EXTRAPULMONARY MUSCULAR CONNECTIONS AS A POTENTIAL CAUSE OF LEFT-ATRIUM-PULMONARY VEIN RECONDUCTIONS AFTER APPARENTLY COMPLETE ELECTRICAL PULMONARY VEINS ISOLATION IN PATIENTS TREATED FOR ATRIAL FIBRILLATION WITH THE CRYOBALLOON TECHNIQUE
J.M. Paylos, C. Ferrero, J.R. Conesa, A. Morales, M. Rayo, M.A. Gómez, V.G. Tello
Arrhythmia Unit and Electrophysiology Lab. Moncloa Hospital European University of Madrid, Madrid, Spain
Introduction: Cryo-balloon technique (CB) for electrical isolation of pulmonary veins (PV) from the left atrium (LA) is a useful tool to treat patients with atrial fibrillation (AF). Limitations include the impossibility to eliminate extrapulmonary muscular connections (EMC), potential cause of PV-LA reconduction.
We analyzed the incidence of EMC in our patients treated with the CB.
Methods: A total of 326 PV from 84 patients with paroxysmal atrial fibrillation (PAF) (72), and persistent (AFP) (12) were treated with the big 28 mm CB, and acute electrical isolation achieve.
A 20 poles circular-catheter mapping (CC) was used for cartography, and checking for bidirectional block (BB) performed.
Antral pacing at the PV-LA junction level, and LA at distal CS was performed in a sequential manner from all the 20 poles of the CC at 3 different CL (600, 500, 400 mS), repeated after adenosine and pacing distal into the vein.
Results: .
Conclusions: The only not evidence of PV electrical activity after CB ablation, neither the demonstration of BB at the antral level is not enough to assure complete PV-LA isolation, and pacing distal PV from the 20 poles of the CC is mandatory to perform, to rule out such a potential cause of PV reconduction.
EMC cannot be eliminated by the CB, representing by themselves a significant percentage of potential reconduction in patients with PAF (11%) and 17% (AFP), which ones, by the contrary, once identified, can be easily eliminated by RF focal applications.
