Abstract 17088: Permanence of Pulmonary Vein Isolation Using Cryoballoon Observed in Repeat Left Atrial Ablation
Background: Cryoballoon ablation using Arctic Front Advance (AFA) (Medtronic, Minneapolis, MN) has been used for the treatment of atrial fibrillation (AF). Permanence of pulmonary vein isolation (PVI) has not been established, particularly correlating to reduced dosing strategies and to time-to-isolation during PVI.
Methods: A single center retrospective chart review of 644 patients who had undergone prior AF ablation using AFA was examined (195 paroxysmal, 335 persistent, and 114 long-standing persistent). Dosing of 3 minutes and repeat ablation at 2 minutes were utilized. In addition, termination with temperature <-55 C were utilized to minimize collateral injury. 73 of 644 patients underwent repeat ablation, where previous procedural characteristics and the status of PVI at the time of repeat ablation were analyzed.
Results: 73 of 644 patients (11.3%) underwent repeat ablation for left atrial arrhythmias (6 paroxysmal, 28 persistent, 39 long-standing persistent) with time to repeat ablation 1.5 month to 18 months (average 4.2 months). Re-examination of 292 PV in 73 patients revealed 282 PVs (96%) were isolated. Of the 10 PVs with recurrent conduction, 5 were in RIPV, 3 were in LIPV, 1 was in RSPV, and 1 was at the left common PV. Initial time-to-isolation was attainable in 92% of PVI. All index PVIs with time-to-isolation <90 seconds with an additional 2 minute repeat ablation were found to have long-term PVI. There were no stroke, no PV stenosis, no phrenic nerve injury, and no atrial-esophageal fistula observed in this series.
Conclusions: Treatment of AF with AFA cryoballoon was able to create significant long-term permanent PVI while still using a reduced dosing strategy. Time-to-isolation was a good predictor of long-term PVI when isolation was obtained in less than 90 seconds. Reduced dosing may also lead to reduced collateral injury while maintain long-term successful PVI.
Author Disclosures: A. Chiu: None. M. Al-Zubaidi: None. W. Su: Other Research Support; Significant; Medtronic.
- © 2014 by American Heart Association, Inc.