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Pressure monitoring predicts pulmonary vein occlusion in cryoballoon ablation

  • Akihiro Sunaga
  • Masaharu Masuda
  • Mitsutoshi Asai
  • Osamu Iida
  • Shin Okamoto
  • Takayuki Ishihara
  • Kiyonori Nanto
  • Takashi Kanda
  • Takuya Tsujimura
  • Yasuhiro Matsuda
  • Syota Okuno
  • Toshiaki Mano
Article
  • 126 Downloads

Abstract

Purpose

Pulmonary venography is routinely used to confirm pulmonary vein (PV) occlusion during cryoballoon ablation. However, this technique is significantly limited by the risks associated with contrast media, such as renal injury and contrast allergy. We hypothesized that PV occlusion can be predicted by elevation of the balloon catheter tip pressure, avoiding the need for contrast media.

Methods

Forty-eight consecutive patients with paroxysmal atrial fibrillation who underwent PV isolation with the cryoballoon technique were enrolled. The balloon catheter tip pressure was measured in each PV before and after balloon inflation.

Results

We analyzed 200 applications of cryoballoon ablation in 185 PVs (excluding 3 common PVs and 1 extremely small right inferior PV) of 48 patients (age, 70 ± 11 years; male, n = 28; mean left atrial diameter, 38 ± 6 mm). Compared with patients with unsuccessful occlusion, patients with successful occlusion demonstrated a larger change in pressure after balloon inflation (6 ± 8 vs. 2 ± 4 mmHg, P < 0.001), a lower minimum temperature (− 49 ± 6 vs. − 40 ± 8 °C, P < 0.001), and a higher PV isolation rate (97 vs. 64%, P < 0.001). The best cutoff value of a change in pressure for predicting PV occlusion was 4.5 mmHg, with a sensitivity of 67%, specificity of 83%, and predictive accuracy of 72%.

Conclusion

Pressure monitoring is helpful to confirm PV occlusion during cryoballoon ablation.

Keywords

Atrial fibrillation Cryoballoon Manometry Contrast media Cryoablation 

Notes

Acknowledgements

We thank Angela Morben, DVM, ELS, from Edanz Group (www.edanzediting.com/ac), for editing a draft of this manuscript.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Akihiro Sunaga
    • 1
  • Masaharu Masuda
    • 1
  • Mitsutoshi Asai
    • 1
  • Osamu Iida
    • 1
  • Shin Okamoto
    • 1
  • Takayuki Ishihara
    • 1
  • Kiyonori Nanto
    • 1
  • Takashi Kanda
    • 1
  • Takuya Tsujimura
    • 1
  • Yasuhiro Matsuda
    • 1
  • Syota Okuno
    • 1
  • Toshiaki Mano
    • 1
  1. 1.Kansai Rosai Hospital Cardiovascular CenterAmagasakishiJapan

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