Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome

Aims To assess safety, feasibility and short term outcome of pulmonary vein (PV) isolation in paroxysmal atrial fibrillation (AF) with a cryoballoon. Methods We consecutively treated 57 patients with a double lumen 23 or 28 mm cryoballoon. The acute results, complications and follow-up over the firs...

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Bibliographic Details
Published in:European heart journal 2007-09, Vol.28 (18), p.2231-2237
Main Authors: Van Belle, Yves, Janse, Petter, Rivero-Ayerza, Maximo J., Thornton, Andrew S., Jessurun, Emile R., Theuns, Dominic, Jordaens, Luc
Format: Article
Language:English
Subjects:
Atrial fibrillation
Atrial Fibrillation - pathology
Atrial Fibrillation - surgery
Balloon
Balloon Occlusion - instrumentation
Biological and medical sciences
Cardiac dysrhythmias
Cardiology. Vascular system
Catheter ablation
Clinical electrophysiology
Cryosurgery - instrumentation
Cryothermal
Equipment Design
Feasibility Studies
Female
Heart
Humans
Length of Stay
Male
Medical sciences
Middle Aged
Pulmonary vein isolation
Pulmonary Veins - pathology
Pulmonary Veins - surgery
Treatment Outcome
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Summary:Aims To assess safety, feasibility and short term outcome of pulmonary vein (PV) isolation in paroxysmal atrial fibrillation (AF) with a cryoballoon. Methods We consecutively treated 57 patients with a double lumen 23 or 28 mm cryoballoon. The acute results, complications and follow-up over the first three months were analysed, using a comprehensive and intensive follow-up period. Results During 57 procedures, 185 of 220 targeted PV's were successfully isolated using the cryoballoon (84%) (balloon group, 33 patients). In 33 veins (15%) an additional segmental isolation (hybrid group, 24 patients) was necessary with a standard cryocatheter to achieve isolation. The average procedure times were respectively 211 ± 108 and 261 ± 83 minutes (NS), the average fluoroscopy times 52 ± 36 and 66 ± 33 minutes (NS). The number of balloon applications did not differ between both groups: respectively a median 9 (4–18) and 10 (5–17) (NS). We observed four phrenic nerve paralysis after ablation of the right superior PV: two resolved immediately after cessation of the cryoenergy, one recovered after 3 months, one persisted up to 6 months. A daily transtelephonic rhythm recording showed a significant drop in mean AF burden from 24% to 10%, 8% and 5% during the three consecutive months of follow-up (p < 0.01 versus baseline). No differences were observed between the treatment groups. 34 patients (60%) were completely free from AF after a single procedure. Conclusions Balloon cryoablation of the pulmonary veins with additional segmental isolation if necessary, is a good approach for patients presenting with paroxysmal AF, showing a significant reduction in AF burden after a single procedure. The major complication seems to be phrenic nerve paralysis after ablation of the right superior PV, but this is potentially reversible over several months.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehm227