Conclusion: RHB ablation can be effective during a long-term follow-up for patients with paroxysmal AF. Safety outcomes were within an acceptable range. (J Cardiovasc Electrophysiol, Vol. 26, pp. 1298-1306, December 2015 atrial fibrillation, catheter ablation, hot balloon ablation, phrenic nerve injury, pulmonary vein isolation

In the case of frequent LET rises while creating the linear lesions for the Box isolation strategy for non-paroxysmal AF, shifting to the PBI strategy was feasible.

Introduction: HotBalloon material is compliant and the balloon size can be enlarged by increasing the intraballoon injection volume. HotBalloon-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF), however, the acute efficacy and clinical outcomes of the HotBalloon-based PVI have never been fully investigated in patients with a left common pulmonary vein (LCPV).Methods and Results: One hundred fifty-three PAF patients underwent HotBalloonbased PVI. Three-dimensional computed tomography was performed in all patients before the ablation. An LCPV was observed in 40 (26%) patients. For HotBalloon ablation of an LCPV, in patients with an LCPV of superoinferior diameter <34 mm, the left common ostium was preferably isolated if sufficient occlusion could be achieved.In patients with an LCPV diameter ≥34 mm, left superior and inferior branches of the LCPV were targeted individually. The number of HotBalloon applications in patients with LCPV was significantly smaller than without LCPV (7.3 ± 2.0 vs 8.1 ± 2.1; P = .04).In patients with LCPV diameter <34 mm, 75% of LCPVs successfully achieved full balloon occlusion (50% were isolated by application at the LCPV ostium alone, 25% by application at the LCPV ostium followed by either superior or inferior LCPV branch ablation) and 25% were isolated individually. One year after a single session, the arrhythmia-free rates were similar between patients with and without LCPV (77% vs 74%, log rank, P = .86). Conclusions:HotBalloon-based PVI delivers long-term favorable success rates with fewer HotBalloon applications in paroxysmal AF patients with an LCPV. K E Y W O R D S atrial fibrillation, HotBalloon, left common pulmonary vein, pulmonary vein isolation 1 | BACKGROUND Balloon-based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of atrial fibrillation (AF). 1-6 However, its ability to adapt to anatomical variation of the pulmonary vein (PV) might be challenging. Over the years, different ablation approaches to the left common PV (LCPV) have been evaluated. The long-term outcome after conventional radiofrequency(RF) catheter ablation of AF has been reported to be similar to normal PV anatomy. 7,8 However, the remote magnetic navigation guided PVI 9 and cryoballoon-based PVI in patients with an LCPV has been reported to be associated with a poor outcome. 10,11

We report a case experiencing repeated common iliac artery (CIA) occlusion due to an unexpected stent deformation. A 74-year-old man with intermittent claudication had undergone balloon-expandable stenting for the left CIA. Six years after his first stent implantation, his left CIA was totally occluded inside the stent. We performed revascularization for the left CIA and achieved sufficient balloon inflation and balloon-expandable stenting. Then, one and a half years later, his left CIA was re-occluded. CT angiography showed compression by the protruding hyperostotic lumbar vertebral body, such that both stents had become deformed into a crescent shape. We were told that he had been using a powerful massage machine to stretch and relieve his spondylotic back pain. We suspected that the external pressure of the hyperostotic spondylosis and massage might have caused the CIA compression and repeated crush of the stents.

BackgroundCatheter ablation of non-paroxysmal atrial fibrillation (non-PAF) is a therapeutic challenge especially in elderly patients. This study describes the feasibility of a posterior left atrium isolation as a substrate modification in addition to pulmonary vein isolation, the so-called Box isolation, for elderly patients with non-PAF.MethodsTwo hundred twenty-nine consecutive patients who underwent Box isolations for drug-refractory non-PAF were divided into two groups according to their age; younger group comprising 175 patients aged <75 years and elderly group comprising 54 patients aged ≥75 years.ResultsDuring 23.7±12.0 months of follow-up, the arrhythmia-free rates after one procedure were 53.1% in younger group versus 48.1% in elderly group (p=0.50). Following the second procedure, all patients had electrical conduction recoveries along the initial Box lesion. However, a complete Box re-isolation was highly established in both age groups (87.1% vs. 92.9%, respectively; p=1.00). Recurrence of macro-reentrant atrial tachycardia was mainly associated with the gaps through the initial Box lesion in both age groups (25.8% vs. 21.4%, p=1.00), but typical cavo-tricuspid isthmus (CTI) dependent atrial flutter was significantly observed in the elderly patients’ group only (all events were observed within 6 months after the initial procedure; 3.2% vs. 28.6%, p=0.009). After two procedures, the arrhythmia-free rates increased to 73.1% in younger group versus 66.7% in elderly group (p=0.38). The occurrence rate of procedural-related complications did not differ between the two age groups, and there were no life-threatening complications even in elderly patients.ConclusionsBox isolation of non-PAF is effective and safe even in elderly patients. A prophylactic CTI ablation combined with Box isolation might be feasible to improve the long-term outcome.