The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study

Abstract

AimsCryothermal energy (CTE) ablation via a balloon catheter (Arctic Front, Cryocath™) represents a novel technology for pulmonary vein isolation (PVI). However, balloon-based PVI approaches are associated with phrenic nerve palsy (PNP). We investigated whether ‘single big cryoballoon’-deployed CTE lesions can (i) achieve acute electrical PVI without left atrium (LA) imaging and (ii) avoid PNP in patients with paroxysmal atrial fibrillation (PAF).Methods and resultsAfter double transseptal punctures, one Lasso catheter and a big 28 mm cryoballoon catheter using a steerable sheath were inserted into the LA. PV angiography and ostial Lasso recordings from all PVs were obtained. Selective PV angiography was used to evaluate balloon to LA–PV junction contact. CTE ablation lasted 300 s, and the PN was paced during freezing at right-sided PVs. Twenty-seven patients (19 males, mean age: 56 ± 9 years, LA size: 42 ± 5 mm) with PAF (mean duration: 6.6 ± 5.7 years) were included. PVI was achieved in 97/99 PVs (98%). Median (Q1; Q3) procedural, balloon, and fluoroscopy times were 220 min (190; 245), 130 min (90; 170), and 50 min (42; 69), respectively. Three transient PNP occurred after distal PV ablations. No PV stenosis occurred. Total median (Q1; Q3) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).ConclusionUsing the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.

Steerable Versus Nonsteerable Sheath Technology in Atrial Fibrillation Ablation

“…[1][2][3][4][5][6][7][8] Until today, for most of these technologies, evidence-based data analyzing the impact on clinical outcome parameters within prospective, randomized, multicenter trials are lacking.…”

Predictors of atrial fibrillation recurrence after atrial fibrillation ablation with cryoballoon

“…Cryoballoon ablation is safe, and has a similar success rate, when compared to RF ablation with comparable procedure and fluoroscopy times in patients suffering from PAF [4]. However, reported 1 year success rates are limited to 60-74% [5][6][7][8]. Therefore, the aim of this study is to identify the predictors of success specifically in patients undergoing cryoballoon ablation for PAF.…”

Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter

“…In contrast, a larger angle between the cryoballoon and the PV typically makes occlusion of the PV more difficult to achieve and therefore results in reduced PVI. Consequently, prior studies (with the first generation cryoballoon catheter) have described the use of a "hockey stick" approach configuration of the cryoballoon when the transseptal site is above the level of the inferior PVs 13,14 . This procedural movement (hockey stick) is not necessary with the second-generation cryoballoon when an IL transseptal site is employed.…”