Validation of electrical ostial pulmonary vein isolation verified with a spiral inner lumen mapping catheter during second‐generation cryoballoon ablation

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Excerpt

Catheter ablation of atrial fibrillation (AF) has become an established therapy in patients with symptomatic paroxysmal AF, and pulmonary vein isolation (PVI) is the cornerstone strategy.1 Electrical disconnections between the left atrium and PVs are the established procedural endpoint, and a circumferential mapping catheter has been used as the gold standard to verify the endpoint.1
In recent years, cryoballoon (CB) ablation has emerged as a valid alternative to radiofrequency (RF) ablation,3 and the more recently introduced second‐generation CB (Arctic Front Advance, Medtronic, Minneapolis, MN, USA) has shown a significant improvement in the procedural and clinical outcomes as compared with its predecessor.4 Previously, electrical PVI could only be confirmed after CB applications by a circumferential mapping catheter that was inserted via either a second transseptal puncture hole or the CB sheath after an exchange of the CB catheter, which was a drawback of the procedure. Since the appearance of an octapolar spiral inner mapping catheter specifically designed for the CB (Achieve, Medtronic) has enabled real‐time monitoring of the PV activity during the applications and/or mapping after the applications,9 currently the single CB catheter approach has become the standard in the second‐generation CB ablation. Although this approach has significantly simplified the procedure and shortened the procedural time, a small validation study pointed out some limitations of this Achieve inner mapping catheter during the first‐generation CB procedure.10 The aim of this study was to evaluate the reliability of accurately confirming an ostial PVI with the Achieve mapping catheter alone during the second‐generation CB procedure in a large consecutive patient series.
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