Abstract 17103: Novel Utilization of Cryoballoon for Ablation of Coumadin Ridge, Left and Right Atrial Appendage for Atrial Fibrillation
Background: Ablation of persistent and long-standing persistent Atrial Fibrillation (AF) often requires the ablations near the Coumadin Ridge and the left and right atrial appendage (LAA and RAA). Large area cryoballoon ablation using Arctic Front Cryoballoon (Medtronic CryoCath LP Montreal Canada) may be safer and easier to ablation these targets, however the safety and technique has not been described.
Methods: 325 patients underwent cryoballoon ablation for persistent and long-standing persistent AF was analyzed. After initial pulmonary vein isolation was accomplished, extra-pulmonary vein ablation was performed. Placement of the cryoballoon tip with anchoring at the LAA then superior and posterior pressure to make contact toward the Coumadin Ridge was performed. Ablation at 3 minutes interval was performed and LAA was intentionally not isolated. 12 of 325 patients also had significant complex fractionated electrogram at RAA, and were ablated with cryoballoon by anchoring at the RAA. Post-ablation voltage map was performed to confirm the intended ablations.
Results: All 325 patients had successful modification of the intended targets confirmed by voltage map. 28 of 325 patients had termination of AF during ablation and 6 of 325 patients had significant vagal response correlating with gangion plexi modification. 12 of 325 patients also had significant complex fractionated electrogram at the RAA which ablation of the RAA resulted in AF termination in 7 of 12 patients. There was no perforation or phrenic injury observed.
Conclusion: This case series demonstrates novel utilization of cryoballoon technology to treat challenging extra-pulmonary vein high-yield regions. Coumadin ridge, RAA, and LAA region can be ablated safely and effectively using cryoballoon to potentially improve the single procedure success rate and reduce the procedural cost.
- © 2013 by American Heart Association, Inc.