Feasibility of the Radiofrequency Hot Balloon Catheter for Isolation of the Posterior Left Atrium and Pulmonary Veins for the Treatment of Atrial Fibrillation

• Published in: Circulation. Arrhythmia and electrophysiology Vol. 2; no. 3; pp. 225 - 232
• Main Authors: Sohara, Hiroshi, Takeda, Hiroshi, Ueno, Hideki, Oda, Toshiyuki, Satake, Shutaro
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD American Heart Association, Inc 01-06-2009; Lippincott Williams & Wilkins
• Subjects: Aged; Antiarythmic agents; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiovascular system; Catheter Ablation - instrumentation; Catheter Ablation - methods; Classical genetics, quantitative genetics, hybrids; Electrophysiologic Techniques, Cardiac; Feasibility Studies; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Genetics of eukaryotes. Biological and molecular evolution; Heart; Heart Atria - surgery; Human; Humans; Male; Medical sciences; Middle Aged; Monitoring, Intraoperative; Pharmacology. Drug treatments; Phrenic Nerve - physiology; Postoperative Complications - prevention & control; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Temperature; Treatment Outcome; Arrhythmia; Complete; Catheter; Endocardium; Cardiovascular disease; Left atrium; Potential; Result; Design; Sinus tachycardia; Heart disease; Dragging; Posterior; Complication; Safety; Pulmonary vein; radiofrequency current; Genetic mapping; Human; Cartography; Radiodiagnosis; Atrial fibrillation; Elimination; Instrumentation therapy; posterior left atrium; Patient; Left pulmonary vein; catheter ablation; Method; Anatomy; Radiofrequency; Excitability disorder; Case study; Resistance; balloon catheter; Isolation; Feasibility; Lesion; Technique
• ISSN: 1941-3149; 1941-3084
• DOI: 10.1161/CIRCEP.108.817205

BACKGROUND—Atrial fibrillation originates mostly from the pulmonary vein (PV) foci or non-PV foci in the posterior left atrium (LA). The present study was designed to evaluate the feasibility and safety of a novel radiofrequency hot balloon catheter for the treatment of patients with atrial fibrillation by electrically isolating the posterior LA, including all PVs.
METHODS AND RESULTS—One hundred consecutive patients with drug-resistant atrial fibrillation (63 paroxysmal, 37 persistent) were enrolled. The isolation of the PVs was performed by wedging the balloon at each PV antrum to create circumferential lesions in each case. Contiguous linear lesions were also created at the roof between the superior PVs and at the bottom of the posterior LA between the inferior PVs by dragging the balloon along the endocardium. Complete elimination of the posterior LA and PV potentials was achieved in all 100 cases, confirmed by either conventional or electro-anatomic mapping system. The total procedure time was 129±26 minutes, inclusive of 29.9±7.3 minutes of fluoroscopy time. Follow-up during 11.0±4.8 months confirmed that 92 patients (60 paroxysmal, 32 persistent) were free from atrial fibrillation without antiarrhythmic drugs, and in the remaining patients except for 2 with LA tachycardia, sinus rhythm was maintained with antiarrhythmic drugs. With precautions of esophageal cooling by irrigation dictated by temperature monitoring and monitoring phrenic nerve pacing, no LA-esophageal fistula or permanent phrenic nerve injury occurred.
CONCLUSION—This feasibility study supports the safety and efficacy of radiofrequency hot balloon catheter for complete isolation of the posterior LA and PVs.