Improved real-time recordings using the fourth generation cryoballoon
technology -- detection of dual fascicle electrograms
Abstract
Introduction: We aimed to analyze the rate of visualization of real-time
(RT) recordings and dual fascicle electrograms in our first series of
patients treated with the fourth generation cryoballoon (CB) device.
Methods: All consecutive patients who underwent CB ablation using the
fourth generation technology were included in the analysis. In all
procedures we used a 28 mm CB placed via a single transseptal puncture
guided by intracardiac ultrasound. A 20 mm octapolar intraluminal
circular catheter was used for intracranial recordings. A single 180
seconds freeze strategy was employed. Results: A total of 123 patients
(72.9% male, mean age 60.1±10.9 years) were enrolled in the study. RT
recordings were detected in 445 (86.2%) pulmonary veins (PVs).
Specifically, RT recordings were visualized in 115 left superior PVs
(89.2%), 107 left inferior PVs (82.9%), 118 right superior PVs
(91.4%) and 105 right inferior PVs (81.3%). Furthermore, in 23 of 516
PVs (4.4%), two fascicle electrograms were detected. Dual fascicles
were most commonly observed in left superior PV (6.2%). In both
inferior PVs dual fascicles were observed in 4.6% while this phenomenon
was least frequent in right superior PV (2.3%). Conclusion: By using
the fourth-generation CB we report a specific pattern of isolation
represented by a sequential isolation of two apparently distinct PV
fascicles during a single CB freeze delivery. This phenomenon occurred
in 4.4% of PV ablations. Of note, the rate of visualization of RT
isolation with this novel CB was very high and could be documented in
86.2% of PVs.