European Heart Journal Advance Access originally published online on June 14, 2007
European Heart Journal 2007 28(18):2231-2237; doi:10.1093/eurheartj/ehm227
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Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome
Clinical Electrophysiology Unit, Department of Cardiology, Thoraxcentre, Erasmus Medical Centre, Dr Molewaterplein 40, Room BD416, 3015 GD Rotterdam, The Netherlands
Received 12 March 2007; revised 1 May 2007; accepted 10 May 2007; online publish-ahead-of-print 14 June 2007.
* Corresponding author. Tel: +31 104633991; fax: +31 104634420. E-mail address: y.vanbelle{at}erasmusmc.nl
Aims: To assess safety, feasibility and short term outcome of pulmonary vein (PV) isolation in paroxysmal atrial fibrillation (AF) with a cryoballoon.
Methods: We consecutively treated 57 patients with a double lumen 23 or 28 mm cryoballoon. The acute results, complications and follow-up over the first three months were analysed, using a comprehensive and intensive follow-up period.
Results: During 57 procedures, 185 of 220 targeted PV's were successfully isolated using the cryoballoon (84%) (balloon group, 33 patients). In 33 veins (15%) an additional segmental isolation (hybrid group, 24 patients) was necessary with a standard cryocatheter to achieve isolation. The average procedure times were respectively 211 ± 108 and 261 ± 83 minutes (NS), the average fluoroscopy times 52 ± 36 and 66 ± 33 minutes (NS). The number of balloon applications did not differ between both groups: respectively a median 9 (4–18) and 10 (5–17) (NS). We observed four phrenic nerve paralysis after ablation of the right superior PV: two resolved immediately after cessation of the cryoenergy, one recovered after 3 months, one persisted up to 6 months. A daily transtelephonic rhythm recording showed a significant drop in mean AF burden from 24% to 10%, 8% and 5% during the three consecutive months of follow-up (p < 0.01 versus baseline). No differences were observed between the treatment groups. 34 patients (60%) were completely free from AF after a single procedure.
Conclusions: Balloon cryoablation of the pulmonary veins with additional segmental isolation if necessary, is a good approach for patients presenting with paroxysmal AF, showing a significant reduction in AF burden after a single procedure. The major complication seems to be phrenic nerve paralysis after ablation of the right superior PV, but this is potentially reversible over several months.
Key Words: Clinical electrophysiology • Atrial fibrillation • Pulmonary vein isolation • Catheter ablation • Cryothermal • Balloon
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  T. Neumann, J. Vogt, B. Schumacher, A. Dorszewski, M. Kuniss, H. Neuser, K. Kurzidim, A. Berkowitsch, M. Koller, J. Heintze, et al. Circumferential Pulmonary Vein Isolation With the Cryoballoon Technique: Results From a Prospective 3-Center Study J. Am. Coll. Cardiol., July 22, 2008; 52(4): 273 - 278. [Abstract] [Full Text] [PDF]
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