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Published in: Clinical Research in Cardiology 8/2009

01-08-2009 | Original Paper

Right ventricular rapid pacing in catheter ablation of atrial fibrillation: a novel application for cryoballoon pulmonary vein isolation

Authors: K. R. Julian Chun, Alexander Fürnkranz, Boris Schmidt, Andreas Metzner, Roland Tilz, Thomas Zerm, Ilka Köster, Buelent Koektuerk, Melanie Konstantinidou, Feifan Ouyang, Karl Heinz Kuck

Published in: Clinical Research in Cardiology | Issue 8/2009

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Abstract

Background

Cryoballoon ablation (Arctic Front, Cryocath™) represents a novel technology for pulmonary vein isolation (PVI). The initial phase of a freeze is crucial for cryolesion formation which is determined by local temperature depending on blood flow. We investigated the impact of right ventricular rapid pacing (RVRP) on temperature kinetics in patients (pts) with paroxysmal atrial fibrillation (PAF).

Methods and results

Right ventricular rapid pacing was performed from the RV apex. Absolute minimal temperature (MT, °C), temperature slopes [time (s) to 80% MT; dT/dt), area under the curve (AUC) and arterial blood pressure (ABP, mmHg) were compared (group I: with RVRP vs. group II: without RVRP). RVRP (mean duration 55 ± 7 s) was performed in 11 consecutive PAF pts (41 PVs, age 58 ± 9 years, LA size 44 ± 6 mm, normal ejection fraction). Only freezes with identical balloon positions were analyzed (11/41 PVs). RVRP (cycle length 333 ± 3 ms) induced a significant drop in ABP (group I: 45 ± 3 mmHg vs. group II: 100 ± 18 mmHg, p < 0.001). MT was not different between group I and group II (−45.0 ± 4.4 vs. −44.3 ± 3.4°C, p = 0.46), whereas slope (38.0 ± 4.6 s vs. 51.6 ± 14.4 s, p = 0.0034) and AUC (1090 ± 4.6 vs. 1181 ± 111.2, p = 0.02) was significantly changed. In one pt, a ventricular tachycardia was induced. PVI was achieved in 41/41 PVs.

Conclusion

Right ventricular rapid pacing significantly accelerates cryoballoon cooling during the initial phase of a freeze possibly suggesting improved cryolesions.
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Metadata
Title
Right ventricular rapid pacing in catheter ablation of atrial fibrillation: a novel application for cryoballoon pulmonary vein isolation
Authors
K. R. Julian Chun
Alexander Fürnkranz
Boris Schmidt
Andreas Metzner
Roland Tilz
Thomas Zerm
Ilka Köster
Buelent Koektuerk
Melanie Konstantinidou
Feifan Ouyang
Karl Heinz Kuck
Publication date
01-08-2009
Publisher
D. Steinkopff-Verlag
Published in
Clinical Research in Cardiology / Issue 8/2009
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-009-0031-3

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