Abstract
Wide-area antral pulmonary vein and posterior wall isolation by way of segmental nonocclusive applications using a novel radiofrequency ablation balloon
Highlights
Pulmonary vein (PV) isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF)[1] and prior studies[2,3] have shown that wide-area, antral PV ablation is superior to ostial PVI
In a meta-analysis of 12 studies including 1183 AF patients treated with ostial vs antral PVI, AF recurrence was significantly lower in those treated with a wide, antral approach, with an odds ratio of 0.33 (95% confidence interval: 0.24–0.46; P, .00001).[3]
Antral PVI and posterior wall isolation (PWI) can be successfully performed using point-by-point RF, retrospective[9,10] and prospective randomized trials[11] of PVI1PWI using balloon-based strategies have consistently found this approach to be superior to PVI alone
Summary
Pulmonary vein (PV) isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF)[1] and prior studies[2,3] have shown that wide-area, antral PV ablation is superior to ostial PVI. Such an approach can yield an antral-level PVI, but it allows the operator to perform extra-PV ablation, such as posterior wall isolation (PWI) In this manuscript, the authors describe the first reported case of PVI with concomitant PWI performed by means of segmental non-PV occlusive applications using the novel radiofrequency (RF) ablation balloon (HelioStar; Biosense Webster, Irvine, CA), under the direct visualization of 3-D mapping and guided by electrode impedance. To achieve wide-area, antral PVI, segmental non-PV occlusive applications are commonly required The follow-up consisted of weekly, 60-second, transtelephonic monitoring during the first 6 months, followed by monthly transmissions from 6–12 months and a 24-hour Holter monitor at 12 months, in addition to routine 12-lead electrocardiograms obtained during 1-, 3-, 6-, and 12-month follow-up visits
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