Comparison of Using Second-Generation Cryoballoon and Radiofrequency Catheter for Atrial Fibrillation Ablation in Patients With the Common Ostium of Inferior Pulmonary Veins

A Distinctive Strategy for Catheter Ablation in Patients With Bilateral Common Ostium in the Inferior Pulmonary Veins: A Case Report

Pulmonary vein anatomical variations are frequently observed in atrial fibrillation patients undergoing catheter ablation. However, when it comes to patients with atrial fibrillation and bilateral common ostium in the inferior pulmonary veins, using a bilateral circumferential pulmonary vein isolation approach during catheter ablation heightens the risk of esophageal injury. At present, there is no established standard catheter ablation strategy for such cases. A 47-year-old female with atrial fibrillation underwent catheter ablation. Prior to the procedure, a left atrial computed tomography angiography indicated a common ostium of the left and right inferior pulmonary veins. During mapping, a low-voltage area was found in the patient's left atrial posterior wall. To avoid esophageal injury and effectively isolate both pulmonary veins and the low-voltage area with minimal ablation points, we used a single-ring ablation approach. In a 12 month follow-up, the patient had no atrial fibrillation recurrence.

Efficacy, safety, and somatosensory comparison of pulsed-field ablation and thermal ablation: outcomes from a 2-year follow-up

BACKGROUND

Pulsed-field ablation (PFA), as a nonthermal ablative approach for atrial fibrillation, has attracted much attention in recent years. And there are few comparative studies on PFA versus conventional thermal ablation, including radiofrequency ablation (RFA) and cryoballoon ablation (CBA). The efficacy, safety, and somatic sensation of PFA and thermal ablation need to be further compared.

METHODS

A total of 109 patients with paroxysmal atrial fibrillation were divided into three groups (27 in the PFA group, 41 in the CBA group, and 41 in the RFA group), and the operation characteristics, efficacy, safety, and somatic sensation were recorded and analyzed. All patients were followed for 2 years.

RESULTS

All pulmonary veins were successfully isolated except for 1 pulmonary vein that was not successfully isolated during the CBA process (PFA vs. CBA vs. RFA = 100% vs. 99% vs. 100%). The total operation time for PFA is considerably shorter than that for thermal ablation (PFA vs. CBA vs. RFA = 65.28 ± 22.78 min vs. 75.38 ± 18.53 min vs. 96.26 ± 23.23 min, P < 0.001), and the same applies to all the sub-phases. PFA was similarly more dominant in terms of somatosensory perception, mainly in headache (PFA vs. CBA = 1.17 ± 0.48 vs. 2.31 ± 1.06, P < 0.001) and chest pain (PFA vs. RFA = 1.45 ± 0.88 vs. 2.52 ± 1.06, P < 0.001). All these three groups demonstrated good maintenance rates (PFA vs. CBA vs. RFA = 85.00% vs. 80.49% vs. 78.05%, 2 years after operation).

CONCLUSION

PFA demonstrates its excellent somatic sensation and favorable safety. And it also showed a great immediate success and maintenance rate, which is not inferior to thermal ablation.

Catheter Ablation of Atrial Tachycardia after Pulmonary Vein Isolation in a Patient with Common Ostium of Inferior Pulmonary Veins: Case Report

Background and Objectives: Atrial fibrillation (AF), a prevalent cardiac arrhythmia, significantly impacts the quality of life of those affected. The preferred treatment for symptomatic AF, particularly when pharmacological methods fall short, is catheter ablation with pulmonary vein isolation (PVI). While common pulmonary vein (PV) anatomical variants, such as the right accessory pulmonary vein and the common ostium of left pulmonary veins (LCPV), have been studied extensively, their impact on the long-term outcome of PVI is known to be minimal. However, data on less common anomalies, like the common ostium of the left and right inferior pulmonary vein (CIPV), remain scarce in the medical literature. This report aims to shed light on the challenges and outcomes of catheter ablation in a patient with a rare CIPV anomaly. By presenting this case, we contribute to the limited knowledge about the management of such unique anatomical variations in AF treatment and discuss the importance of individualized treatment approaches. Case Presentation: We present a case involving a 56-year-old male diagnosed with AF in 2018. Initial PVI treatment was successful, but the patient experienced symptom recurrence after three years. A preprocedural CT scan before the second ablation revealed a CIPV anomaly. During the repeat procedure, a right superior pulmonary vein (RSPV) reisolation was performed due to identified gaps in the previous ablation line. Post-procedure, the patient maintained a sinus rhythm and reported no further symptoms. Conclusions: This case highlights the importance of recognizing rare PV anatomies like CIPV in the effective management of AF. Tailored ablation strategies, accounting for unique anatomical conditions, can lead to successful long-term outcomes, reinforcing the need for personalized approaches in AF treatment, especially in cases involving complex anatomical variations.

Single ring isolation of pulmonary veins combined with electrical isolation of the superior vena cava in patients with paroxysmal atrial fibrillation

Background

Single-ring isolation (SRI) of the pulmonary veins and the left atrial post wall (LAPW) is an accepted strategy in atrial fibrillation ablation. Whether SRI combined with superior vena cava isolation (SVCI) could further increase the success rate of paroxysmal atrial fibrillation (PAF) has not been reported.

Objective

This study aimed to investigate whether SRI combined with SVCI was feasible and whether it could improve the success rate of PAF ablation.

Methods and results

In our study, sixty patients with PAF from May 2019 to March 2021 were included. SRI plus SVCI was completed with ablation index (AI)-guided high-power ablation. The success rates of SRI and SVCI were 100% and 97%, respectively. One-pass SRI was achieved in 41 out of 60 patients, with 19 out of 60 patients requiring additional ablation to complete the SRI. SVC was not isolated in 2 out of the 60 cases due to concerns about the phrenic nerve (PN) injury. Among the enrolled patients, 2 patients had anomalous pulmonary veins (PVs) (common ostium of inferior PVs). SRI was applied to achieve the PV and PW isolation. After ablation, one patient had an ischemic stroke but recovered without severe morbidity. The average follow-up period was (20 ± 7) months, and single-procedure freedom from atrial arrhythmia was 91.7%. AT/AF recurred in five patients, and 2 out of 5 patients underwent redo ablation. The multi-procedure freedom from atrial arrhythmia was 95%.

Conclusion

Our novel ablation strategy, SRI combined with SVCI, in patients with PAF was feasible and safe, with a relatively high success rate.