BACKGROUND: Systematic use of a 28mm balloon has been proposed for pulmonary vein cryoisolation in patients with atrial fibrillation. OBJECTIVE: To assess the results of a dual balloon size strategy using a 23 or 28mm cryoballoon catheter for pulmonary vein isolation. METHODS: A total of 118 patients (mean age 56 ± 10 years) with paroxysmal (n=85) or persistent atrial fibrillation (n=33) were enrolled. Patients with four pulmonary veins<20mm in diameter were isolated with a 23mm cryoballoon (n=29); patients with one pulmonary vein diameter ≥20mm were isolated with a 28mm cryoballoon (n=89). RESULTS: No significant difference in procedural variables was observed between the two groups. AF-free survival, after a mean follow-up of 19.9 ± 5 months, was similar in the two groups (69% vs 62%; p=0.57 and between patients with paroxysmal atrial fibrillation (68% vs 68%; p=0.91) or persistent AF (75% vs 48%; p=0.60). AF duration before the ablation procedure (p=0.005) was an independent predictor of AF recurrence. Phrenic nerve palsy rate was not statistically different in the two groups (4 [14%] vs 9 [10%]; p=0.73). The temperature in the right superior pulmonary vein (p=0.008) was an independent predictor of phrenic nerve palsy. Five patients developed left atrial flutter with the 28mm diameter balloon versus none with the 23mm balloon. CONCLUSIONS: A dual balloon size strategy was not associated with a lower AF-free survival or a higher procedure-related complication rate in patients in whom the 23mm balloon was used. Pulmonary vein isolation with a 23mm cryoballoon catheter appears to be an appropriate option in selected patients with small pulmonary vein diameters.
BACKGROUND: Systematic use of a 28mm balloon has been proposed for pulmonary vein cryoisolation in patients with atrial fibrillation. OBJECTIVE: To assess the results of a dual balloon size strategy using a 23 or 28mm cryoballoon catheter for pulmonary vein isolation. METHODS: A total of 118 patients (mean age 56 ± 10 years) with paroxysmal (n=85) or persistent atrial fibrillation (n=33) were enrolled. Patients with four pulmonary veins<20mm in diameter were isolated with a 23mm cryoballoon (n=29); patients with one pulmonary vein diameter ≥20mm were isolated with a 28mm cryoballoon (n=89). RESULTS: No significant difference in procedural variables was observed between the two groups. AF-free survival, after a mean follow-up of 19.9 ± 5 months, was similar in the two groups (69% vs 62%; p=0.57 and between patients with paroxysmal atrial fibrillation (68% vs 68%; p=0.91) or persistent AF (75% vs 48%; p=0.60). AF duration before the ablation procedure (p=0.005) was an independent predictor of AF recurrence. Phrenic nerve palsy rate was not statistically different in the two groups (4 [14%] vs 9 [10%]; p=0.73). The temperature in the right superior pulmonary vein (p=0.008) was an independent predictor of phrenic nerve palsy. Five patients developed left atrial flutter with the 28mm diameter balloon versus none with the 23mm balloon. CONCLUSIONS: A dual balloon size strategy was not associated with a lower AF-free survival or a higher procedure-related complication rate in patients in whom the 23mm balloon was used. Pulmonary vein isolation with a 23mm cryoballoon catheter appears to be an appropriate option in selected patients with small pulmonary vein diameters.
Authors: Alexander Bohó; Silvia Mišíková; Peter Spurný; Erika Komanová; Michal Kerekanič; Marek Hudák; Branislav Stančák Journal: Wien Klin Wochenschr Date: 2015-07-04 Impact factor: 1.704
Authors: David R Altmann; Sven Knecht; Christian Sticherling; Peter Ammann; Beat Schaer; Stefan Osswald; Michael Kühne Journal: J Atr Fibrillation Date: 2012-04-14
Authors: Jason G Andrade; Marc Dubuc; Peter G Guerra; Laurent Macle; Lena Rivard; Denis Roy; Mario Talajic; Bernard Thibault; Paul Khairy Journal: Indian Pacing Electrophysiol J Date: 2012-04-30