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A novel double cryoballoon strategy in persistent atrial fibrillation: a pilot study

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Abstract

Aims

Cryoballoon technology is a promising technique in paroxysmal atrial fibrillation (AF) ablation. However, success rates in patients with persistent AF have not been convincing. There is a trend toward performing more extensive procedures that are referred to as ‘pulmonary vein isolation plus.’ To combine pulmonary vein isolation (PVI) and antral substrate modification, we used both the 23-mm and 28-mm cryoballoon in a single approach in patients with persistent AF.

Methods and results

33 consecutive patients (26 men, age 60 ± 10 years, LA size 44 ± 5 mm) with persistent AF were prospectively included. All patients underwent the “double balloon strategy:” at least two applications at each pulmonary vein (PV) using the smaller 23-mm balloon to isolate the PV at the ostial level plus at least one additional freeze by the 28-mm balloon at the wide PV antral level. 7-day Holter monitors were performed during follow-up at 1, 3, 6, 9, 12, 18 and 24 months post-ablation. 131 of 133 PVs were targeted and isolated (98.4 %). A mean of 14 ± 2 cryoballoon applications per patient or 3.5 ± 1.5 applications per vein were performed. After a single procedure and mean follow-up of 15 ± 3 months, 69.7 % of patients remained in sinus rhythm (3-month blanking period). There were no major complications.

Conclusions

In persistent AF, the “double balloon strategy;” combining the small and large cryoballoon allowed ostial PV isolation followed by antral cryoablation is feasible, safe and associated with a favorable outcome.

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Abbreviations

AF:

Atrial fibrillation

PV:

Pulmonary vein

PVI:

Pulmonary vein isolation

LA:

Left atrium

LSPV:

Left superior pulmonary vein

LIPV:

Left inferior pulmonary vein

RSPV:

Right superior pulmonary vein

RIPV:

Right inferior pulmonary vein

SD:

Standard deviation

ICE:

Intracardiac echocardiography

PNP:

Phrenic nerve palsy

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Conflict of interest

No disclosures relevant to the manuscript have to be declared.

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Authors and Affiliations

  1. Department of Cardiology, Klinikum München-Bogenhausen, Englschalkingerstr. 77, 81925, Munich, Germany

    Martin Schmidt, Uwe Dorwarth, Florian Straube, Michael Wankerl, Jürgen Krieg, Alexander W. Leber, Hans Ullrich Ebersberger & Ellen Hoffmann

  2. Department of Radiology, Technical University of Munich, Munich, Germany

    Armin Huber & Ernst Rummeny

  3. Department of Cardiology, University of Utah, Salt Lake, UT, USA

    Marcos Daccarett

Authors
  1. Martin Schmidt
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  2. Uwe Dorwarth
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Correspondence to Martin Schmidt.

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Schmidt, M., Dorwarth, U., Straube, F. et al. A novel double cryoballoon strategy in persistent atrial fibrillation: a pilot study. Clin Res Cardiol 101, 777–785 (2012). https://doi.org/10.1007/s00392-012-0456-y

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  • DOI: https://doi.org/10.1007/s00392-012-0456-y

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