Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 20;39(6):997-1000.
doi: 10.1002/joa3.12926. eCollection 2023 Dec.

Four typical pulmonary venous pressure curves displaying the level of occlusion during atrial fibrillation ablation by cryoballoon

Antoine Milhem  1 , Caroline Allix-Béguec  2 , Virginie Laurençon  2 , Frédéric Treguer  3 , Olivier Cesari  4
Affiliations

Four typical pulmonary venous pressure curves displaying the level of occlusion during atrial fibrillation ablation by cryoballoon

Antoine Milhem et al. J Arrhythm. .

Abstract

Background: Cryoballoon ablation is safe and effective for pulmonary vein isolation in patients with symptomatic drug-refractory paroxysmal atrial fibrillation. To monitor adhesion between the balloon and the pulmonary vein, an alternative technique to pulmonary venography is to analyze changes in the pressure curve.

Methods: We have described the adhesion level characterized by four types of pressure waveforms.

Results: These correlated with the extent of contrast agent leakage (Cohen's kappa of 0.81 [IC 95%: 0.63-0.99]).

Conclusion: Monitoring the venous pressure curve is easy to perform and has the advantage of being able to detect balloon movement during the first few seconds of treatment.

Keywords: atrial fibrillation; catheter ablation; cryotherapy; pulmonary vein; venography.

PubMed Disclaimer

Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

FIGURE 1
FIGURE 1
Pictures of the four pulmonary venous pressure curves representative of the level of adhesion between the balloon and the pulmonary vein antrum in atrial fibrillation (left pictures) and sinus rhythm (right pictures). (A) Type‐1 curve: the sizes of atrial and ventricular waves are similar (no adhesion); (B) type‐2 curve: the atrial wave is still visible, which indicates a wrong position of the balloon; (C) type‐3 curve: exclusive ventricular wave with pressure drop (inward‐curving slope) indicating an imperfect balloon position; (D) type‐4 curve: exclusive ventricular wave with a slow decrease in pressure (outward‐curving slope) indicating perfect adhesion. The so‐called A (atrial) wave is in fact observed in the same way in sinus rhythm as in fibrillation and therefore does not correspond to atrial contraction.
FIGURE 2
FIGURE 2
Agreement between the results of the conventional contrast injection approach and the pulmonary venous pressure curves.
See this image and copyright information in PMC

References

    1. Su W, Kowal R, Kowalski M, Metzner A, Svinarich JT, Wheelan K, et al. Best practice guide for cryoballoon ablation in atrial fibrillation: the compilation experience of more than 3000 procedures. Heart Rhythm. 2015;12(7):1658–1666. - PubMed
    1. Hasegawa K, Miyazaki S, Kaseno K, Hisazaki K, Amaya N, Miyahara K, et al. Pressure‐guided second‐generation cryoballoon pulmonary vein isolation: prospective comparison of the procedural and clinical outcomes with the conventional strategy. J Cardiovasc Electrophysiol. 2019;30(10):1841–1847. - PubMed
    1. Sharma A, Dhoot J, Wang J, Jones P, Gupta S, Wimmer AP. Outcomes following cryoballoon ablation for atrial fibrillation guided by pressure waveform monitoring without the routine use of pulmonary venography. J Interv Card Electrophysiol. 2017;49(1):75–82. - PubMed
    1. SiklÓdy CH, Minners J, Allgeier M, Allgeier HJ, Jander N, Keyl C, et al. Pressure‐guided cryoballoon isolation of the pulmonary veins for the treatment of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2010;21(2):120–125. - PubMed
    1. Safavi‐Naeini P, Shanoon F, Nazeri A, Rasekh A, Saeed M, Razavi M, et al. Cryoballoon pressure waveform change during balloon inflation is not a reliable predictor of adequate pulmonary vein occlusion. Pacing Clin Electrophysiol. 2014;37(12):1702–1707. - PubMed