Shah Shivang, Xu Wenjie, Adelstein Evan, Voigt Andrew, Saba Samir, Jain Sandeep
Center for Atrial Fibrillation, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Center for Atrial Fibrillation, Heart and Vascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Indian Pacing Electrophysiol J. 2019 Jul-Aug;19(4):129-133. doi: 10.1016/j.ipej.2019.02.004. Epub 2019 Feb 20.
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.
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.
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.
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.
北极星冷冻球囊系统是一项技术，房颤（AF）复发患者的基质改变尚未得到充分表征。在本研究中，我们评估了肺静脉（PV）重新连接的部位以及Achieve™环形标测导管在冷冻消融后检测这些重新连接的准确性。
本研究纳入了15例在先前单次冷冻消融术后接受再次AF消融的患者。通过测量Achieve导管4个向量的PV信号和高输出起搏来确定PV重新连接部位。将结果与左心房内旋转心内超声心动图（ICE）引导的游动标测导管进行比较。
所有患者均有PV重新连接（2.1±0.8条静脉/患者）。左上肺静脉最常重新连接（n = 11），而右下肺静脉最不可能重新连接（n = 3）。隆突（左：n = 11；右：n = 7）和左心耳嵴（n = 11）也经常重新连接。与ICE引导标测相比，使用Achieve导管标测显示阳性预测值（PPV）为100%，阴性预测值（NPV）为96%。在2例患者中，Achieve未识别出右上肺静脉重新连接。
在初次冷冻消融后的再次AF消融过程中，多个肺静脉通常会重新连接，隆突和左心耳嵴是常见的重新连接部位。Achieve标测导管能够以较高的阳性和阴性预测值识别重新连接。
