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Additional cryoapplications at the pulmonary vein antrum using a 28-mm second-generation cryoballoon: a pilot study of extra-pulmonary vein ablation

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Abstract

Isolation areas post-28-mm cryoballoon pulmonary vein isolation (CB-PVI) are smaller than post-radiofrequency PV antrum isolation at the left superior PV (LSPV) antrum and recurrent atrial fibrillation (AF) can originate from this area. This pilot study evaluated the impact of additional extra-PV CB applications at the LSPV antrum following conventional CB-PVI. Eighteen paroxysmal AF patients underwent CB-PVI with single 3-min freeze techniques. Following the CB-PVI, 2-min CB applications were added once or twice at the LSPV antrum. Before and after extra-PV ablation, left atrial (LA) 3-D electroanatomical maps were created. Seventy-two total PVs were successfully isolated with 4.2 ± 0.4 applications/patient with 28-mm CBs. The mean LA posterior wall (LAPW) and non-isolated LAPW areas were 14.9 ± 3.6 and 6.9 ± 2.8 cm2, respectively. After 1.6 ± 0.5 mean extra-PV applications, the upper non-isolated LAPW area significantly decreased from 3.3 ± 1.8 to 2.5 ± 1.8 cm2 (p < 0.001). The lowest esophageal temperatures during the extra-PV ablation were 27 °C. The total procedure and fluoroscopic times were 72.8 ± 13.1 and 15.2 ± 5.9 min, respectively. Silent gastric hypomotility was detected in 2/9 patients 1 day later, and mild PV stenosis was observed in 4/72 PVs 3 months later, but did not progress. At 12-month after single procedures, 16 (88.9%) patients were free from recurrent AF off antiarrhythmic drugs. A median of 8.0 [6.0–10.0] months later, PV reconnections were detected in 3/12 (25.0%) PVs. The non-isolated LAPW area was significantly larger in the chronic than acute phase (14.3 ± 5.2 cm2, p = 0.016). This pilot study suggested the potential feasibility of additional LSPV antral cryoapplications following a conventional CB-PVI. The strategy warrants further study in more patients.

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Acknowledgements

We would like to thank Mr. John Martin for his help in the preparation of the manuscript.

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Authors and Affiliations

  1. Department of Cardiovascular Medicine, Fukui University, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan

    Shinsuke Miyazaki

  2. Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan

    Shinsuke Miyazaki, Takatsugu Kajiyama, Tomonori Watanabe, Sadamitsu Ichijo & Yoshito Iesaka

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  1. Shinsuke Miyazaki
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  2. Takatsugu Kajiyama
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  3. Tomonori Watanabe
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  5. Yoshito Iesaka
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Correspondence to Shinsuke Miyazaki.

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Miyazaki, S., Kajiyama, T., Watanabe, T. et al. Additional cryoapplications at the pulmonary vein antrum using a 28-mm second-generation cryoballoon: a pilot study of extra-pulmonary vein ablation. Heart Vessels 33, 1052–1059 (2018). https://doi.org/10.1007/s00380-018-1142-4

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  • DOI: https://doi.org/10.1007/s00380-018-1142-4

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