Pulmonary vein re-mapping after cryoballoon ablation for atrial fibrillation

Aims Establishment of pulmonary vein isolation (PVI) during cryoballoon (CB) ablation is generally confirmed by use of an octapolar inner-lumen mapping catheter (Achieve (R)). The aim of this study is to evaluate the residual PV potential (PVP) using the conventional circular catheter after CB-PVI. Methods and results A total of 105 consecutive patients (418 PVs) with paroxysmal AF who underwent the initial CB-PVI were prospectively included in this study. Of those, 305 (73%) PVs with real-time recordings of PVP elimination by Achieve (R) catheter during successful PVI were included. After isolation of all 4 PVs, PV antral remapping by conventional circular mapping catheter was performed. After CB-PVI, residual PVP was detected in 4.3% (13/305) of PVs (1.2% of left-superior PV, 2.5% of left-inferior PV, none of right-superior PV, and 20% of right-inferior PV). Almost 60% of residual PV potential was located around the bottom portion of the right-inferior PV. In PVs with residual potential, PV trunk was shorter (12.7 +/- 5.7 mm vs. 18.7 +/- 7.9, P = 0.001), minimal balloon temperature was higher (-46.6 +/- 5.9 degrees C vs. -50.9 +/- 8.2, P = 0.02), and balloon warming time was shorter (35.6 +/- 17.8 s vs. 50.0 +/- 22.8, P = 0.006) than those without. All residual potentials were eliminated by additional touch up ablation. After the initial ablation procedure, 1-year AF-free rate was 79.5%. Conclusion PV remapping after CB-PVI revealed residual antral PVP in 4.3% of PVs and in 20% of RIPVs in particular. The Achieve (R) catheter sometimes fails to detect complete PV antral isolation.