BACKGROUND: Pulmonary vein isolation using the cryoballoon technique (CB-PVI) has evolved into a simple and safe alternative for point-by-point radiofrequency ablation. Systematic analysis of conduction recovery occurring after CB-PVI and causing recurrent atrial fibrillation has not yet been performed. OBJECTIVE: The purpose of this study was to analyze conduction recovery after PVI using the single big (28-mm) cryoballoon technique. METHODS: Twenty-six patients with recurrent atrial tachyarrhythmia after previous CB-PVI underwent repeat ablation. Pulmonary vein (PV) reisolation was performed by antral irrigated radiofrequency ablation using electroanatomic mapping. For analysis of the location of conduction gaps, the ipsilateral LA-PV junction was divided into six equally distributed segments. RESULTS: PV reconduction frequently occurred into multiple (>2) PVs (54% patients). Conduction gaps could be abolished by single point ablation in 63% (lateral) and 41% (septal) of patients or by incomplete circular lesions in the remaining patients. A significantly higher number of patients exhibited conduction recovery at inferior segments (85% lateral, 77% septal) compared with superior segments (42% lateral, 31% septal). Furthermore, the ridge between PV ostia and left atrial appendage (LAA) was highly associated with reconduction into lateral PVs (81% of patients). Retrospective analysis of the initial CB-PVI-procedure revealed lower freezing temperatures at superior than inferior PVs as well as sharp catheter angulations with loss of central cryoballoon alignment to reach inferior PVs. CONCLUSION: Conduction recovery after CB-PVI occurs at a high incidence at inferior sites around ipsilateral PV ostia and the LAA-PV ridge. Modifications of the technique to ensure optimal balloon-tissue contact at predilection sites may improve long-term success rates.
BACKGROUND: Pulmonary vein isolation using the cryoballoon technique (CB-PVI) has evolved into a simple and safe alternative for point-by-point radiofrequency ablation. Systematic analysis of conduction recovery occurring after CB-PVI and causing recurrent atrial fibrillation has not yet been performed. OBJECTIVE: The purpose of this study was to analyze conduction recovery after PVI using the single big (28-mm) cryoballoon technique. METHODS: Twenty-six patients with recurrent atrial tachyarrhythmia after previous CB-PVI underwent repeat ablation. Pulmonary vein (PV) reisolation was performed by antral irrigated radiofrequency ablation using electroanatomic mapping. For analysis of the location of conduction gaps, the ipsilateral LA-PV junction was divided into six equally distributed segments. RESULTS: PV reconduction frequently occurred into multiple (>2) PVs (54% patients). Conduction gaps could be abolished by single point ablation in 63% (lateral) and 41% (septal) of patients or by incomplete circular lesions in the remaining patients. A significantly higher number of patients exhibited conduction recovery at inferior segments (85% lateral, 77% septal) compared with superior segments (42% lateral, 31% septal). Furthermore, the ridge between PV ostia and left atrial appendage (LAA) was highly associated with reconduction into lateral PVs (81% of patients). Retrospective analysis of the initial CB-PVI-procedure revealed lower freezing temperatures at superior than inferior PVs as well as sharp catheter angulations with loss of central cryoballoon alignment to reach inferior PVs. CONCLUSION: Conduction recovery after CB-PVI occurs at a high incidence at inferior sites around ipsilateral PV ostia and the LAA-PV ridge. Modifications of the technique to ensure optimal balloon-tissue contact at predilection sites may improve long-term success rates.
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Heart Rhythm Date: 2017-05-12 Impact factor: 6.343
Authors: Hugh Calkins; Karl Heinz Kuck; Riccardo Cappato; Josep Brugada; A John Camm; Shih-Ann Chen; Harry J G Crijns; Ralph J Damiano; D Wyn Davies; John DiMarco; James Edgerton; Kenneth Ellenbogen; Michael D Ezekowitz; David E Haines; Michel Haissaguerre; Gerhard Hindricks; Yoshito Iesaka; Warren Jackman; José Jalife; Pierre Jais; Jonathan Kalman; David Keane; Young-Hoon Kim; Paulus Kirchhof; George Klein; Hans Kottkamp; Koichiro Kumagai; Bruce D Lindsay; Moussa Mansour; Francis E Marchlinski; Patrick M McCarthy; J Lluis Mont; Fred Morady; Koonlawee Nademanee; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Douglas L Packer; Carlo Pappone; Eric Prystowsky; Antonio Raviele; Vivek Reddy; Jeremy N Ruskin; Richard J Shemin; Hsuan-Ming Tsao; David Wilber Journal: Heart Rhythm Date: 2012-03-01 Impact factor: 6.343
Authors: Arash Aryana; Sheldon M Singh; Giacomo Mugnai; Carlo de Asmundis; Marcin Kowalski; Deep K Pujara; Andrew I Cohen; Steve K Singh; Charles E Fuenzalida; Nelson Prager; Mark R Bowers; Padraig Gearoid O'Neill; Pedro Brugada; André d'Avila; Gian-Battista Chierchia Journal: J Interv Card Electrophysiol Date: 2016-07-30 Impact factor: 1.900
Authors: Hugh Calkins; Gerhard Hindricks; Riccardo Cappato; Young-Hoon Kim; Eduardo B Saad; Luis Aguinaga; Joseph G Akar; Vinay Badhwar; Josep Brugada; John Camm; Peng-Sheng Chen; Shih-Ann Chen; Mina K Chung; Jens Cosedis Nielsen; Anne B Curtis; D Wyn Davies; John D Day; André d'Avila; N M S Natasja de Groot; Luigi Di Biase; Mattias Duytschaever; James R Edgerton; Kenneth A Ellenbogen; Patrick T Ellinor; Sabine Ernst; Guilherme Fenelon; Edward P Gerstenfeld; David E Haines; Michel Haissaguerre; Robert H Helm; Elaine Hylek; Warren M Jackman; Jose Jalife; Jonathan M Kalman; Josef Kautzner; Hans Kottkamp; Karl Heinz Kuck; Koichiro Kumagai; Richard Lee; Thorsten Lewalter; Bruce D Lindsay; Laurent Macle; Moussa Mansour; Francis E Marchlinski; Gregory F Michaud; Hiroshi Nakagawa; Andrea Natale; Stanley Nattel; Ken Okumura; Douglas Packer; Evgeny Pokushalov; Matthew R Reynolds; Prashanthan Sanders; Mauricio Scanavacca; Richard Schilling; Claudio Tondo; Hsuan-Ming Tsao; Atul Verma; David J Wilber; Teiichi Yamane Journal: Europace Date: 2018-01-01 Impact factor: 5.214
Authors: Jesus M Paylos; Aracelis Morales; Luis Azcona; Marisol Paradela; Raquel Yagüe; Fernando Gómez-Guijarro; Lourdes Lacal; R N Clara Ferrero; Octavio Rodríguez Journal: J Atr Fibrillation Date: 2016-04-30