Cryoablation and GP modification

18. Scanavacca M, Pisani CF, Hachul D, Lara S, Hardy C, Darrieux F et al. Selective atrial vagal denervation guided by evoked vagal reflex to treat patients with paroxysmal atrial fibrillation. Circulation 2006;114:876 –85. 19. Neumann T, Vogt J, Schumacher B, Dorszewski A, Kuniss M, Neuser H et al. Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. J Am Coll Cardiol 2008;52:273 –8. 20. Klein G, Oswald H, Gardiwal A, Lusebrink U, Lissel C, Yu H et al. Efficacy of pulmonary vein isolation by cryoballoon ablation in patients with paroxysmal atrial fibrillation. Heart Rhythm 2008;5:802 – 6. 21. Andrade JG, Khairy P, Guerra PG, Deyell MW, Rivard L, Macle L et al. Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm 2011;8:1444 –51. 22. Chierchia GB, Capulzini L, Droogmans S, Sorgente A, Sarkozy A, Muller-Burri A et al. Pericardial effusion in atrial fibrillation ablation: a comparison between cryoballoon and radiofrequency pulmonary vein isolation. Europace 2010;12:337 –41. 23. Chen SW, Liu SW, Lin JX. [Incidence, risk factors and management of pericardial effusion post radiofrequency catheter ablation in patients with atrial fibrillations]. Zhonghua Xin Xue Guan Bing Za Zhi 2008;36:801 – 6. 24. Lellouche N, Sebag FA, Elbaz N, Hassine M, Chaachoui N, Teiger E et al. Acute pericardial effusion following atrial fibrillation ablation: characteristics and relationship with arrhythmia recurrences. Arch Cardiovasc Dis 2011;104:450 –7. 25. Tanno K, Kobayashi Y, Kurano K, Kikushima S, Yazawa T, Baba T et al. Histopathology of canine hearts subjected to catheter ablation using radiofrequency energy. Jpn Circ J 1994;58:123 –35. 26. Lellouche N, Sacher F, Wright M, Nault I, Brottier J, Knecht S et al. Usefulness of C-reactive protein in predicting early and late recurrences after atrial fibrillation ablation. Europace 2009;11:662 –4.

27. Oswald H, Klein G, Koenig T, Luesebrink U, Duncker D, Gardiwal A. Cryoballoon pulmonary vein isolation temporarily modulates the intrinsic cardiac autonomic nervous system. J Interv Card Electrophysiol 2010;29:57–62. 28. Schmidt M, Dorwarth U, Straube F, Daccarett M, Rieber J, Wankerl M et al. Cryoballoon in AF ablation: impact of PV ovality on AF recurrence. Int J Cardiol 2013;167: 114 –20. 29. Sorgente A, Chierchia GB, de Asmundis C, Sarkozy A, Namdar M, Capulzini L et al. Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation. Europace 2011;13:205 –12. 30. Kubala M, Hermida JS, Nadji G, Quenum S, Traulle S, Jarry G. Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein. Pacing Clin Electrophysiol 2011;34:837 –43. 31. Chierchia GB, de Asmundis C, Sorgente A, Paparella G, Sarkozy A, Muller-Burri SA et al. Anatomical extent of pulmonary vein isolation after cryoballoon ablation for atrial fibrillation: comparison between the 23 and 28 mm balloons. J Cardiovasc Med 2011;12:162 –6. 32. Reddy VY, Neuzil P, d’Avila A, Laragy M, Malchano ZJ, Kralovec S et al. Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation? Heart Rhythm 2008;5:353 –60. 33. Van Belle Y, Knops P, Janse P, Rivero-Ayerza M, Jessurun E, Szili-Torok T et al. Electroanatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins. J Interv Card Electrophysiol 2009;25:59 –65. 34. Chen F, Yang SN, Wang T. [The role of coronary sinus musculature on electrical conduction between left atrium and right atrium in isolated canine heart]. Zhonghua Xin Xue Guan Bing Za Zhi 2008;36:834 – 7.


Catheter ablation of atrial fibrillation and left atrial flutter in a patient with a left atrial appendage occlusion device David A. Steckman, Duy Thai Nguyen, and William H. Sauer* Section of Cardiac Electrophysiology, University of Colorado, 12401 East 17th Avenue, B136, Aurora, CO 80045, USA

* Corresponding author. Tel: +1 720 848 6510; fax: +1 720 848 0475, Email: [email protected]

A 60-year-old woman with atrial fibrillation (AF) and prior implantation of an Amplatzer Cardiac Plug (ACP) left atrial appendage (LAA) occlusion device was referred for ablation. A pre-procedural transoesophageal echocardiography revealed device deformation of the anterior aspect of the left superior pulmonary vein (LSPV) and ligament of Marshall. Delivery of radiofrequency energy near the ACP device resulted in automatic generator shut-off with impedance measurement errors. Sustained mitral annular flutter (MA AFL) was consistently induced with burst pacing. As demonstrated in the figure, electrical isolation of the left PVs and LAA together was achieved with the creation of contiguous ablation lesions connecting the anterior MA to the right superior PV and the lateral MA to the left inferior PV in addition to a posterior lesion set around the left PVs. Ablation in the coronary sinus was required to achieve block. Entrance and exit block was confirmed for all PVs and MA AFL was non-inducible. She has since remained AF free 1 year postprocedure. Our case required a unique ablation set to achieve durable PV isolation. This successfully terminated MA AFL and resulted in LSPV isolation. This ablation approach may be necessary when dealing with patients having LAA occlusion devices, specifically the ACP.

Roof Line Roof Line LSPV


LAA Occlusion Device LIPV

Anterior Mitral Line

Inferior Mitral Line

The full-length version of this report can be viewed at: http://www.escardio.org/communities/EHRA/publications/ep-case-reports/ Documents/Catheter-ablation-of-atrial-fibrillation.pdf.

Published on behalf of the European Society of Cardiology. All rights reserved. & The Author 2014. For permissions please email: [email protected]

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doi:10.1093/europace/euu039 Online publish-ahead-of-print 2 March 2014


Catheter ablation of atrial fibrillation and left atrial flutter in a patient with a left atrial appendage occlusion device.

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