Abstract
Observation of the time-to-pulmonary vein isolation (TTI) by a spiral mapping catheter has emerged as a valuable procedural parameter in cryoballoon pulmonary vein isolation (PVI). The 1st generation spiral mapping catheter (Achieve, SMC1) has been available as an 8-polar catheter with a distal loop diameter of 15 or 20 mm. The novel spiral mapping catheter (Achieve Advance, SMC2) was designed as a true guidewire and is available, in addition to the sizes of the SMC1, as a 10-polar mapping catheter with a distal loop diameter of 25 mm. Whether these novel features of SMC2 influence procedural characteristics of Cryo-PVI in comparison to SMC1 has not been reported. In this prospective cohort study 158 patients (age 65.1 ± 12.4 years, female 39%, paroxysmal AF 60%) undergoing PVI with the 2nd generation cryoballoon were included. SMC1 was used in 57 patients (36%), whereas 101 patients (64%) underwent Cryo-PVI with the SMC2. All PVs (623/623, 100%) were isolated successfully. Mean procedure duration was 72.0 ± 18.9 min in the SMC1 group and 74.4 ± 19.1 min in the SMC2 group (p = 0.432). Mean fluoroscopy time was also not different between both study groups (SMC1 15.7 ± 6.6 min, SMC2 15.7 ± 7.3 min, p = 0.593). TTI was observed in 68.6% of pulmonary veins in the SMC1 group, whereas TTI observation rate was 82.6% in the SMC2 group (p < 0.001). Number of freezes (5.5 ± 1.5 vs. 6.5 ± 1.9; p = 0.001) and total freeze duration (14.1 ± 4.5 vs. 17.6 ± 5.6; p < 0.001) were increased in the SMC2 group. SMC2 significantly increases TTI observation rate during Cryo-PVI. Procedure duration and fluoroscopy time are similar and number of freezes and total freeze duration are increased compared to PVI with SMC1 due to decreased stability and maneuverability of SMC2.
Highlights
Pulmonary vein isolation (PVI) is the cornerstone in the treatment of patients with symptomatic atrial fibrillation [1,2,3,4]
SMC1 was exclusively used with a diameter of 20 mm, SMC2 with a 20 mm diameter was applied in 12 patients, SMC2 with a 25 mm diameter was used in 89 patients (Table 2)
In the SMC1 group we identified 226 pulmonary vein (PV) and 397 PVs were identified in the SMC2 group
Summary
Pulmonary vein isolation (PVI) is the cornerstone in the treatment of patients with symptomatic atrial fibrillation [1,2,3,4]. The 2nd generation of the spiral mapping catheter (Achieve Advance, Medtronic Inc, Minneapolis, MN, SMC2), has been designed as a true guidewire by abandoning the steel jacket of SMC1 which contained the electrical wires and instead putting the electrical wires around a core wire. This design changes lead to a much more flexible shaft. SMC2 is available, in addition to the sizes of the SMC1, as a 10-polar mapping catheter
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