In a feature article in this month’s EP Lab Digest®, Arjun V. Gururaj, MD and colleagues from Sunrise Hospital in Las Vegas present a case of a 56-year-old patient with paroxysmal atrial fibrillation and an unusual anatomic variant that presented some challenges regarding ablation. Pulmonary vein isolation is an accepted treatment for paroxysmal atrial fibrillation; ablation success rates at 12 months are in the 65-75% range. In this case, the authors were able to isolate the four pulmonary veins acutely with low-power RF application.
In our January 2014 issue, Andrew Wickliffe, MD and Dan Dan, MD presented their experience using balloon cryoablation for paroxysmal atrial fibrillation at the Piedmont Heart Institute in Atlanta. The patient was a 64-year-old male who was initially diagnosed with paroxysmal atrial fibrillation about 5 years ago. At first the patient noticed brief episodes of palpitations or flutters, but over the course of a year, the episodes became more frequent and lasted up to 20 minutes. The patient first underwent pulmonary vein isolation using irrigated radiofrequency energy in a WACA strategy, which was acutely successful. After that point, the patient was referred to the Piedmont Heart Institute for further evaluation and management, and repeat ablation using balloon cryoablation was performed. Following the ablation, the patient felt significant improvement and has had no evidence of recurrent atrial fibrillation. They write that using balloon cryoablation for paroxysmal atrial fibrillation has resulted in a significant decrease in procedure time, fluoroscopy time, and left atrial dwell time.