Abstract 20134: Can Cryoballoon Ablation Isolate the Left Atrial Posterior Wall Including the Pulmonary Veins for Paroxysmal Atrial Fibrillation?
Introduction: Pulmonary vein (PV) isolation with cryoballoon ablation (CRA) has been introduced and proven useful for curing atrial fibrillation (AF). Isolating the left atrial posterior wall (LAPW) including the PVs with radiofrequency ablation (RFA) has been reported to be a useful method to increase a success rate of curing AF, because the LAPW plays an important role for AF pathophysiology. In RFA isolation lines can be arbitrary, while an isolation area by CRA is usually limited by the anatomical relation between the cryoballoon and the PV ostium. Whether CRA can isolate the LAPW is unknown.
Methods: Consecutive 39 patients underwent CRA (28 mm, Arctic Front Advance) for paroxysmal AF. Simplified PV isolation with CRA was performed in initial 11 patients (PCr-Group, 8 men, 63 y/o). In the rest of 28 patients we ablated the LAPW additionaly with the cryoballoon by pushing the cryoballoon toward the LAPW after PV isolation (WCr-Group, 17 men, 65 y/o). From the post-ablation voltage map (EnSite NavX system) of the LA we measured the shortest distance between contralateral margins of ≤ 0.1 mV area in the LAPW, which was represented in the gray region in the Figure (PWD).
Results: The mean left atrial diameter was 35.5 mm in the PCr-Group and 34.2 mm in the WCr-Group. The mean PWD in the WCr-Group (1.3 mm) was significantly shorter than that in the PCr-Group (23.9 mm) (p <0.01) . In the WCr-group the PWD was 0 mm like left atrial posterior isolation (Figure) in 19 patients (67.9%) and was significantly correlated with left atrial diameter (r=0.514, p=0.005). Thirty-five mm of the LAD was the optimal cut-off value which determined whether the PWD was 0 mm or not. (sensitivity: 0.74, specificity: 0.67). In 1 patient (2.6%) post-procedural recurrence of PAF occured.
Conclusions: Isolation of the LAPW including the PV with CRA was feasible and may lead to better results for curing AF.
Author Disclosures: Y. Murakami: None.
- © 2016 by American Heart Association, Inc.