The challenging right inferior pulmonary vein: A systematic approach for successful cryoballoon ablation.
Atrial fibrillation
Cryoablation
Fibrillation Atriale
Isolation veineuse pulmonaire
Pulmonary vein isolation
Right inferior pulmonary vein
Veine pulmonaire inférieure droite
Journal
Archives of cardiovascular diseases
ISSN: 1875-2128
Titre abrégé: Arch Cardiovasc Dis
Pays: Netherlands
ID NLM: 101465655
Informations de publication
Date de publication:
Historique:
received:
20
12
2018
revised:
23
02
2019
accepted:
21
05
2019
pubmed:
27
8
2019
medline:
28
11
2019
entrez:
27
8
2019
Statut:
ppublish
Résumé
Pulmonary vein isolation (PVI) using cryoballoon ablation is widely used for rhythm control in patients with paroxysmal atrial fibrillation. This technique has a steep learning curve, and PVI can be achieved quickly in most patients. However, the right inferior pulmonary vein (RIPV) is often challenging to occlude and isolate. We aimed to analyse the efficacy of RIPV ablation using a systematic approach. Consecutive patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. A systematic approach was used for RIPV cryoablation. The primary endpoint was acute RIPV isolation during initial freeze. A total of 214 patients were included. RIPV isolation during initial freeze occurred in 179 patients (82.2%). Real-time PVI could be observed in 72 patients (33.6%), whereas cryoballoon stability required pushing the Achieve™ catheter inside the RIPVs in the remaining patients. The rate of unsuccessful or aborted first freeze as a result of insufficient minimal temperature was significantly higher in patients with real-time pulmonary vein potential recording (16.7% vs. 6.3%; P=0.031). To overcome this issue and obtain both stability and real-time PVI, a dedicated "whip technique" was developed. Twelve patients (5.6%) required a redo ablation; only two of these had a reconnected RIPV. A systematic approach to RIPV cryoablation can lead to a high rate of first freeze application. Operators should not struggle to visualize pulmonary vein potentials before ablation, as this may decrease cryoapplication efficacy. Thus, stability should be preferred over real-time PVI for RIPV ablation. Both stability and real-time PVI can be obtained using a "whip technique".
Sections du résumé
BACKGROUND
BACKGROUND
Pulmonary vein isolation (PVI) using cryoballoon ablation is widely used for rhythm control in patients with paroxysmal atrial fibrillation. This technique has a steep learning curve, and PVI can be achieved quickly in most patients. However, the right inferior pulmonary vein (RIPV) is often challenging to occlude and isolate.
AIM
OBJECTIVE
We aimed to analyse the efficacy of RIPV ablation using a systematic approach.
METHODS
METHODS
Consecutive patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. A systematic approach was used for RIPV cryoablation. The primary endpoint was acute RIPV isolation during initial freeze.
RESULTS
RESULTS
A total of 214 patients were included. RIPV isolation during initial freeze occurred in 179 patients (82.2%). Real-time PVI could be observed in 72 patients (33.6%), whereas cryoballoon stability required pushing the Achieve™ catheter inside the RIPVs in the remaining patients. The rate of unsuccessful or aborted first freeze as a result of insufficient minimal temperature was significantly higher in patients with real-time pulmonary vein potential recording (16.7% vs. 6.3%; P=0.031). To overcome this issue and obtain both stability and real-time PVI, a dedicated "whip technique" was developed. Twelve patients (5.6%) required a redo ablation; only two of these had a reconnected RIPV.
CONCLUSIONS
CONCLUSIONS
A systematic approach to RIPV cryoablation can lead to a high rate of first freeze application. Operators should not struggle to visualize pulmonary vein potentials before ablation, as this may decrease cryoapplication efficacy. Thus, stability should be preferred over real-time PVI for RIPV ablation. Both stability and real-time PVI can be obtained using a "whip technique".
Identifiants
pubmed: 31447317
pii: S1875-2136(19)30130-5
doi: 10.1016/j.acvd.2019.05.006
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
502-511Informations de copyright
Copyright © 2019 Elsevier Masson SAS. All rights reserved.