Abstract 18046: Lower Transseptal Puncture Site Improves the Mechanical Advantage in Cryoballoon Ablation
Background: Cryoballoon ablation is an effective pulmonary veins isolation tool. The mechanical translation of forces from the groin is critical to the success of the procedure and is dependent on the incident angle at the transseptal site. Sharper negative angles, particularly for the inferior veins, leads to inferior leaks and the inability to completely isolate the pulmonary veins with cryoballoon alone. We hypothesize that a more inferior transseptal puncture site will allow better alignment of the cryoballoon system. However, the safety, feasibility and the quantification of the angle improvements have not been described.
Methods: Analysis of 200 consecutive cryoballoon ablation procedures was performed. Intracardiac ultrasound guidance and a Mullins type of sheath was used to perform transseptal puncture at least 1 centimeter below that of a typical fossa ovalis. Analysis of the change of angle of incidence was completed.
Results: The mechanical angles from the septum to the pulmonary veins were calculated and are displayed graphically below. Ability to perform an inferior transseptal puncture and perform all four pulmonary vein isolation without focal touchup was seen in 186 of 200 patients (93%). There were no acute complications from the lower transseptal puncture sites. Figure 1: Change of Incident Angle of Pulmonary Veins with a lower Transseptal Site
Conclusions: Inferior transseptal access in cryoballoon ablation is safe, feasible, and can improve the mechanical translation of cryoballoon ablation. This can lead to a higher pulmonary vein isolation success rate with cryoballoon alone, especially in the inferior veins. This may translate to an improved outcome and shorter procedure time. Extrapolation of this technique to other ablation technologies will need to be assessed.
- © 2012 by American Heart Association, Inc.