Abstract 3503: Effective Isolation of Pulmonary Veins with Cryoballoon Technique in Atrial Fibrillation: First Follow-up
Purpose: In the treatment of paroxysmal atrial fibrillation (af) a reliable anatomically oriented approach to isolate the pulmonary veins (pv) seems optimal. However, segmental isolation with radiofrequency energy showed a reconduction in 90 % and pv stenoses in about 5 % of patients (p). Substrate modification unfortunately associated with the risk of esophago-left atrial fistulas may be an overtreatment in trigger induced af. This study reports on the first experience in isolating pv with a new balloon technique with cryoenergy.
Methods: After pv angiography and Lasso mapping of sleeve potentials isolation was performed with a new 28/23mm balloon (Arctic Front, Cryocath, Canada). After inflation the over a wire balloon occludes the venous ostium and freezes down to −50 to − 70° C 8 minutes two times per vein with nitrous oxide. Lasso mapped rest potentials were eliminated with additional balloon freezes or with the 9 french Freezor Max catheter.
Results: We treated 49 patients (p) (13 women, mean age 59±11 years, 42 with paroxysmal, 7 persistent af, left atrium 42±5 mm, 29 with lone af, 12 hypertension, 8 mild structural heart disease) with the new 23 or 28 mm Arctic Front balloon. Mean vein diameter was 18.8±4 mm angiographically. With a mean number of 2.4±0.6 impulses and a mean temperature of − 48±19°C we could isolate 72% of the left pv, 73 % of the right upper and 59 % of the right lower pv with balloon only. After touch up of rest potentials in 31 % of pv we isolated 100 % of all pv. The procedure time was 222±41 min, the X-ray burden 39 ±11 min. We observed phrenic nerve palsy in three p treated with the 23 mm balloon. During a first short-term follow-up of 3–6 months, 24 of 31 p (including 5 redos) had no af recurrence controlled with 7-day Holter. 7 p with recurrence showed a marked reduction of af burden.
Conclusion: The new cryoballoon technique is safe and highly effective acutely and during follow-up. The advantage in comparison with other innovative tools is the high cooling power, isolation of parts of venous antrum and a high percentage of stand alone pv isolation. Avoidance of prenic nerve palsy and efficacy of different balloon sizes has to be focused.