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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

View larger version (26K): [in a new window]   Figure 1 Isolation of the left superior pulmonary vein (PV). A decapolar ring catheter (PV1-2 to PV10-1) is positioned at the ostium of the left superior PV. Recordings of the surface electrocardiographic leads I, aVL, and V1 and the cryoablation catheter (CryoDis) are shown during distal coronary sinus (CSDis) pacing. After initial cryoablation applications at the earliest activation sites (*) of the PV potential at electrodes 9-10 (Baseline), the PV activation sequence changes and the local endocardial activation time at electrodes 9-10 increases from 60 to 130 ms (Cryo9-10). Further cryoablation applications at the earliest activation sites (*) of the PV potential at electrodes 3-4 resulted in complete electrical isolation without any PV potential (Cryo3-4).

View larger version (28K): [in a new window]   Figure 2 An example of exit block of the pulmonary vein (PV) potential after isolation of the left inferior PV using cryoablation. Isolation of the PV is confirmed by abolition (but there are still potentials visible) of all PV potentials as recorded by the decapolar ring catheter (PV1-2 to PV10-1). Exit block of the PV potential (arrow) is observed during spontaneous discharge inside the PV. CSDis = distal coronary sinus; CryoDis = cryoablation catheter.

View larger version (117K): [in a new window]   Figure 3 Three-dimensional reconstruction of pulmonary veins (PVs) using a contrast-enhanced spiral computed tomography scan. The diameters of the ostia of the left superior pulmonary vein (LSPV), right superior pulmonary vein (RSPV), left inferior pulmonary vein (LIPV), and right inferior pulmonary vein (RIPV) are shown.

View larger version (18K): [in a new window]   Figure 4 Serial changes in the diameter of the ostia of the treated (solid bars) and untreated (open bars) pulmonary veins (PVs), as measured by a computed tomography scan of the thorax at baseline and 3 months (3M) and 12 months (12M) of follow-up.

View larger version (17K): [in a new window]   Figure 5 Serial changes in the diameter of the ostia of the treated left superior pulmonary vein (LSPV), right superior pulmonary vein (RSPV), left inferior pulmonary vein (LIPV), and right inferior pulmonary vein (RIPV), as measured by a computed tomography scan of the thorax at baseline (B) and 3 months (3M) and 12 months (12M) of follow-up.