Cryoablation for atrial fibrillation: biophysics and a contemporary step-by-step approach.

Figures

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  Fig. 1. The sequence of thermal effects in cryoablation [3,5].

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  Fig. 2. Placement of surface ECG electrodes for recording of diaphragmatic compound muscle action potential(left). CMAP during the start of cryoablation(middle)and later showing a reduction in CMAP during the development of phrenic injury(right).

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  Fig. 3. The utility of ICE in cryoablation. (Left), tenting of the interatrial septum by the septal puncture needle during LA entry (video 3), (middle), image assessing for leak during balloon occlusion and monitoring of phrenic nerve function using pulsed wave Doppler using ICE (right).

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  Fig. 4. Pre- and post-images of cryoablation PVI created with electroanatomic map-CT fusion imaging.