Author + information
- Received September 21, 2017
- Accepted September 27, 2017
- Published online February 19, 2018.
- Francesco Santoro, MDa,b,∗ (, )
- Andreas Metzner, MDa,
- Feifan Ouyang, MDa,
- Karl-Heinz Kuck, MDa and
- Andreas Rillig, MDa
- aDepartment of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
- bDepartment of Medical and Surgery Science, University of Foggia, Foggia, Italy
- ↵∗Address for correspondence:
Dr. Francesco Santoro, Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstrasse 5, 20099, Hamburg, Germany.
A 68-year-old woman with symptomatic drug refractory paroxysmal atrial fibrillation and an implanted dual-chamber pacemaker was referred for cryoballoon atrial fibrillation ablation. Congenital persistent left superior caval vein and atresia of the right superior caval vein were known. After coronary sinus angiography, a decapolar catheter was advanced through the persistent left superior caval vein to the right subclavian vein (Figure 1A) and phrenic nerve capture was achieved with stimulation output of 12 mV and duration of 2.9 ms. Diaphragmatic contraction was proven with fluoroscopy and electrocardiographic monitoring, evaluating compound motor action potentials. Transseptal puncture was performed and left pulmonary veins were isolated with a single freeze cycle of 180 s for each vein. During continuous phrenic nerve capture (cycle length: 700 ms) (Figures 1B and 1C), the right pulmonary veins were isolated with a single freeze cycle of 180 s each. No phrenic nerve palsy occurred.
We report on the safety and feasibility of cryoballoon ablation for atrial fibrillation in a patient with congenital vein anomalies. Phrenic nerve palsy represents the most common complication of cryoablation during this procedure with an incidence of 2.7% in larger studies (1). However monitoring of phrenic nerve capture during freezing cycles at the right pulmonary veins (2) can potentially reduce this complication even in patients with complex cardiac anatomy.
Dr. Metzner has received honoraria from Medtronic. Dr. Kuck has received consulting fees and honoraria from Medtronic, Boston Scientific, Abbott, and Biosense Webster. Dr. Rillig has received travel support and lecture fees from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors' institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received September 21, 2017.
- Accepted September 27, 2017.
- 2018 American College of Cardiology Foundation