Catheter Ablation -> Atrial Fibrillation & Atrial Flutter: -> Ablation Techniques D-PO02 - Poster Session II (ID 47) Poster

D-PO02-159 - Low Incidence Of Acute Complications During Superior Vena Isolation With The Third- Generation Cryoballoon (ID 1038)


Background: Superior vena cava (SVC) isolation with radiofrequency energy remains a challenge due to potential side effects, especially phrenic nerve (PN) or sinus node injury.
Objective: The purpose of this study was to evaluate the feasibility of SVC isolation using the third-generation cryoballoon (CB3) and the incidence of acute complications.
Methods: Patients undergoing atrial fibrillation (AF) ablation were prospectively included. The procedure was performed with the CB3, beginning with the pulmonary veins and ending with SVC isolation. During applications in the SVC, continuous phrenic nerve (PN) capture and sinus heart rate were monitored. Once reached SVC isolation during the application, 60 s more was applied, with no bonus application. If after 90 s the SVC was not isolated, application was stopped. A maximum number of 4 applications were permitted. The endpoint for ablation is defined as the complete elimination or dissociation of SVC potentials.
Results: Thirty-five patients (62 ± 9 years; 74% male, 78% paroxysmal AF) were included. No SVC activity was observed in two patients. All patients were in sinus rhythm at SVC isolation. Success rate for SVC isolation was 88%. Mean number of applications per patient was 2.3±1. Mean time to SVC isolation was 36±19 s. Mean duration of application was 92 ± 15 s. Mean total time of procedure for SVC isolation was 216 ± 42 s. Successful applications achieved a mean balloon nadir temperature (ºC) significantly lower as compared to non-successful applications (-45±4 vs -36±5; p<0.001). We recorded only three transient and minor complications: one transient PN palsy and two cases with short and transient sinus arrest (less than 1 min). After a mean follow-up of 5 ± 2 months, 88 % of the patients are free from arrhythmia recurrence.
Conclusion: Superior vena cava isolation with the CB3 provides a high success rate and very low incidence of complications