Abstract 14002: Long Term Success in Antral Cryo Isolation of Pulmonary Veins
Background: In cryo balloon based antral isolation of the pulmonary veins (pv) the recommended goal is to freeze not only the ostia and avoid phrenic nerve palsy. The large and the small Cryoballoon are used depending of the size and shape of the pv. This study reports the long term success in a large individually treated patient cohort with paroxysmal atrial fibrillation.
Methods: Pv isolation was performed with best fitting 28 or 23mm balloon (Arctic Front, Medtronic) or both sizes mostly due to mismatch with small veins freezing 6 minutes twice per vein. Residual potentials were eliminated with additional balloon freezes. Patients (p) were followed every three months (m) with 7 day holter and clinical visits, since one year every six months.
Results: We treated 710 pt (239 women, mean age 59±11 years, 682 with paroxysmal, 28 persistent af, left atrium 42±6 mm, 335 pt with lone af,292 hypertension, 83 mild structural heart disease, mean duration of af 68.4±69.4 months). With a mean number of 2.4±1 impulses we isolated in 656 pt (92%) all pv with balloon only, in earlier 53 pt with additional touch up. Out of the 656 pt in 289 i.e. 44 % we combined two balloon sizes. Procedure time decreased to 136±33 min and x ray burden to 22±8.8 min. Phrenic nerve palsy could be reduced from 2% to 0.7% (last 560 pt) using monitoring by pacing. During a mean follow up of 21±15 m and 1.1 procedures per pt of analyzed 421 pt 79 % (332 ) were free of af , with one procedure 70%. During a follow up of 27±14 m success rate of 301 p (FU ≥ 1 year) stabelized at 80%, 67% with one procedure.
Conclusion: Cryo balloon based antral isolation of the pv creates remaining success stability in long term outcome, although the equatorial freezing area especially of the 28 mm balloon may create inferior gaps and therefore recurrence of af. The development of the second balloon generation with homogeneous cooling and flow will fit with more sizes and shapes of pv. Side effects can be minimized.
- © 2012 by American Heart Association, Inc.