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CLINICAL RESEARCH: ELECTROPHYSIOLOGY

Pulmonary vein isolation using transvenous catheter cryoablation for treatment of atrial fibrillation without risk of pulmonary vein stenosis

Hung-Fat Tse, MD, FACC^*,*, Sven Reek, MD, Carl Timmermans, MD, PhD, FACC, Kathy Lai-Fun Lee, MBBS^*, J. Christoph Geller, MD, Luz-Maria Rodriguez, MD, PhD, FACC, Benoit Ghaye, MD, Gregory M. Ayers, MD, PhD, FACC^||, Harry J. G. M. Crijns, MD, PhD, Helmut U. Klein, MD and Chu-Pak Lau, MD, FACC^*

^* University of Hong Kong, Queen Mary Hospital, Hong Kong, China
Division of Cardiology, Otto-von-Guericke University, Magdeburg, Germany
Department of Cardiology, Academic Hospital Maastricht and Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
Department of Medical Imaging, Department of Medical Imaging, University Hospital of Liége, Liége, Belgium
^|| CryoCor Inc., San Diego, California, USA

Manuscript received July 26, 2002; revised manuscript received April 29, 2003, accepted May 9, 2003.

^* Reprint requests and correspondence: Dr. Hung-Fat Tse, Room 1928, Block K, Cardiology Division, Department of Medicine, University of Hong Kong, Queen Mary Hospital, Hong Kong, China.
hftes{at}hkucc.hku.hk

OBJECTIVES: We sought to evaluate the efficacy and safety of pulmonary vein (PV) isolation using transvenous cryoablation for the treatment of atrial fibrillation (AF).

BACKGROUND: Although electrical isolation of PVs with radiofrequency energy for the treatment of AF is feasible, it is associated with a significant risk of PV stenosis. Cryoablation is a new alternative therapy allowing ablation of tissue while preserving its underlying architecture.

METHODS: In 52 patients with paroxysmal (n = 45) or persistent (n = 7) AF, PV isolation using the CryoCor cryoablation system (CyroCor Inc., San Diego, California) with a 10F deflectable transvenous catheter was performed as guided by ostial PV potentials. Cryoablation was applied twice at each targeted site (2.5 to 5 min/application). Computed tomography (CT) of the thorax was performed at baseline and at 3 and 12 months to evaluate for PV stenosis.

RESULTS: All targeted PVs were completely isolated in 49 (94%) of 52 of patients. Of 152 PVs targeted, 147 (97%) were successfully isolated (mean 3.0 PVs isolated per patient). After a mean period of 12.4 ± 5.5 months of follow-up, 37 (71%) of 52 patients had no recurrence of AF or were clinically improved, including 29 patients (56%) who had no recurrence of AF with (n = 11) or without the use of anti-arrhythmic drugs. At 3 and 12 months, the CT scan showed no evidence of PV stenosis associated with cryoablation in any patients.

CONCLUSIONS: Transvenous catheter cryoablation is an effective method to create PV electrical isolation for the treatment of AF. A clinically satisfactory result can be achieved in 71% of patients with AF, without the risk of PV stenosis.

Abbreviations and Acronyms   AF   atrial fibrillation   CT   computed tomography   LIPV   left inferior pulmonary vein   LSPV   left superior pulmonary vein   PV   pulmonary vein   RF   radiofrequency   RIPV   right inferior pulmonary vein   RSPV   right superior pulmonary vein

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