Cryoballoon Left Atrial Roof Block Creation Leveraging the Left Atrial Roof Vein

Figures

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  FIGURE 1. Preoperative computed tomography (CT) and intraoperative fluoroscopic images of the procedure. (A) Pre‐procedural CT demonstrated the roof vein, along with the left superior, left inferior, right superior, and right inferior pulmonary veins. (B) The POLARMAP catheter was positioned at the RSPV, and a 180‐s freeze achieved isolation. Phrenic pacing was performed via a duodecapolar catheter in the right subclavian vein to prevent phrenic injury. (C) The first cryoapplication targeted the left atrial roof, with the POLARMAP catheter advanced deeply into the upper RSPV and a 180‐s freeze delivered using the raise‐up technique. (D, E) The second (D) and third (E) cryoapplications targeted the left atrial roof, with the POLARMAP catheter anchored in the upper RSPV and sequential overlapping freezes delivered using the same rotational and sheath‐manipulation technique. (F) The fluoroscopic images show the fourth cryoapplication directed at the left atrial roof. During this freeze, the cryoballoon lost stable anchoring and collapsed toward the LSPV. Repositioning the POLARMAP catheter into the roof vein (RV) allowed successful completion of the freeze. (G) Post‐mapping using the CARTO3…

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  FIGURE 2. The schema drawing of cryoballoon‐guided LARB creation. (A) The POLARMAP catheter was positioned in the upper RSPV, and a 180‐s freeze achieved isolation (Figure 1B). (B) The first cryoapplication targeted the left atrial roof, with the POLARMAP catheter positioned in the upper RSPV (Figure 1C). (C, D) The second and third cryoapplications also targeted the left atrial roof, with the POLARMAP catheter similarly advanced deeply into the upper RSPV (Figure 1D,E, respectively). (E) The fourth cryoapplication was directed at the left atrial roof; however, shortly after the initiation of freezing, the cryoballoon lost its stable anchoring and collapsed toward the LSPV. (F) The POLARMAP catheter was repositioned into the RV, allowing successful completion of the fourth freeze. In the LAO view, the RV, located posterior to the RSPV (appearing more rightward), provided a more reliable anchoring point, enhancing stability on the LSPV side of the roof line (Figure 1F). (G) The lesion created by the fourth freeze was confirmed to be continuous with the freeze lesion for LSPV isolation. AP, anterior to posterior; LAO, left anterior oblique; RSPV, right superior pulmonary vein; LARB, left…