Abstract 19678: Safety of Cryoablation of Atrial Fibrillation in the Presence of Mechanical Mitral Valve
Introduction: Pulmonary vein isolation is an effective therapy for recurrent, symptomatic, drug-refractory atrial fibrillation (AF). Radiofrequency ablation (RFA) has long been the standard of care, while cryoballoon technology has emerged as a feasible approach with promising results in paroxysmal AF. There is risk of catheter entrapment during RFA in patients with mechanical mitral valve and the experience is limited. To the best of our knowledge pulmonary vein isolation (PVI) with cryoablation has never been reported in a patient with a mechanical mitral valve.
Case: A 52 year old male presented with symptomatic paroxysmal AF, nonischemic cardiomyopathy biventricular defibrillator, mechanical aortic and mitral valve replacement for rheumatic valvular disease. The patient was highly symptomatic while on sotalol therapy. We proceeded with PVI using cryoablation technology.
Procedure: After a single transseptal puncture, a 28 mm cryoballoon catheter and 20mm 8 pole circular recording catheter were advanced into the left atrium. All four pulmonary veins were isolated with the aid of intracardiac echo, fluoroscopy and Ensite 3-D mapping. Caution was maintained to minimize catheter manipulation and to keep the catheters away from the mechanical valvular plane.
Discussion: The use of cryoablation for PVI has several potential advantages over radiofrequency ablation including greater improvement in fluoroscopic time and total procedure duration. The risk of prosthetic valve dysfunction due to trauma from ablation catheter, and entrapment of the circular mapping catheter in the mitral valve apparatus represent major concerns when performing PVI in patients with mitral valve replacement, however, less need for manipulation of catheter is an advantage of cryoablation compared to RFA in this case. This case illustrates that cryoablation can be successfully performed in a patient with a prosthetic mechanical mitral valve.
Author Disclosures: S. Rajsheker: None. P. Gujja: None. M. Attari: None.
- © 2014 by American Heart Association, Inc.