Video Article Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter (original) (raw)
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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...
Indian Pacing and Electrophysiology Journal, 2016
Cryoballoon ablation of the pulmonary veins (CAPV) has been demonstrated to be non-inferior to radiofrequency (RF) ablation for paroxysmal atrial fibrillation (AFib). As CAPV requires a larger transseptal sheath than RF ablation, it can be challenging in the presence of an Amplatzer™ Septal Occluder (ASO) device. Real-time three-dimensional transesophageal echocardiography (RT3DTEE) provides enhanced visualization of various complex cardiac defects and has revolutionized interventional procedures by guiding catheter positioning. We describe successful RT3DTEE guided transseptal puncture for CAPV of paroxysmal AFib in the presence of an ASO in a 53-year-old male.
Transesophageal Echocardiography during Pulmonary Vein Cryoballoon Ablation for Atrial Fibrillation
Echocardiography, 2014
We describe our first 20 cases of cryoablation of atrial fibrillation (AF) using transesophageal echocardiography (TEE). Continuous procedural monitoring with TEE by a cardiologist and senior sonographer assists the electrophysiologist in performance of the cryoballoon procedure of AF. Previously using intracardiac echocardiography (ICE) we have found TEE to have better overall procedural imaging, and monitoring for pericardial effusion or thrombus formation. We have found TEE monitoring to be helpful with positioning for interatrial septal (IAS) puncture, catheter tip avoidance of the left atrial appendage (LAA), and guidance of the balloon catheter into each pulmonary vein (PV), with proper positioning within each PV orifice, and documentation of PV occlusion for the cryoballoon procedure. Procedural equipment and the cryoballoon protocol used are presented in detail. The role of TEE imaging during the procedure and in preventing potential dangers is illustrated. It is the goal of this study to demonstrate how the electrophysiology and echocardiography laboratories work together in this cryoablation procedure.
Pacing and Clinical Electrophysiology, 2015
Background: In this study, we aimed to determine pulmonary vein (PV) variation patterns in patients undergoing cryoballoon ablation for atrial fibrillation (AF) and their impacts on procedural success and recurrence and also to identify predictors for recurrence. Methods: We enrolled 54 patients with AF and having symptoms despite medical therapy. Prior to the procedure, PV variation and left atrium (LA) size were evaluated in all patients by computed tomography scan. Ablation procedure was performed with single balloon and predictors for AF recurrence were determined. Results: The study population consisted of 54 patients (male: 50 [27%], mean age: 53 ± 12) with AF.
Atrial fibrillation cryoballoon ablation in patients with a common pulmonary vein trunk
Journal of Arrhythmology, 2020
Objective: we aimed to assess the efficacy and safety of pulmonary vein (PV) cryoballoon ablation (CBA) in patients with a common trunk of the pulmonary veins (PVCT).Materials and methods: We performed a retrospective analysis of 596 primary PV CBA procedures using the second-generation cryoballoon (CB) Arctic Front Advance (28 mm). PV anatomy was visualized using direct LA angiography during high-frequency right ventricular pacing. We included forty-nine patients in whom a PVCT was identified. The one-step and sequential ablation approaches with simultaneous recording of biophysical and electrophysiological parameters were used for PVCT isolation. During CBA in the right PVs, high-output (2000 ms, 25 mA) pacing of the right phrenic nerve was performed via a electrode placed in the superior vena cava, and amplitude of diaphragm movement was monitored. In the case of impairment/loss of the diaphragm contraction ablation was immediately stopped.Results: 91.1% (543) patients had the no...
Pacing and Clinical Electrophysiology, 2019
BackgroundCurrently available second‐generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exist about 1‐year outcomes of CB2 ablation, data on long‐term outcomes are scarce.ObjectiveWe aimed to assess the long‐term outcomes of PVI using CB2 in a large‐scale symptomatic atrial fibrillation (AF) population at our tertiary referral center.MethodsIn this nonrandomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa)‐free survival was defined as the absence of AF, atrial flutter, or atrial tachycardia recurrence ≥30 s following a 3 months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models.ResultsAcute procedural success rate was 99.8% (1898/1902 PVs). Me...
International Journal of Cardiology, 2018
Background: Real-time visualization of the electrical activity of the pulmonary veins (PV) is not always possible in the setting of atrial fibrillation (AF) cryoballoon ablation. We investigated the relation between the effective documentation of time to PV isolation and the clinical outcome in a cohort of patients with paroxysmal AF who underwent cryoballoon ablation. Methods: One thousand forty two consecutive patients were enrolled. An inner lumen mapping catheter was typically used to visualize real-time electrical activity inside the PVs. Results: Time to PV isolation was documented in all targeted PVs in 391 patients (Group 1), in 651 patients it was not possible to record PV potentials and assess time to PV isolation in at least one PV (Group 2). In Group 1 a longer procedure duration and ablation time were observed, while a longer fluoroscopy time was observed in Group 2. After a mean follow-up of 14 ± 11 months, 209/1042 (20%) patients had an atrial arrhythmia recurrence (20.2% in Group 1, 19.9% in Group 2, p = 0.25). Complications occurred in 54/1042 (5.2%) patients without any difference among the two study groups. Conclusion: In our retrospective analysis, in about two thirds of patients undergoing cryoballoon ablation it was not possible to acutely assess time to PV isolation in all PVs. However, one-year freedom from clinically symptomatic atrial tachyarrhythmia was similar to that of patients in which time to PV isolation was documented in all targeted veins. Clinical Trial Registration: clinicaltrials.gov (NCT01007474).