title: Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon.
abstract: BACKGROUND
  There are 2 Food and Drug Administration-approved catheters (ThermoCool RF and Arctic Front Advance cryoballoon) for the treatment of drug refractory and symptomatic paroxysmal atrial fibrillation. Each tool is used to ablate the area surrounding the pulmonary veins (PVs). However, no study has described and quantified the ablated surface area after the application of cryoablation lesions with the second-generation cryoballoon.
  
  
  OBJECTIVE
  The purpose of this study was to determine the area of ablation during cryoballoon PV isolation.
  
  
  METHODS
  Preprocedural computed tomography angiography of the left atrium (LA) was conducted in 43 patients to accurately determine spatial chamber dimensions. Before and after the ablation procedure, a detailed 3-dimensional electroanatomic map of the LA was created and merged onto the computed tomography angiogram to improve the accuracy of the data recordings.
  
  
  RESULTS
  The posterior LA wall had a mean surface area of 31.1 (±1.6 SEM) cm(2). Left- and right-sided antral PV surface areas of cryoballoon ablation were not statistically different (P = .935), which were 11.4 (±0.8 SEM) and 11.3 (±0.8 SEM) cm(2), respectively. In total, 27% of the posterior LA wall remained unablated, electrically functional, and homogeneous with regard to voltage conductivity. This ablation strategy resulted in 95.3% freedom from atrial fibrillation at 6 months.
  
  
  CONCLUSIONS
  The area of the posterior LA wall ablation with the cryoballoon catheter is wide and antral, and the resulting posterior LA wall debulking could be a part of the cryoballoon efficacy beyond discrete PV isolation.
authors.affiliation: Florida Heart Rhythm Specialist, Plantation, Florida. Electronic address: dkenigsb@yahoo.com.
authors.forename: David N
authors.initials: DN
authors.lastname: Kenigsberg
authors.affiliation: St Jude Medical, Inc, St Paul, Minnesota.
authors.forename: Natalia
authors.initials: N
authors.lastname: Martin
authors.affiliation: Medtronic, Inc, Mounds View, Minnesota.
authors.forename: Hae W
authors.initials: HW
authors.lastname: Lim
authors.affiliation: Staten Island University Hospital, Staten Island, New York.
authors.forename: Marcin
authors.initials: M
authors.lastname: Kowalski
authors.affiliation: Virginia Commonwealth University School of Medicine, Richmond, Virginia.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Ellenbogen
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D057785:Catheters; D003452:Cryosurgery / Q000295:instrumentation*; D022062:Electrophysiologic Techniques, Cardiac; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
keywords: Atrial fibrillation; Catheter ablation; Cryoablation; Cryoballoon; Radiofrequency ablation; Wide area circumferential ablation