Pressure Monitoring Predicts Pulmonary Vein Occlusion in Cryoballoon Ablation

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2018 Apr 12

PMID 29637378

Citations 3

Authors

Akihiro Sunaga

Masaharu Masuda

Mitsutoshi Asai

Osamu Iida

Shin Okamoto

Takayuki Ishihara

Kiyonori Nanto

Takashi Kanda

Takuya Tsujimura

Yasuhiro Matsuda

Syota Okuno

Toshiaki Mano

Affiliations

Soon will be listed here.

Abstract

Purpose: Pulmonary venography is routinely used to confirm pulmonary vein (PV) occlusion during cryoballoon ablation. However, this technique is significantly limited by the risks associated with contrast media, such as renal injury and contrast allergy. We hypothesized that PV occlusion can be predicted by elevation of the balloon catheter tip pressure, avoiding the need for contrast media.

Methods: Forty-eight consecutive patients with paroxysmal atrial fibrillation who underwent PV isolation with the cryoballoon technique were enrolled. The balloon catheter tip pressure was measured in each PV before and after balloon inflation.

Results: We analyzed 200 applications of cryoballoon ablation in 185 PVs (excluding 3 common PVs and 1 extremely small right inferior PV) of 48 patients (age, 70 ± 11 years; male, n = 28; mean left atrial diameter, 38 ± 6 mm). Compared with patients with unsuccessful occlusion, patients with successful occlusion demonstrated a larger change in pressure after balloon inflation (6 ± 8 vs. 2 ± 4 mmHg, P < 0.001), a lower minimum temperature (- 49 ± 6 vs. - 40 ± 8 °C, P < 0.001), and a higher PV isolation rate (97 vs. 64%, P < 0.001). The best cutoff value of a change in pressure for predicting PV occlusion was 4.5 mmHg, with a sensitivity of 67%, specificity of 83%, and predictive accuracy of 72%.

Conclusion: Pressure monitoring is helpful to confirm PV occlusion during cryoballoon ablation.

Citing Articles

Pressure guided pulmonary vein isolation by means of a novel cryoballoon technology for the management of complex anatomy: A case report.

Simone A, La Rocca V, Agresta A, Maiorino M, Malacrida M, Ricciolino R HeartRhythm Case Rep. 2023; 9(8):569-572.

PMID: 37614383 PMC: 10444553. DOI: 10.1016/j.hrcr.2023.05.016.

Clinical utility of the "balloon lever technique" in the right inferior pulmonary vein cryoballoon ablation.

Wakabayashi Y, Kobayashi M, Ichikawa T, Koyama T, Abe H J Arrhythm. 2023; 39(1):42-51.

PMID: 36733329 PMC: 9885310. DOI: 10.1002/joa3.12801.

JCS/JHRS 2021 guideline focused update on non-pharmacotherapy of cardiac arrhythmias.

Nogami A, Kurita T, Kusano K, Goya M, Shoda M, Tada H J Arrhythm. 2022; 38(1):1-30.

PMID: 35222748 PMC: 8851582. DOI: 10.1002/joa3.12649.

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