PULMONARY VEIN CRYOBALLOON ABLATION IN PATIENTS WITH THE COMMON TRUNK OF THE PULMONARY VEINS

Objective: To assess the effi cacy and safety of pulmonary vein (PV) cryoballoon ablation (CBA) in patients with the common trunk of the pulmonary veins (PVCT).
Materials and methods: A retrospective analysis was performed on procedural data of the 596 primary PV CBA using the second-generation cryoballoon (CB) Arctic Front Advance (28мм, Medtronic). A direct LA angiography on high-frequency right ventricular pacing was performed for PV anatomy visualization. 49 patients with evaluated PVCTs were enrolled in the study. One-step and sequential ablation approaches with simultaneous recording of biophysical and electrophysiological parameters were used for PVCT isolation. During cryoablation in right PVs, a high-output (2000ms, 25mA) pacing of right phrenic nerve was performed by the electrode placed in superior vena cava and the amplitude of the diaphragm movement was monitored. In the case of impairment/loss of the diaphragm’s contraction ablation was immediately stopped.
Results: The typical drainage of PV was evaluated in 91,1% (543) patients. In 4 patients (0,67%) an additional right pulmonary vein was identifi ed. The prevalence of PVCT was 8,2% (49pts): left common trunk (LCT) was observed in 43 patients (87,7%), right common trunk (RCT) - in 6 patients (12,2%). Acute effi cacy of PVCT isolation was 95,9% (47/79): in LCT – 95,3%, in RCT - 100%. Thefeasibilityofone-stepantralisolationwas59,1% (n=29). With a median follow up of 12:(3-20) months the clinical success rate of the procedure was 69.4%. Comparative analysis showed no signifi cant difference between common trunk ablation approaches and clinical effi cacy(p=0,346).
Conclusion: Cryoballoon ablation is effi cient and safe for symptomatic AF patients’ treatment with PVCT. Simultaneous and sequential ablation tactics can be performed with comparable effi cacy.

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