title: Stand-alone mapping using different transluminal mapping catheters--an accurate and safe way to isolate all pulmonary veins with the cryoballoon?
abstract: OBJECTIVE
  Cryoballoon isolation of the pulmonary veins (PVI) is an effective and safe method in the treatment of patients with paroxysmal atrial fibrillation (PAF). The circular mapping catheter Achieve® (Medtronic Inc., Minneapolis, USA) can be introduced into the pulmonary vein (PV) through the inner lumen of the balloon catheter, allowing online mapping of the PV electrograms during ablation. We prospectively compared the accuracy of this catheter in both available sizes to a standard circular mapping catheter (SCMC) in order to determine bidirectional PV block.
  
  
  METHODS
  Patients with symptomatic PAF underwent cryoballoon ablation using either the Achieve® 15-mm catheter (group 1, 15 patients) or the Achieve® 20 mm (group 2, 15 patients). PV potentials were recorded using Achieve® before, during, and after ablation, and exit block was obtained by pacing from inside the PV. Accuracy of PV potential detection was controlled by a SCMC before and after ablation.
  
  
  RESULTS
  Rate of PV which could be isolated exclusively using the Achieve® as guidewire was 98 % (59/60) in group 1 and 93 % (57/60) in group 2. Online signal recording during ablation was possible in 40 and 60 % of PV (p = 0.037), respectively. Final Achieve® diagnosis was accurate in 55/60 (92 %) of the PVs and 12/15 (80 %) of patients in group 1 and 60/60 (100 %) of PV and 15/15 (100 %) of patients in group 2.
  
  
  CONCLUSIONS
  Stand-alone mapping using Achieve® 15 mm resulted in a significant lack of diagnostic accuracy. Achieve® 20 mm provided excellent diagnostic accuracy comparable to a SCMC and should be preferentially used.
authors.affiliation: The Heart Center Bad Neustadt/Saale, Clinic for Electrophysiology, Ruhr-University Bochum, Salzburger Leite 1, 97616, Bad Neustadt/Saale, Germany, anja.schade@kardiologie-bad-neustadt.de.
authors.forename: Anja
authors.initials: A
authors.lastname: Schade
authors.forename: Burghard
authors.initials: B
authors.lastname: Schumacher
authors.forename: Johannes W
authors.initials: JW
authors.lastname: Dietrich
authors.forename: Anke
authors.initials: A
authors.lastname: Langbein
authors.forename: Guido
authors.initials: G
authors.lastname: Groschup
authors.forename: Katrin
authors.initials: K
authors.lastname: Koucky
authors.forename: Joachim
authors.initials: J
authors.lastname: Krug
authors.forename: Carsten
authors.initials: C
authors.lastname: Stahl
authors.forename: Patrick
authors.initials: P
authors.lastname: Müller
authors.forename: Karin
authors.initials: K
authors.lastname: Nentwich
authors.forename: Markus
authors.initials: M
authors.lastname: Roos
authors.forename: Thomas
authors.initials: T
authors.lastname: Deneke
mesh_terms: D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D018780:Body Surface Potential Mapping / Q000295:instrumentation*; D062906:Cardiac Catheters; D003452:Cryosurgery / Q000295:instrumentation*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D011667:Pulmonary Veins / Q000601:surgery*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D018511:Systems Integration; D016896:Treatment Outcome