A Novel Cryoballoon Technique for Mapping and Isolating Pulmonary Veins: A Feasibility and Efficacy Study

A Novel Cryoballoon Technique . Introduction: The study was designed to evaluate the feasibility and efficacy of a simplified cryoballoon technique in which a microcircular catheter was introduced into the central lumen of a cryoballoon catheter for the purpose of recording pulmonary vein (PV) potentials during ablation procedures and without interchanging catheters. Methods and Results: A total of 23 consecutive patients with paroxysmal atrial fibrillation (AF) were enrolled. A single transseptal puncture was made and a cryoballoon catheter was inserted into the left atrium. A 6‐pole mapping catheter with a 0.035‐inch shaft diameter was introduced into the PV through the central lumen of the cryoballoon catheter. In addition to the function as a recording device, the mapping catheter was also used as a “guide‐wire” during the procedure. A total of 84 PVs (84/92, 91.3%) were completely isolated using this novel cryoballoon technique. In 43 of the 84 veins (51.2%), isolation was observed in real time during the cryoablation; in the remaining 41 veins (48.8%), isolation was confirmed immediately post ablation attempt with the mapping catheter. Procedure time was 152.7 ± 54.9 minutes, and fluoroscopy time was 33.2 ± 17.3 minutes. At follow‐up (7.4 months, range 2–18 months), 17 (73.9%) patients were free from AF. There was 1 occurrence of phrenic nerve palsy during ablation of a right superior PV, which fully resolved after 1 month. Conclusion: The use of a cryoballoon catheter equipped with a 6‐pole micromapping catheter inserted through its central lumen for the purpose of mapping and ablation during PV isolation procedures is both feasible and effective. (J Cardiovasc Electrophysiol, Vol. 21, pp. 626‐631, June 2010)     

RELATIVE AND POPULATION ATTRIBUTABLE RISK OF TRAFFIC INJURIES IN RELATION TO BLOOD-ALCOHOL LEVELS IN A MEDITERRANEAN COUNTRY

Blood samples were taken from, and interviews were conductedwith, 76 persons injured in motor vehicle crashes, and from126 controls with a home and leisure injury. The analysis wasundertaken by modelling the data through conditional logisticregression, controlling for gender- and age-matched variablesand other potentially confounding variables, including educationand visual acuity. Detectable alcohol levels were associatedwith a 4.9 relative risk (95% confidence intervals 1.4 to 16.8).The population attributable fraction was about 10% with wideconfidence intervals. There was no evidence for a safe thresholdin these data. The increased injury risk associated with detectableblood-alcohol levels was disproportionally, albeit non-significantly,elevated among occasional drinkers in comparison to regulardrinkers. We conclude that alcohol intake is an important causeof road traffic injuries even in the context of the Mediterraneancountries where alcohol is taken in moderation and mainly inthe form of wine during meals.     

Project Megapoles: Promoting better health for socially disadvantaged groups across Europe

A new public health network is looking at ways of achievingbetter health and reducing differences in health between Europe'scapital cities. A report from the Socially Disadvantaged Groupssub-network of Megapoles.     

Reconstructing and Registering Three-Dimensional Rotational Angiogram of Left Atrium during Ablation of Atrial Fibrillation

Background: Three-dimensional (3D) image of left atrium (LA) can greatly facilitate ablation of atrial fibrillation (AF). Reconstructing method using computed tomography (CT) has certain limitations. The 3D image of LA can be intraprocedurally reconstructed by a rotational angiography technique.
Methods: Forty-six patients undergoing AF ablation were included in this study. Preprocedural CT imaging and intraprocedural reconstructing 3D rotational angiogram (3DRA) of LA were performed in all the patients. Rapid ventricular pacing (RVP, 300 ms) was used to inhibit the drainage of atrium. During RVP, contrast medium was injected into the LA, and rotational angiography was performed. The 3DRA was reconstructed and was registered with the live fluoroscopy. The 3DRA was evaluated in comparison to the CT image. In the navigation of the registered 3DRA, the ablation of AF was performed.
Results: Forty-four 3DRAs (95.7%) were successfully reconstructed and registered with the live fluoroscopy. The LA anatomy was delineated in the 3DRA in comparison to a CT image. AF ablation was successfully performed in the 44 patients in the navigation of the registered 3DRA. There were good correlations in the PV ostial diameter and the LA volume as assessed by 3DRA in comparison to a CT image (r >= 0.87). The radiation exposure in rotational angiography was substantially less than that in CT scanning (2.7 ± 0.9 mSv vs. 24.9 ± 3.1 mSv, P < 0.001).
Conclusions: It is feasible to reconstruct and register the 3DRA with live fluoroscopy using the RVP method during the ablation of AF.