Author + information
- Albert Chiu,
- Erica Flores,
- Andrew Tseng,
- Andrew Williams and
- Wilber Su
Background: Cryoballoon ablation is an effective treatment for Paroxysmal Atrial Fibrillation (PAF). Optimal dosing of the second-generation cryoballoon (CB2; Arctic Front AdvanceTM, Medtronic Inc) is still unclear. Time-to-effect (TTE) is the physiologic end-point when acute pulmonary vein signals are lost and can be monitored during cryoballoon ablation. Correlation between TTE and actual pulmonary vein isolation (PVI) success is yet to be established. Canine dosing study have suggested TTE dosing may improve the current practice of time based ablation, however this has not been applied to human experience. The purpose of this study was to determine the effectiveness of TTE dosing regimen of CB2 for pulmonary vein isolation (PVI) while avoiding collateral injury in human subjects.
Methods: 20 patients underwent pulmonary vein isolation for PAF with dosing based on TTE. A 28mm CB2 was used for all ablations. PVI were examined using the Achieve™ Mapping Catheter. TTE of less than 30 seconds received 120 seconds single ablation, and TTE less than 60 seconds received 180 seconds ablation. Acute isolation was assessed, and holding period of 30 minutes was performed with recording of acute isolation.
Results: 20 patients or 80 PVI was performed with acute isolation and TTE was recorded. In 90% of PV (72 PV), TTE was recorded and utilized for dosing study. Adenosine and isoproterenol challenge was performed at the end of 30 minutes holding period, with no recurrences acutely during the ablation procedure. No collateral injury was noted.
Conclusions: TTE based dosing is an improved dosing regimen for cryoballoon ablation. Dosing using the TTE may reduce the total ablation time and better predict the success of PVI while and reducing collateral injury. Larger population and longer term monitoring will be needed to validate the TTE dosing regimen.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Arrhythmias and Clinical EP: Devices 3
Abstract Category: 5. Arrhythmias and Clinical EP: Devices
Presentation Number: 1188-082
- 2017 American College of Cardiology Foundation