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  • Title: Characterization of conduction recovery after pulmonary vein isolation using the "single big cryoballoon" technique.
    Author: Fürnkranz A, Chun KR, Nuyens D, Metzner A, Köster I, Schmidt B, Ouyang F, Kuck KH.
    Journal: Heart Rhythm; 2010; 7(2):184-90. PubMed ID: 20129295.
    Abstract:
    BACKGROUND: Pulmonary vein isolation using the cryoballoon technique (CB-PVI) has evolved into a simple and safe alternative for point-by-point radiofrequency ablation. Systematic analysis of conduction recovery occurring after CB-PVI and causing recurrent atrial fibrillation has not yet been performed. OBJECTIVE: The purpose of this study was to analyze conduction recovery after PVI using the single big (28-mm) cryoballoon technique. METHODS: Twenty-six patients with recurrent atrial tachyarrhythmia after previous CB-PVI underwent repeat ablation. Pulmonary vein (PV) reisolation was performed by antral irrigated radiofrequency ablation using electroanatomic mapping. For analysis of the location of conduction gaps, the ipsilateral LA-PV junction was divided into six equally distributed segments. RESULTS: PV reconduction frequently occurred into multiple (>2) PVs (54% patients). Conduction gaps could be abolished by single point ablation in 63% (lateral) and 41% (septal) of patients or by incomplete circular lesions in the remaining patients. A significantly higher number of patients exhibited conduction recovery at inferior segments (85% lateral, 77% septal) compared with superior segments (42% lateral, 31% septal). Furthermore, the ridge between PV ostia and left atrial appendage (LAA) was highly associated with reconduction into lateral PVs (81% of patients). Retrospective analysis of the initial CB-PVI-procedure revealed lower freezing temperatures at superior than inferior PVs as well as sharp catheter angulations with loss of central cryoballoon alignment to reach inferior PVs. CONCLUSION: Conduction recovery after CB-PVI occurs at a high incidence at inferior sites around ipsilateral PV ostia and the LAA-PV ridge. Modifications of the technique to ensure optimal balloon-tissue contact at predilection sites may improve long-term success rates.
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