Key result
Cryoballoon-based pulmonary vein isolation left 65.6 ± 16.9% of the posterior wall and 75.4 ± 18.4% of the left atrial roof unablated, with major regions remaining electrically normal.
Why the study?
The size of collaterally created lesion sets adjacent to the PVs after cryoballoon PVI using individualized time-to-isolation protocols remains unclear.
What is the extent of collateral lesion formation at the posterior wall and roof of the left atrium following cryoballoon-based pulmonary vein isolation in patients with atrial fibrillation?
Observational (n=30)
What is the extent of collateral lesion formation at the posterior wall and roof of the left atrium following cryoballoon-based pulmonary vein isolation in patients with atrial fibrillation?
Answers are grounded in this paper and cite their sources.
High-density mapping demonstrates that cryoballoon-based PVI leaves major regions of the posterior wall and roof electrically normal, with unablated antral areas predominantly in the anterior segments of the superior PVs.
Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment modality for patients with atrial fibrillation (AF) with encouraging acute and long-term outcome data. However, the size of collaterally created lesion sets adjacent to the pulmonary veins (PVs) remains unclear, especially when CB ablation is performed with individualized time-to-isolation (TTI) protocols. This study seeks to investigate the extension of lesions at the posterior wall and the roof of the left atrium (LA). Thirty patients with paroxysmal or persistent AF underwent ablation with a fourth-generation CB. The individual freeze-cycle duration was set at TTI + 120 s. A total of 120 PVs were identified, and all were successfully isolated. A three-dimensional electroanatomical high-density (HD) mapping of the LA was performed in every patient before and after PVI. The surface areas of the posterior wall and LA roof were measured and compared with lesion extension after PVI. After CB ablation, 65.6 ± 16.9% of the posterior wall and 75.4 ± 18.4% of the LA roof remained unablated. In addition, non-antral lesion formation was observed in every patient in at least one PV. After CB ablation, anterior antral parts of the superior PVs showed the greatest unablated areas compared with the other antral areas. HD re-mapping after CB-based PVI demonstrated that major regions of the posterior wall and roof remained electrically normal and unaffected. Unablated antral areas were localized predominantly in the anterior segments of the superior PVs and may be partly responsible for AF recurrence.
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Mathew et al. (2021) conducted an observational in Paroxysmal or persistent atrial fibrillation (n=30). Cryoballoon-based pulmonary vein isolation was evaluated on Percentage of unablated surface area of the posterior wall and left atrial roof. Cryoballoon-based pulmonary vein isolation left 65.6 ± 16.9% of the posterior wall and 75.4 ± 18.4% of the left atrial roof unablated, with major regions remaining electrically normal.
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