Impact of Pulmonary Vein Isolation on Superior Vena Cava Potentials With a Second-Generation Cryoballoon.
BACKGROUND
Radiofrequency ablation of the right superior pulmonary vein (RSPV) can lead to inadvertent superior vena cava (SVC) isolation due to the close anatomical proximity. This study aimed to evaluate the impact of PV isolation on SVC potentials with a second-generation cryoballoon.


METHODS
Thirty-one consecutive paroxysmal atrial fibrillation patients who underwent PV isolation exclusively with a 28 mm second-generation cryoballoon and single 3-minute freeze technique were prospectively enrolled. The produced SVC potential conduction delay during the RSPV isolation was prospectively evaluated using circular mapping catheters placed in the SVC throughout the cryoballoon procedure.


RESULTS
Stable SVC potentials were recorded in 28 (90.3%) patients. The produced SVC potential conduction delay during the RSPV isolation was a median of 6.0 (0.5-7.6) milliseconds, and >5.0 milliseconds in 16 (57.1%) patients. Among them, the delay had shortened by >5.0 milliseconds in 7 (43.8%) patients within 5 minutes after the RSPV application. The distance between the RSPV ostium and SVC was the sole parameter correlated with the produced delay (R = 0.77, P < 0.0001). For the association between the distance and a produced delay of >5 milliseconds, the area under the curve was 0.896 (95% confidential interval = 0.775-1.000). The optimal cutoff point for the distance predicting the occurrence of the conduction delay (>5 milliseconds) was 2.5 mm (sensitivity 83.3%, specificity 81.2%).


CONCLUSIONS
RSPV isolation with a second-generation cryoballoon could produce an SVC potential conduction delay. The anatomical distance between the RSPV and SVC significantly correlated with the impact.
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Noboru
N
Ichihara
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Shinsuke
S
Miyazaki
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Akio
A
Kuroi
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Hitoshi
H
Hachiya
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Hiroaki
H
Nakamura
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Hiroshi
H
Taniguchi
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Makoto
M
Araki
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Takamitsu
T
Takagi
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Jin
J
Iwasawa
Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan.
Yoshito
Y
Iesaka
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000503:physiopathology* / Q000628:therapy*; D018780:Body Surface Potential Mapping / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods*; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011667:Pulmonary Veins; D016896:Treatment Outcome; D014683:Vena Cava, Superior / Q000503:physiopathology*
D000889:Anti-Arrhythmia Agents
atrial fibrillation; catheter ablation; cryoballoon; pulmonary vein isolation; superior vena cava