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Pulmonary Vein Isolation Using the ArcticFront Cryoballoon: The MonashHeart Experience
S158
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
356 PULMONARY VEIN ISOLATION USING THE ARCTICFRONT CRYOBALLOON: THE MONASHHEART EXPERIENCE L. Bittinger, G. Lee, D. Adam, J. Alison Monash Cardiovascular Research Centre, MonashHEART, Southern Health & Department of Medicine (MMC), Monash University, Melbourne, Australia
357 REAL WORLD EXPERIENCES WITH RIGHT VENTRICULAR SEPTAL LEAD IMPLANTATION: ECG CHARACTERISTICS, LEAD PARAMETERS AND COMPLICATIONS Geoffrey Lee, Logan Bittinger, Stuart Allen, Nick Youngs, Damian Haldane, Emily Kotschet, David Adam, Jack Krafchek, Jeff Alison MonashHeart, Melbourne, Australia
Introduction: Pulmonary vein isolation (PVI) is a proven therapy for symptomatic drug refractory paroxysmal atrial fibrillation (PAF) and is usually performed using various circumferential radiofrequency ablation (RFA) lesion sets. The ArcticFront cryoballoon ablation catheter (CBAC) has been developed as an alternative to RFA to create circumferential pulmonary vein lesions using cryotherapy. The CBAC has been used successfully in Europe and in trials in North America. MonashHeart performed the first PVIs using the CBAC in the Asia-Pacific region in September 2007. Aim: To describe an Australian experience of cryotherapy for PVI over a 15-month period regarding: ability to achieve complete PVI, symptomatic results, and complications. Methods: Selected patients had symptomatic PAF despite anti-arrhythmic drug (AAD) therapy, no structural heart disease, no previous PVI procedures and were deemed suitable for PVI by an Electrophysiologist. Procedures were performed by one of two operators (Op1/Op2), using the 28 mm double-lumen CBAC. Epidemiological, historical and procedural data were collected. Follow-up was completed by review consultation and phoneinterview. Results:
Introduction: We aim to report our experience with selective RV septal lead implants in regards to ECG characteristics, lead parameters and complications. Methods: 50 consecutive patients with standard pacing indications were prospectively analyzed. All RV leads placed in the mid RV septum as is our institutions preference. A paced 12-lead ECG was analyzed retrospectively. Septal lead parameters were checked at implant, 6 weeks, and 3 months Results: We were able to implant the lead in the RV septum in all cases. Lead parameters at implant were within accepted industry standards and remained stable at 6 weeks and 3 months. The only complication was one lead dislodgement. Mean QRS duration was 0.135 ± 0.022 s. Overall vector analysis showed the mean frontal cardiac axis of 16.4 ± 64.9◦ . 3 distinct ECG patterns emerged during septal pacing (Fig. 1). Despite these three quite distinct ECG patterns there was no significant statistical difference in QRS duration between the three groups (P = 0.89). Conclusions: The RV septal implantation is safe and technically achievable with stable lead parameters and a narrow QRS. The QRS morphology in the limb leads during forced ventricular pacing shows poor correlation to eventual QRS duration.
Procedures
12
4 (±0.97)
doi:10.1016/j.hlc.2009.05.359
Patients Male
11 9 (81%)
2.4 (±0.58) 42.7 (±9.7)
Age (years) AADs tried
56 (±9.9) 1.9 (±0.54)
358 REGIONAL LEFT ATRIAL CONDUCTION VELOCITY AND ITS RELATIONSHIP TO CFAE
AF duration (years) Procedure times (min) Mean time Op.1 (N = 9)
8.4 (±5.1) 220 (±48) 233 (±48)
Mean time Op.2 (N = 3)
181 (±25)
Veins per patient Lesions per vein Mean ablation time Veins isolated Mean follow-up % off AAD Symptom free Symptoms improved Complications
43 (94%) 7.27 months (±5.25) 9 (82%) 8 (72%) 9 (82%) 1 phrenic palsy
Conclusions: All cases were performed without significant complication, with high rates of complete PVI and symptomatic results comparable to RFA. doi:10.1016/j.hlc.2009.05.358
Anthony Brooks, Patrick Connolly, Paolo De Scisio, Pawel Kuklik, Hany Dimitri, Bobby John, Nicholas J. Shipp, Nicholas Chia, Glenn D. Young, Prashanthan Sanders Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, The University of Adelaide, Adelaide, Australia Introduction: High frequency SR signals have previously been described as ‘AF nests’ and fractionated signals in AF are clinically significant. Complex electrograms may arise within regions of slowed conduction, but this relationship has not been objectively investigated in a clinical setting. Methods: Electro-anatomical maps were created in SR (77 ± 38 points) and induced AF (71 ± 16 points) in 10 patients. Customised software was used to segment the atrium into six regions (roof, anterior, posterior, septal, lateral and inferior) in which conduction velocity,
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
356 PULMONARY VEIN ISOLATION USING THE ARCTICFRONT CRYOBALLOON: THE MONASHHEART EXPERIENCE L. Bittinger, G. Lee, D. Adam, J. Alison Monash Cardiovascular Research Centre, MonashHEART, Southern Health & Department of Medicine (MMC), Monash University, Melbourne, Australia
357 REAL WORLD EXPERIENCES WITH RIGHT VENTRICULAR SEPTAL LEAD IMPLANTATION: ECG CHARACTERISTICS, LEAD PARAMETERS AND COMPLICATIONS Geoffrey Lee, Logan Bittinger, Stuart Allen, Nick Youngs, Damian Haldane, Emily Kotschet, David Adam, Jack Krafchek, Jeff Alison MonashHeart, Melbourne, Australia
Introduction: Pulmonary vein isolation (PVI) is a proven therapy for symptomatic drug refractory paroxysmal atrial fibrillation (PAF) and is usually performed using various circumferential radiofrequency ablation (RFA) lesion sets. The ArcticFront cryoballoon ablation catheter (CBAC) has been developed as an alternative to RFA to create circumferential pulmonary vein lesions using cryotherapy. The CBAC has been used successfully in Europe and in trials in North America. MonashHeart performed the first PVIs using the CBAC in the Asia-Pacific region in September 2007. Aim: To describe an Australian experience of cryotherapy for PVI over a 15-month period regarding: ability to achieve complete PVI, symptomatic results, and complications. Methods: Selected patients had symptomatic PAF despite anti-arrhythmic drug (AAD) therapy, no structural heart disease, no previous PVI procedures and were deemed suitable for PVI by an Electrophysiologist. Procedures were performed by one of two operators (Op1/Op2), using the 28 mm double-lumen CBAC. Epidemiological, historical and procedural data were collected. Follow-up was completed by review consultation and phoneinterview. Results:
Introduction: We aim to report our experience with selective RV septal lead implants in regards to ECG characteristics, lead parameters and complications. Methods: 50 consecutive patients with standard pacing indications were prospectively analyzed. All RV leads placed in the mid RV septum as is our institutions preference. A paced 12-lead ECG was analyzed retrospectively. Septal lead parameters were checked at implant, 6 weeks, and 3 months Results: We were able to implant the lead in the RV septum in all cases. Lead parameters at implant were within accepted industry standards and remained stable at 6 weeks and 3 months. The only complication was one lead dislodgement. Mean QRS duration was 0.135 ± 0.022 s. Overall vector analysis showed the mean frontal cardiac axis of 16.4 ± 64.9◦ . 3 distinct ECG patterns emerged during septal pacing (Fig. 1). Despite these three quite distinct ECG patterns there was no significant statistical difference in QRS duration between the three groups (P = 0.89). Conclusions: The RV septal implantation is safe and technically achievable with stable lead parameters and a narrow QRS. The QRS morphology in the limb leads during forced ventricular pacing shows poor correlation to eventual QRS duration.
Procedures
12
4 (±0.97)
doi:10.1016/j.hlc.2009.05.359
Patients Male
11 9 (81%)
2.4 (±0.58) 42.7 (±9.7)
Age (years) AADs tried
56 (±9.9) 1.9 (±0.54)
358 REGIONAL LEFT ATRIAL CONDUCTION VELOCITY AND ITS RELATIONSHIP TO CFAE
AF duration (years) Procedure times (min) Mean time Op.1 (N = 9)
8.4 (±5.1) 220 (±48) 233 (±48)
Mean time Op.2 (N = 3)
181 (±25)
Veins per patient Lesions per vein Mean ablation time Veins isolated Mean follow-up % off AAD Symptom free Symptoms improved Complications
43 (94%) 7.27 months (±5.25) 9 (82%) 8 (72%) 9 (82%) 1 phrenic palsy
Conclusions: All cases were performed without significant complication, with high rates of complete PVI and symptomatic results comparable to RFA. doi:10.1016/j.hlc.2009.05.358
Anthony Brooks, Patrick Connolly, Paolo De Scisio, Pawel Kuklik, Hany Dimitri, Bobby John, Nicholas J. Shipp, Nicholas Chia, Glenn D. Young, Prashanthan Sanders Cardiovascular Research Centre, Department of Cardiology, Royal Adelaide Hospital and the Disciplines of Medicine and Physiology, The University of Adelaide, Adelaide, Australia Introduction: High frequency SR signals have previously been described as ‘AF nests’ and fractionated signals in AF are clinically significant. Complex electrograms may arise within regions of slowed conduction, but this relationship has not been objectively investigated in a clinical setting. Methods: Electro-anatomical maps were created in SR (77 ± 38 points) and induced AF (71 ± 16 points) in 10 patients. Customised software was used to segment the atrium into six regions (roof, anterior, posterior, septal, lateral and inferior) in which conduction velocity,