The challenging right inferior pulmonary vein A systematic approach for successful cryoballoon ablation

Autor: Nathalie Behar, Mathieu Lederlin, Celine Chérel, D. Pavin, Raphaël P. Martins, Christophe Leclercq, Philippe Mabo, Camille Pichard, Vincent Galand, Jean-Claude Daubert, Amélie Nicolas
Přispěvatelé: Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CCSD, Accord Elsevier
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
Reoperation
Cryoablation
medicine.medical_specialty
Isolation veineuse pulmonaire
medicine.medical_treatment
Action Potentials
Rhythm control
030204 cardiovascular system & hematology
Cryosurgery
Pulmonary vein isolation
Pulmonary vein
03 medical and health sciences
0302 clinical medicine
Right inferior pulmonary vein
Heart Rate
Recurrence
medicine
Humans
Prospective Studies
030212 general & internal medicine
Cryoballoon ablation
ComputingMilieux_MISCELLANEOUS
Aged
[SDV.IB] Life Sciences [q-bio]/Bioengineering
Veine pulmonaire inférieure droite
business.industry
Atrial fibrillation
General Medicine
Middle Aged
medicine.disease
Ablation
Surgery
Fibrillation Atriale
Catheter
Treatment Outcome
Pulmonary Veins
Female
[SDV.IB]Life Sciences [q-bio]/Bioengineering
Cardiology and Cardiovascular Medicine
business
Zdroj: Archives of cardiovascular diseases
Archives of cardiovascular diseases, Elsevier/French Society of Cardiology, 2019, 112 (8-9), pp.502-511. ⟨10.1016/j.acvd.2019.05.006⟩
Archives of cardiovascular diseases, 2019, 112 (8-9), pp.502-511. ⟨10.1016/j.acvd.2019.05.006⟩
ISSN: 1875-2136
1875-2128
DOI: 10.1016/j.acvd.2019.05.006⟩
Popis: Summary Background Pulmonary vein isolation (PVI) using cryoballoon ablation is widely used for rhythm control in patients with paroxysmal atrial fibrillation. This technique has a steep learning curve, and PVI can be achieved quickly in most patients. However, the right inferior pulmonary vein (RIPV) is often challenging to occlude and isolate. Aim We aimed to analyse the efficacy of RIPV ablation using a systematic approach. Methods Consecutive patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. A systematic approach was used for RIPV cryoablation. The primary endpoint was acute RIPV isolation during initial freeze. Results A total of 214 patients were included. RIPV isolation during initial freeze occurred in 179 patients (82.2%). Real-time PVI could be observed in 72 patients (33.6%), whereas cryoballoon stability required pushing the Achieve™ catheter inside the RIPVs in the remaining patients. The rate of unsuccessful or aborted first freeze as a result of insufficient minimal temperature was significantly higher in patients with real-time pulmonary vein potential recording (16.7% vs. 6.3%; P = 0.031). To overcome this issue and obtain both stability and real-time PVI, a dedicated “whip technique” was developed. Twelve patients (5.6%) required a redo ablation; only two of these had a reconnected RIPV. Conclusions A systematic approach to RIPV cryoablation can lead to a high rate of first freeze application. Operators should not struggle to visualize pulmonary vein potentials before ablation, as this may decrease cryoapplication efficacy. Thus, stability should be preferred over real-time PVI for RIPV ablation. Both stability and real-time PVI can be obtained using a “whip technique”.
Databáze: OpenAIRE
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