Focal Atrial Tachycardia Originating from the Right Atrial Appendage: First Successful Cryoballoon Isolation (original) (raw)
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Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2015
Focal atrial tachycardia arising from the right atrial appendage usually responds well to radiofrequency ablation; however, successful ablation in this anatomic region can be challenging. Surgical excision of the right atrial appendage has sometimes been necessary to eliminate the tachycardia and prevent or reverse the resultant cardiomyopathy. We report the case of a 48-year-old man who had right atrial appendage tachycardia resistant to multiple attempts at ablation with use of conventional radiofrequency energy guided by means of a 3-dimensional mapping system. The condition led to cardiomyopathy in 3 months. The arrhythmia was successfully ablated with use of a 28-mm cryoballoon catheter that had originally been developed for catheter ablation of paroxysmal atrial fibrillation. To our knowledge, this is the first report of cryoballoon ablation without isolation of the right atrial appendage. It might also be an alternative to epicardial ablation or surgery when refractory atrial...
Cryoballoon ablation of the right atrial appendage to treat tachycardia in a pediatric patient
Progress in Pediatric Cardiology, 2019
Catheter ablation to treat atrial tachycardia originating in the atrial appendages can be challenging due to complex anatomy and concerns for myocardial perforation. When conventional endocardial ablation is unsuccessful or patients have recurrent tachycardia, alternative approaches may be entertained, including an epicardial transcatheter approach or surgical isolation or resection of the atrial appendage. Endocardial cryoballoon ablation is commonly used in adults with atrial fibrillation to electrically isolate the pulmonary veins, and has been extended to isolate the left atrial appendage to improve outcomes in these patients. There are limited reports using cryoballoon ablation to treat adults with non-fibrillation tachycardia originating in atrial appendages, and none in children. In this report, we describe our experience using cryoballoon ablation to electrically isolate the right atrial appendage to treat a pediatric patient with recurrent atrial tachycardia following 2 previous catheter ablation procedures.
Successful cryoablation of an incessant atrial tachycardia arising from the right atrial appendage
Indian Pacing and Electrophysiology Journal, 2015
The right atrial appendage can be the origin of focal atrial tachycardias. Their ablation can be challenging owing to the complexity of the appendage anatomy. To our knowledge, we describe the first successful solid tip cryoablation of a focal tachycardia within the right atrial appendage in a patient presenting with tachycardia-induced cardiomyopathy.
Navx-guided Cryoablation of Atrial Tachycardia Inside the Left Atrial Appendage
Indian pacing and electrophysiology journal, 2011
Radiofrequency ablation procedures inside the left atrial appendage (LAA) are likely to involve dangerous complications because of a high thrombogenic effect. Cryoablation procedures are supposed to be safer. We describe two cases of successful cryoablation procedures. Two NavX-guided cryoablations of permanent focal atrial arrhythmias arising from the LAA were performed. Left atrial reconstruction and mapping allowed the zone of the earliest atrial potential to be recorded; the entire course of the ablation catheter was monitored. The arrhythmias were successfully ablated; no thrombotic complications were observed.
Europace, 2016
Although the generation of linear lesions by ablation improves success rates in patients with persistent atrial fibrillation (AF), the procedure has been considered unsuitable for cryoablation balloon catheter technologies. We developed a technique for linear ablations, using second-generation cryoballoon technology. Methods and results This was a single-arm, prospective study in 76 patients with persistent AF treated consecutively at our centre. Cryoablation was performed using a 28 mm second-generation cryoballoon. The first cryoenergy application was performed in close proximity to the position during isolation of the left superior pulmonary vein (PV). Sequential overlapping freezes were applied along the left atrial (LA) roof by slight clockwise rotation of the sheath in combination with slight retraction of the sheath and incremental advancement of the cryoballoon, until reaching the original position for right superior PV isolation. The acute endpoint was the creation of a roofline, defined as complete conduction block across the LA roof .120 ms and ascending activation across the posterior LA wall. Acute success in roofline generation was achieved in 88% of patients, applying on average five (median 4-6) freezes with nadir temperature of 2408C (236 to 2448C). In five patients, conduction block could not be achieved. No phrenic nerve injuries occurred during roofline generation. Conclusion Generation of linear roofline lesions is possible with the second-generation cryoballoon. The technique can be used in combination with PV isolation to treat persistent AF with good acute success rates, short procedure times, and acceptable safety concerns. If validated by further studies, the method would be an appealing alternative to radiofrequency ablation techniques.
Europace, 2011
Atrial fibrillation • Radiofrequency balloon • Pulmonary vein isolation • Radiofrequency ablation • Catheter ablation • Single-shot predictors What's new? • Single-shot ablation technology demonstrated equal efficacy to point-by-point ablation to achieve pulmonary vein isolation (PVI). • PVI with the multielectrode radiofrequency balloon catheter (RFB) is safe and effective, with a rate of major complications of 1%. • The RFB achieves fast and effective single-shot isolation, with a freedom from any atrial tachyarrhythmias of 82.9% after a mean followup of 10.1 ± 5.3 months. • Specific cutoffs of impedance drop (>19.2 Ω) and temperature rise (>11.1°C) demonstrated good predictive value for persistent single-shot isolation. These ablation parameters may be implemented during procedural workflow to determine the effectiveness of the ablation set.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2015
First-line ablation prior to antiarrhythmic drug (AAD) therapy is an option for symptomatic paroxysmal atrial fibrillation (PAF); however, the optimal ablation technique, radiofrequency (RF), or cryoballoon (CB) has to be determined. The FREEZE Cohort Study compares RF and CB ablation. Treatment-naïve patients were documented in the FREEZEplus Registry. Periprocedural data and outcome were analysed. From 2011 to 2014, a total of 373/4184 (8.9%) patients with PAF naïve to AAD were identified. Pulmonary vein isolation (PVI) was performed with RF (n = 180) or CB (n = 193). In the RF group, patients were older (65 vs. 61 years, P < 0.01) compared with the CB group. The procedure time was significantly shorter and radiation exposure higher in the CB group. Major adverse events occurred in 1.6% (CB) and 3.7% (RF) of patients (P = 0.22). AF/atrial tachycardia (AT) recurrence until discharge was 4.5% (RF) and 8.5% (CB, P = 0.2). Follow-up (FU) ≥12 months was available in 99 (RF) and 107 ...
Journal of visualized experiments : JoVE, 2015
The cryoballoon catheter ablates atrial fibrillation (AF) triggers in the left atrium (LA) and pulmonary veins (PVs) via transseptal access. The typical transseptal puncture site is the fossa ovalis (FO) - the atrial septum's thinnest section. A potentially beneficial transseptal site, for the cryoballoon, is near the inferior limbus (IL). This study examines an alternative transseptal site near the IL, which may decrease the frequency of acute iatrogenic atrial septal defect (IASD). Also, the study evaluates the acute pulmonary vein isolation (PVI) success rate utilizing the IL location. 200 patients were evaluated by retrospective chart review for acute PVI success rate with an IL transseptal site. An additional 128 IL transseptal patients were compared to 45 FO transseptal patients by performing Doppler intracardiac echocardiography (ICE) post-ablation to assess transseptal flow after removal of the transseptal sheath. After sheath removal and by Doppler ICE imaging, 42 of 12...