Background: Pulmonary vein stenosis (PVS) after PV isolation (PVI) for atrial fibrillation (AF) is a severe complication that requires angioplasty. This study aimed to compare the reduction of the cross-sectional PV area (PVA) and the incidence of PVS after cryoballoon (CB)-PVI, hot balloon (HB)-PVI, or laser balloon (LB)-PVI.
Methods and Results:A total of 320 patients who underwent an initial catheter ablation procedure for AF using a CB, HB, or LB in 2 hospitals were included. They underwent contrast-enhanced multidetector CT before and 3 months after the procedure. In all 4 PVs, the reduction in PVA was more significant in the LB group than in the CB or HB groups, respectively. Moderate (50-75%) and severe (>75%) PVS were observed in 5.3% and 0.5% of the PVs, respectively. Although moderate PVS was more frequently observed in the LB group than in the CB or HB groups (8.2%, 3.8%, and 5.0%; P=0.03), the incidence of severe PVS was similar in the LB, CB, and HB groups (0.3%, 0.5%, and 1.0%; P=0.46). Symptomatic PVS requiring intervention occurred in 1 (0.3%) patient.
Conclusions:Although the reduction in cross-sectional PVA and the incidence of moderate PVS after LB-PVI was more significant than after CB-PVI or HB-PVI, it rarely led to severe PVS. Symptomatic PVS requiring intervention was rare after the balloon ablation of AF.
We report a case of atrial fibrillation with frequent monomorphic atrial
premature contractions (APCs) in which P-wave morphology was negative in
II, III, and aVF and positive in I and aVL leads. After pulmonary vein
isolation using a cryoballoon, high-resolution electroanatomical mapping
revealed ectopic beats from the posteroseptal area within the inferior
vena cava (IVC) with concealed bigeminy. Catheter ablation just above
the ectopic focus eliminated the APC with residual dissociated activity
inside the IVC. This is the first report to reveal continuous ectopic
bigeminy definitely originating from the tiny area within the IVC by
detailed three-dimensional mapping.
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