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Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome

(2007) EUROPEAN HEART JOURNAL. 28(18). p.2231-2237
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Abstract
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.
Keywords
STENOSIS, SYSTEM, EFFICACY, DOGS, MYOCARDIUM, CRYOABLATION, ESOPHAGEAL FISTULA, PAROXYSMAL ATRIAL-FIBRILLATION, RADIOFREQUENCY CATHETER ABLATION, balloon, cryothermal, catheter ablation, OSTIAL ABLATION, pulmonary vein isolation, atrial fibrillation, clinical electrophysiology

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Chicago
Van Belle, Yves, Petter Janse, Maximo J Rivero-Ayerza, Andrew S Thornton, Emile R Jessurun, Dominic Theuns, and Luc Jordaens. 2007. “Pulmonary Vein Isolation Using an Occluding Cryoballoon for Circumferential Ablation: Feasibility, Complications, and Short-term Outcome.” European Heart Journal 28 (18): 2231–2237.
APA
Van Belle, Yves, Janse, P., Rivero-Ayerza, M. J., Thornton, A. S., Jessurun, E. R., Theuns, D., & Jordaens, L. (2007). Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome. EUROPEAN HEART JOURNAL, 28(18), 2231–2237.
Vancouver
1.
Van Belle Y, Janse P, Rivero-Ayerza MJ, Thornton AS, Jessurun ER, Theuns D, et al. Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome. EUROPEAN HEART JOURNAL. 2007;28(18):2231–7.
MLA
Van Belle, Yves et al. “Pulmonary Vein Isolation Using an Occluding Cryoballoon for Circumferential Ablation: Feasibility, Complications, and Short-term Outcome.” EUROPEAN HEART JOURNAL 28.18 (2007): 2231–2237. Print.
@article{8163538,
  abstract     = {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.},
  author       = {Van Belle, Yves and Janse, Petter and Rivero-Ayerza, Maximo J and Thornton, Andrew S and Jessurun, Emile R and Theuns, Dominic and Jordaens, Luc},
  issn         = {0195-668X},
  journal      = {EUROPEAN HEART JOURNAL},
  keywords     = {STENOSIS,SYSTEM,EFFICACY,DOGS,MYOCARDIUM,CRYOABLATION,ESOPHAGEAL FISTULA,PAROXYSMAL ATRIAL-FIBRILLATION,RADIOFREQUENCY CATHETER ABLATION,balloon,cryothermal,catheter ablation,OSTIAL ABLATION,pulmonary vein isolation,atrial fibrillation,clinical electrophysiology},
  language     = {eng},
  number       = {18},
  pages        = {2231--2237},
  title        = {Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome},
  url          = {http://dx.doi.org/10.1093/eurheartj/ehm227},
  volume       = {28},
  year         = {2007},
}

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