, St. Georges Hospital, London, UK.
authors.forename: Paramdeep S
authors.initials: PS
authors.lastname: Dhillon
authors.forename: Giulia
authors.initials: G
authors.lastname: Domenichini
authors.forename: Hanney
authors.initials: H
authors.lastname: Gonna
authors.forename: Rachel
authors.initials: R
authors.lastname: Bastiaenen
authors.forename: Mark
authors.initials: M
authors.lastname: Norman
authors.forename: Mark M
authors.initials: MM
authors.lastname: Gallagher
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D062906:Cardiac Catheters; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D017679:Cryotherapy / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D015641:Radiography, Interventional; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000503:physiopathology / Q000601:surgery*; D014684:Venae Cavae / Q000503:physiopathology / Q000601:surgery*
keywords: atrial fibrillation; atrial flutter; cavotricuspid isthmus ablation; cryoablation; pulmonary vein isolation; radiofrequency ablation