Learning curves in atrial fibrillation ablation – A comparison between second generation cryoballoon and contact force sensing radiofrequency catheters

Figures

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  Fig. 1. Image of the left atrium generated from 3D rotational angiography (posterior-anterior view) LSPV – left superior pulmonary vein, LIPV – left inferior pulmonary vein, RSPV – right superior pulmonary vein, RIPV – right inferior pulmonary vein.

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  Fig. 2. Real time pulmonary vein isolation visualized by the Achieve catheter. Please note the typical progressive delay of pulmonary vein potentials (arrows) and final disappearance when achieving the entrance block.

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  Fig. 3. Cryoballoon ablation, anterior-posterior view. The CB is positioned at the RSPV antrum/ostium. The optimal pulmonary vein occlusion is documented by contrast injection from the distal tip of the catheter. A) A decapolar catheter in superior vena cava/right v. subclavia junction for the phrenic nerve pacing B) Cryoballoon C) ICE catheter in the right atrium D) Achieve circular catheter in the RSPV CB – Cryoballoon, ICE – intracardiac echo catheter, RSPV – right superior pulmonary vein.

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  Fig. 4. Radiofrequency ablation. A) PV potentials before ablation can be seen on circular catheter (20A) and ablation catheter (MAP) located in LSPV (thin arrow). B) After the PV isolation only far field electrograms could be detected on circular catheter (thick arrow). LSPV – left superior pulmonary vein, PV pulmonary vein.

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  Fig. 5. Evolution of procedural characteristics during the study period. Panel A – Radiofrequency point by point procedures. Panel B – Cryoballoon procedures. Major complications are denoted on y axis, for the given patient when the complication happened.

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  Fig. 6. Kaplan-Meier arrhythmia free survival curves. Blue line - CB group; green line - RF group. Lower, the table indicates the remaining patients free from the AF during the follow up.