Hong Kong Med J 2011;17:386–90 | Number 5, October 2011
Initial experience of cryoballoon catheter ablation for atrial fibrillation in Hong Kong
NY Chan, CC Choy, CL Lau, YK Lo, PS Chu, HC Yuen, NS Mok, PT Tsui, ST Lau
Department of Medicine, Princess Margaret Hospital, Laichikok, Hong Kong
OBJECTIVE. To report the initial experience in using cryoballoon catheter ablation in the treatment of atrial fibrillation in Hong Kong.
DESIGN. Single-centre, prospective case series.
SETTING. Regional hospital, Hong Kong.
PATIENTS. Sixteen patients (mean age, 55 years; standard deviation, 14 years; 11 males) with paroxysmal (n=12) or persistent (n=4) atrial fibrillation.
INTERVENTIONS. Pulmonary vein isolation by ablation with a 28-mm cryoballoon catheter.
MAIN OUTCOME MEASURES. Safety, effectiveness, and learning curve of this procedure.
RESULTS. Of 67 pulmonary veins, 61 (91%) could be successfully isolated with the cryoballoon alone. The remaining pulmonary veins were isolated with additional ablation using an 8-mm tip cryocatheter. One phrenic nerve palsy developed during right middle pulmonary vein ablation, which resolved. Another patient endured a minor guidewire dissection of the right inferior pulmonary vein. The mean (standard deviation) procedural and fluoroscopic times were 231 (32) and 62 (18) minutes, respectively. On comparing the first nine and last seven procedures, there was a significant improvement in procedural time (mean [standard deviation], 244 [32] vs 213 [24] minutes; P=0.04) and in the fluoroscopic time (70 [21] vs 51 [7] minutes; P=0.038). With a median follow-up of 21 months, nine (75%) of the 12 patients with paroxysmal atrial fibrillation and one (25%) of those four with persistent atrial fibrillation had no recurrence, without the use of anti-arrhythmic drugs.
CONCLUSIONS. Pulmonary vein isolation by cryoballoon catheter ablation is safe and effective in treating patients with paroxysmal, but not for patients with persistent atrial fibrillation. A relatively short learning curve of around 10 cases was deemed appropriate.
Key words: Angioplasty, balloon; Atrial fibrillation; Catheter ablation; Cryosurgery; Pulmonary veins
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