Intracardiac echocardiography guided nonocclusive balloon cryothermal applications to achieve antral isolation during pulmonary vein isolation.
J Interv Card Electrophysiol
; 62(2): 329-336, 2021 Nov.
Article
en En
| MEDLINE
| ID: mdl-33106958
ABSTRACT
OBJECTIVE:
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.METHODS:
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.RESULTS:
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.CONCLUSION:
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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Venas Pulmonares
/
Fibrilación Atrial
/
Ablación por Catéter
/
Criocirugía
Tipo de estudio:
Prognostic_studies
Límite:
Humans
Idioma:
En
Revista:
J Interv Card Electrophysiol
Asunto de la revista:
CARDIOLOGIA
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos