Shortening of freezing cycles provides equal outcome to standard ablation procedure using second-generation 28 mm cryoballoon after 15-month follow-up.

AIMS: Complications such as thermal oesophageal lesions, phrenic nerve injury, and pulmonary haemorrhage were found in cryoballoon (CB) ablation. Whether shortening of freezing times translates into equal efficacy rate and outcome is unknown. The aim of this study was to test the hypothesis that a single freeze cycle per pulmonary vein (PV) without dormant conduction during adenosine infusion is equally effective to standard CB procedure with a bonus freeze after documented PV isolation (PVI). METHODS AND RESULTS: In 53 patients with drug-refractory atrial fibrillation (AF) demonstrating PVI after a single 240 s freeze cycle without PV activity during adenosine no additional bonus freeze was applied (study group). In 139 patients, PVI was performed using a bonus freeze (240 s) after documented PVI (control group). Primary endpoint was recurrence of AF. Secondary endpoint was the assessment of quality of life (QoL-score from 1 to 6, being 1 the best and 6 the worst). Follow-up (FU) was performed at 3, 6, and 12 months. Freedom from symptomatic AF during a mean FU of 458 ± 107 days was achieved in 43 (81%) patients in the study group and in 110 (79%) control patients (P = ns). The QoL-score improved equally in both groups (4.8 ± 0.9 to 2.1 ± 0.7, P < 0.05 and 4.7 ± 0.6 to 2.2 ± 0.6, P < 0.05). Procedure duration (79 ± 14 vs. 98 ± 16 min, P < 0.01) was shorter in the study group. Complication rate was similar in both groups. CONCLUSION: Shortening of freezing times to 4 min per PV without residual dormant PV conduction after adenosine provocation is equally effective to the standard CB ablation protocol using a bonus freeze.

Emergency catheter ablation in critical patients.

Emergency catheter ablation is justified in critical patients with drug-refractory life-threatening arrhythmias. The procedure can be used for ablation of an accessory pathway in preexcitation syndrome with high risk of ventricular fibrillation and in patients with shock due to ischemic cardiomyopathy and incessant ventricular tachycardia. Emergency catheter ablation can also be justified in patients with an electrical storm of the implanted cardioverter-defibrillator or in patients with idiopathic ventricular fibrillation.

Closure of an iatrogenic aortocoronary arteriovenous fistula: transcatheter balloon embolization following failed coil embolization and salvage of coils that migrated into the coronary venous system.

We report a 50-year-old patient with successful percutaneous closure of a large inadvertent surgical aortocoronary arteriovenous fistula (shunt flow: 1.8 L/min). With initial embolization of multiple coils, no lasting occlusion of the large fistula could be achieved. Above that, two coils migrated into the coronary venous system. Following rescue of the migrated coils through a retrograde coronary sinus approach, the fistula was occluded using a detachable balloon. Follow-up angiograms confirmed successful closure of the fistula. In contrast to coil embolization, use of a detachable balloon seems to be the appropriate technique for percutaneous closure of such fistulas.