Author + information
- A. Baimbetov,
- K. Yergeshov,
- K. Bizhanov,
- I. Yakupova and
- K. Abzaliev
Aim and Objective
to demonstrate our primary results after pulmonary vein cryoisolation using 2nd generation in patients with paroxysmal and persistent atrial fibrillation. Long term outcomes is not yet avialable.
Materials and Methods
From 2014, in our electrophysiological laboratory, more than 200 ablation procedures of pulmonary vein isolation were carried our using 2nd generation cryoballoon in patients with different forms of atrial fibrillation. In selecting patients for cryoablation procedure patients with paroxysmal and persistent form of atrial fibrillation are taken with a condition of size of the left atrium is not more than 4.5 cm and not previously received any treatment. All patients received standard anticoagulation therapy with a target INR of (2.0-2.5). Before procedure, all the patients underwent transesophageal echocardiography (TEE) in order to exclude presence of thrombus in the left atrial appendage. Also, all the patients conducted computed tomography (CT) with reconstruction of the anatomy of the left atrium and pulmonary veins with their size measurement. In order to avoid impairment of phrenic nerve, pacing through superior vena cava was carried out with a frequency of 5 pulses per minute. At the end of isolation of each vein spiral mapping catheter was used to confirm the degree of isolation. The result showed that it is possible to achieve 95 % of complete isolation in all the veins and 5 % of incomplete isolation which is due to the anatomy of the left atrium and pulmonary veins.
During the procedure, significant complications were not observed. However, there was phrenic nerve palsy in 18 patients which evolved during isolation of right superior pulmonary vein. In 2 patients, the phrenic nerve palsy was maintained for 6 months, the rest went on their own within 1 month. In addition to that, return of AF was observed in 30 patient who again underwent a RFA procedure using the navigation system with the construction of three-dimensional map of the left atrium.
The method of pulmonary vein isolation using cryoballoon of 2nd generation is considered as highly effective and safe procedure in treatment of paroxysmal atrial fibrillation with anatomic non-dilated left atrium. This technique can be recommended not only for patients with paroxysmal, but also for persistent atrial fibrillation with careful patient selection.