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