Intracardiac echocardiography guided nonocclusive balloon cryothermal applications to achieve antral isolation during pulmonary vein isolation.
Atrial fibrillation
Catheter ablation
Cryoablation
Cryoballoon
Posterior wall isolation
Pulmonary vein isolation
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
04
09
2020
accepted:
21
10
2020
pubmed:
28
10
2020
medline:
27
10
2021
entrez:
27
10
2020
Statut:
ppublish
Résumé
Ablation for atrial fibrillation (AF) requires electrical isolation of the pulmonary veins (PV) by wide-area circumferential PV antral isolation (PVAI). Cryoballoon ablation delivers cryoenergy circumferentially after occlusion of the PV by the cryoballoon; thus, it is likely that the level of isolation, determined by adequate balloon-tissue contact, depends on PV anatomy. We sought to examine the need for nonocclusive segmental cryoballoon ablation in achieving antral isolation, describe methods of accurate visualization of the cryoballoon using intracardiac echocardiography (ICE), and provide data on biophysical characteristics of an effective nonocclusive cryothermal lesion. Forty consecutive patients undergoing catheter ablation with a second-generation 28-mm cryoballoon and electroanatomic mapping (EAM) were included. Balloon was visualized with ICE, and its location was registered in EAM using available technology (CARTOSOUND, Biosense Webster). Need for delivery of nonocclusive lesions was based on level of isolation post occlusive lesions. Nonocclusive lesions to PVAI was required in 26 of 40 patients (65%) or 46 out of 148 veins (31%). Left PVs > 19.4 ± 2.9 mm, right superior PV > 20.2 ± 4.7mm, funnel-shaped PVs, and right PVs not converging to a carina were more likely to require nonocclusive lesions to achieve an antral level of isolation. Projection of balloon contour on EAM using CARTOSOUND successfully predicted level of isolation by voltage mapping. Nonocclusive cryoballoon applications are commonly required to achieve antral isolation. Use of ICE can be helpful in determining the accurate location of the balloon and in predicting the level of isolation by voltage map.
Identifiants
pubmed: 33106958
doi: 10.1007/s10840-020-00905-9
pii: 10.1007/s10840-020-00905-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
329-336Informations de copyright
© 2020. Springer Science+Business Media, LLC, part of Springer Nature.
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