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 |
|
This article has been cited by other articles:
|
|
|
|
 
K.-R. J. Chun, B. Schmidt, A. Metzner, R. Tilz, T. Zerm, I. Koster, A. Furnkranz, B. Koektuerk, M. Konstantinidou, M. Antz, et al.
The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study
Eur. Heart J.,
December 24, 2008;
(2008)
ehn570v1.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Van Belle, P. Janse, D. Theuns, T. Szili-Torok, and L. Jordaens
One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation
Europace,
November 1, 2008;
10(11):
1271 - 1276.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Weerasooriya, P. Jais, M. Hocini, F. Sacher, and M. Haissaguerre
Balloon cryoablation for paroxysmal atrial fibrillation
Europace,
November 1, 2008;
10(11):
1251 - 1252.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Malmborg, S. Lonnerholm, and C. Blomstrom-Lundqvist
Acute and clinical effects of cryoballoon pulmonary vein isolation in patients with symptomatic paroxysmal and persistent atrial fibrillation
Europace,
November 1, 2008;
10(11):
1277 - 1280.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. Moreira, R. Manusama, C. Timmermans, B. Ghaye, S. Philippens, H. J.J. Wellens, and L.-M. Rodriguez
Long-Term Follow-Up After Cryothermic Ostial Pulmonary Vein Isolation in Paroxysmal Atrial Fibrillation
J. Am. Coll. Cardiol.,
February 26, 2008;
51(8):
850 - 855.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y. Van Belle, P. Janse, M. J. Rivero-Ayerza, A. S. Thornton, E. R. Jessurun, D. Theuns, and L. Jordaens
Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome
Eur. Heart J.,
September 2, 2007;
28(18):
2231 - 2237.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Sacher, K. H. Monahan, S. P. Thomas, N. Davidson, P. Adragao, P. Sanders, M. Hocini, Y. Takahashi, M. Rotter, T. Rostock, et al.
Phrenic Nerve Injury After Atrial Fibrillation Catheter Ablation: Characterization and Outcome in a Multicenter Study
J. Am. Coll. Cardiol.,
June 20, 2006;
47(12):
2498 - 2503.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Khatri and S. E. Kasner
Ischemic strokes after cardiac catheterization: opportune thrombolysis candidates?
Arch Neurol,
June 1, 2006;
63(6):
817 - 821.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Sarabanda, T. J. Bunch, S. B. Johnson, S. Mahapatra, M. A. Milton, L. R. Leite, G. K. Bruce, and D. L. Packer
Efficacy and Safety of Circumferential Pulmonary Vein Isolation Using a Novel Cryothermal Balloon Ablation System
J. Am. Coll. Cardiol.,
November 15, 2005;
46(10):
1902 - 1912.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G.P. Kimman, D.A.M.J. Theuns, T. Szili-Torok, M.F. Scholten, J.C. Res, and L.J. Jordaens
CRAVT: a prospective, randomized study comparing transvenous cryothermal and radiofrequency ablation in atrioventricular nodal re-entrant tachycardia
Eur. Heart J.,
December 2, 2004;
25(24):
2232 - 2237.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. F. Scholten and L. J. Jordaens
Catheter ablation of atrial fibrillation: still investigational or already an established therapy?
Europace,
January 1, 2004;
6(2):
79 - 82.
[Full Text]
[PDF]
|
|
|
|
