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European Heart Journal Advance Access originally published online on December 24, 2008
European Heart Journal 2009 30(6):699-709; doi:10.1093/eurheartj/ehn570
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org
The online version of this article has been published under an open access model. Users are entitled to use, reproduce, disseminate, or display the open access version of this article for non-commercial purposes provided that the original authorship is properly and fully attributed; the Journal, Learned Society and Oxford University Press are attributed as the original place of publication with correct citation details given; if an article is subsequently reproduced or disseminated not in its entirety but only in part or as a derivative work this must be clearly indicated. For commercial re-use, please contact journals.permissions@oxfordjournals.org

The ‘single big cryoballoon’ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study

Kyoung-Ryul Julian Chun, Boris Schmidt, Andreas Metzner, Roland Tilz, Thomas Zerm, Ilka Köster, Alexander Fürnkranz, Buelent Koektuerk, Melanie Konstantinidou, Matthias Antz, Feifan Ouyang and Karl Heinz Kuck*

Department of Cardiology, Asklepios Klinik St Georg, Lohmühlenstr. 5, 20099 Hamburg, Germany

Received 8 July 2008; revised 6 November 2008; accepted 27 November 2008; online publish-ahead-of-print 24 December 2008.

* Corresponding author. Tel: +49 40 1818 85 2305, Fax: +49 40 1818 85 4435, Email: jongichun{at}t-online.de

See page 636 for the editorial comment on this article (doi:10.1093/eurheartj/ehp031)

Aims: Cryothermal energy (CTE) ablation via a balloon catheter (Arctic Front, CryocathTM) represents a novel technology for pulmonary vein isolation (PVI). However, balloon-based PVI approaches are associated with phrenic nerve palsy (PNP). We investigated whether ‘single big cryoballoon’-deployed CTE lesions can (i) achieve acute electrical PVI without left atrium (LA) imaging and (ii) avoid PNP in patients with paroxysmal atrial fibrillation (PAF).

Methods and results: After double transseptal punctures, one Lasso catheter and a big 28 mm cryoballoon catheter using a steerable sheath were inserted into the LA. PV angiography and ostial Lasso recordings from all PVs were obtained. Selective PV angiography was used to evaluate balloon to LA–PV junction contact. CTE ablation lasted 300 s, and the PN was paced during freezing at right-sided PVs. Twenty-seven patients (19 males, mean age: 56 ± 9 years, LA size: 42 ± 5 mm) with PAF (mean duration: 6.6 ± 5.7 years) were included. PVI was achieved in 97/99 PVs (98%). Median (Q1; Q3) procedural, balloon, and fluoroscopy times were 220 min (190; 245), 130 min (90; 170), and 50 min (42; 69), respectively. Three transient PNP occurred after distal PV ablations. No PV stenosis occurred. Total median (Q1; Q3) follow-up time was 271 days (147; 356), and 19 of 27 patients (70%) remained in sinus rhythm (3-month blanking period).

Conclusion: Using the single big cryoballoon technique, almost all PVs (98%) could be electrically isolated without LA imaging and may reduce the incidence of PNP as long as distal ablation inside the septal PVs is avoided.

Key Words: Catheter ablation • Atrial fibrillation • Cryoballoon • Pulmonary vein


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