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Case Reports
. 2015 Feb 20;4(1):e25592.
doi: 10.5812/cardiovascmed.25592. eCollection 2015 Feb.

Failure to reach the optimal temperature during cryoablation due to refrigerant cylinder problem

Narendra Kumar  1 , Trang Dinh  1 , Mohamed Magdi Abbas  2 , Kevin Phan  3 , Randolph Manusama  1 , Suzanne Philippens  1 , Jos Maessen  4 , Carl Timmermans  1
Affiliations
Case Reports

Failure to reach the optimal temperature during cryoablation due to refrigerant cylinder problem

Narendra Kumar et al. Res Cardiovasc Med. .

Abstract

Introduction: Pulmonary vein (PV) isolation is considered as a key to atrial fibrillation (AF) treatment. Cryoballoon ablation is an effective therapy for PV isolation for AF with minimal side effects and was approved by the US Food and Drug Administration (FDA) several years ago. Successful isolation of PVs during cryoablation depends on the balloon temperature and helps in early identification of noneffective cryoballoon applications. A lower balloon temperature has been associated with long-term success in isolation of PVs.

Case presentation: At the start of the procedure, the cryoconsole displayed "low refrigerant level". After a few cycles of successful cryoballoon applications, for a fresh application for a new PV, the optimal temperature was not obtained in spite of obtaining good grade of occlusion and ostial positioning for right inferior pulmonary vein (RIPV). Later, immediately after changing the refrigerant cylinder, suitable temperature was obtained. We faced this situation thrice in a span of eight months.

Conclusion: Low refrigerant level may cause nonoptimal temperature during cryoablation, which can be resolved by premature change of a gas cylinder.

Keywords: Atrial Fibrillation; Cryoablation; Pulmonary vein; refrigeration.

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Figures

Figure 1.
Figure 1.. Fluoroscopy Image Showing Complete Occlusion of Right Inferior Pulmonary Vein Using 50% Diluted Contrast With Cryoballoon and in-Situ Catheters
GW, achieve catheter; IC, impending contrast; CB, cryoballoon; His, His catheter; CS, coronary sinus catheter.
Figure 2.
Figure 2.. The Cryoconsole Screen
The minimal temperature achieved (-47°C) following the change of the refrigerant tank.
See this image and copyright information in PMC

References

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    1. Kumar N, Timmermans C, Das M, Dassen W, Philippens S, Maessen J, et al. Hemoptysis after cryoablation for atrial fibrillation: truth or just a myth? Chest. 2014;146(5):e173–5. doi: 10.1378/chest.14-1600. - DOI - PubMed
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