Abstract 15707: Change in Cryo-Balloon Pressure Waveforms during Balloon Inflation is Poorly Correlated with Pulmonary Vein Occlusion
Background: Pulmonary vein (PV) isolation by means of balloon cryoablation is widely used to treat atrial fibrillation (AF).
Objective: The goal of this study was to find a correlation between PV occlusion and a change in the pressure waveforms recorded at the tip of the cryoablation catheter.
Methods: We analyzed 36 pulmonary veins in 10 consecutive patients (68±8 years old) undergoing cryoablation of paroxysmal AF. Pulmonary vein occlusion was confirmed by transesophageal echocardiography (TEE) and PV angiography. Occlusion was rated on a scale of 1 to 4, in which 1 indicated poor occlusion and 4 indicated excellent occlusion without leakage on TEE. We documented the point at which the pressure curve recorded at the balloon tip was converted from a left atrial (LA) into an exaggerated V-wave pressure tracing.
Results:The change in the pressure waveform (from LA to V-wave pressures) correlated with a PV occlusion score of 4 (complete occlusion without leak) in 25 (70%) of the 36 pulmonary veins, for a sensitivity of 88%. On the other hand, the specificity was only 62%: in 23 attempts to occlude the PV, no waveform changes were seen, and leakage was still present on TEE; in 13 other attempts to occlude the PV, PV waveform changes were not seen, yet occlusion was confirmed by TEE and PV angiography.
Conclusion: The change in pressure waveforms is moderately sensitive but not specific for confirming cryo-balloon occlusion of PVs. Therefore, during cryoablation PV isolation, occlusion should be confirmed by using TEE or PV angiography.
- Arrhythmias, treatment of
- Atrial fibrillation
- Catheter ablation
- Transesophageal echocardiography
- © 2012 by American Heart Association, Inc.