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Characterization of pulmonary vein reconnection post Cryoballoon ablation

BACKGROUND: The Arctic Front Cryoballoon System is a technology in which substrate alterations in patients with atrial fibrillation (AF) recurrence have not been well characterized. In this study, we evaluated sites of pulmonary vein (PV) reconnections and the accuracy of the Achieve™ circular mappi...

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Autores principales: Shah, Shivang, Xu, Wenjie, Adelstein, Evan, Voigt, Andrew, Saba, Samir, Jain, Sandeep
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697463/
https://www.ncbi.nlm.nih.gov/pubmed/30796960
http://dx.doi.org/10.1016/j.ipej.2019.02.004
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author Shah, Shivang
Xu, Wenjie
Adelstein, Evan
Voigt, Andrew
Saba, Samir
Jain, Sandeep
author_facet Shah, Shivang
Xu, Wenjie
Adelstein, Evan
Voigt, Andrew
Saba, Samir
Jain, Sandeep
author_sort Shah, Shivang
collection PubMed
description BACKGROUND: The Arctic Front Cryoballoon System is a technology in which substrate alterations in patients with atrial fibrillation (AF) recurrence have not been well characterized. In this study, we evaluated sites of pulmonary vein (PV) reconnections and the accuracy of the Achieve™ circular mapping catheter in detecting these reconnections after cryoablation. METHODS: This study included 15 patients undergoing redo AF ablation after a prior single cryoablation procedure. PV reconnection sites were determined by measuring PV signals and high output pacing from 4 vectors of the Achieve catheter. The results were compared with a roving mapping catheter guided by rotational intracardiac echocardiography (ICE) in the left atrium. RESULTS: All patients had PV reconnections (2.1 ± 0.8 veins/patient). The left superior PV was most commonly reconnected (n = 11), whereas the right inferior PV was least likely (n = 3). Both carinas (left: n = 11; right: n = 7) and left atrial appendage ridge (n = 11) were also frequently reconnected. Mapping with the Achieve catheter showed a positive predictive value (PPV) 100% and negative predictive value (NPV) 96% when compared with ICE guided mapping. In 2 patients, right superior PV reconnection was not identified by the Achieve. CONCLUSION: During redo AF ablation after index cryoablation, multiple PVs are usually reconnected, with both carinas and left atrial appendage ridge being common sites of reconnection. The Achieve mapping catheter was able to identify reconnection with high positive and negative predictive values.
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spelling pubmed-66974632019-08-19 Characterization of pulmonary vein reconnection post Cryoballoon ablation Shah, Shivang Xu, Wenjie Adelstein, Evan Voigt, Andrew Saba, Samir Jain, Sandeep Indian Pacing Electrophysiol J Original Article BACKGROUND: The Arctic Front Cryoballoon System is a technology in which substrate alterations in patients with atrial fibrillation (AF) recurrence have not been well characterized. In this study, we evaluated sites of pulmonary vein (PV) reconnections and the accuracy of the Achieve™ circular mapping catheter in detecting these reconnections after cryoablation. METHODS: This study included 15 patients undergoing redo AF ablation after a prior single cryoablation procedure. PV reconnection sites were determined by measuring PV signals and high output pacing from 4 vectors of the Achieve catheter. The results were compared with a roving mapping catheter guided by rotational intracardiac echocardiography (ICE) in the left atrium. RESULTS: All patients had PV reconnections (2.1 ± 0.8 veins/patient). The left superior PV was most commonly reconnected (n = 11), whereas the right inferior PV was least likely (n = 3). Both carinas (left: n = 11; right: n = 7) and left atrial appendage ridge (n = 11) were also frequently reconnected. Mapping with the Achieve catheter showed a positive predictive value (PPV) 100% and negative predictive value (NPV) 96% when compared with ICE guided mapping. In 2 patients, right superior PV reconnection was not identified by the Achieve. CONCLUSION: During redo AF ablation after index cryoablation, multiple PVs are usually reconnected, with both carinas and left atrial appendage ridge being common sites of reconnection. The Achieve mapping catheter was able to identify reconnection with high positive and negative predictive values. Elsevier 2019-02-20 /pmc/articles/PMC6697463/ /pubmed/30796960 http://dx.doi.org/10.1016/j.ipej.2019.02.004 Text en © 2019 Indian Heart Rhythm Society. Production and hosting by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Shah, Shivang
Xu, Wenjie
Adelstein, Evan
Voigt, Andrew
Saba, Samir
Jain, Sandeep
Characterization of pulmonary vein reconnection post Cryoballoon ablation
title Characterization of pulmonary vein reconnection post Cryoballoon ablation
title_full Characterization of pulmonary vein reconnection post Cryoballoon ablation
title_fullStr Characterization of pulmonary vein reconnection post Cryoballoon ablation
title_full_unstemmed Characterization of pulmonary vein reconnection post Cryoballoon ablation
title_short Characterization of pulmonary vein reconnection post Cryoballoon ablation
title_sort characterization of pulmonary vein reconnection post cryoballoon ablation
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6697463/
https://www.ncbi.nlm.nih.gov/pubmed/30796960
http://dx.doi.org/10.1016/j.ipej.2019.02.004
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