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Conjoined Inferior Pulmonary Veins during Pulmonary Vein Isolation: Prevalence and Novel Approach for Pulmonary Vein Isolation with Cryoballoon

The number of patients referred for ablation of atrial fibrillation (AF) has been increasing with the advent of cryoenergy use in addition to the preexistent radiofrequency therapy for pulmonary vein isolation. Successful pulmonary vein isolation using cryoballoon is immensely dependent on the atrial and the pulmonary vein anatomy. Presented here are three successfully completed cases out of 351 cryoballoon ablations, performed in two centers from January 2010 to December, 2013 found to have unique pulmonary vein anatomy not previously described in association with cryoballoon. Prior to the procedure, these patients had undergone CT Angiography to determine pulmonary vein anatomy and size. During the procedure, The FlexCath catheter and a circular mapping catheter were used to map the pulmonary veins and for stability of the cryoballoon, after which the standard cryoballoon technique was performed. All three cases where successful cryoablations, despite the variant anatomy. Further improvements to cryoballoon technology will further shed light on these variant anatomies and make cryoablation more amenable in the future.

Credits: Estelle Torbey MD; Jonathan Spagnola MD ; Rob Sangrigoli MD FHRS*; John Harding MD, FHRS*; Marcin Kowalski MD, FHRS

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Introduction to AFib
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