Case Study: Cryoablation for Atrial Fibrillation

Samir Saba, MD

A 49 year old woman was referred to UPMC for curative treatment of atrial fibrillation in the form of pulmonary vein isolation.

She had a history of:

• Rheumatic heart disease status post subacute bacterial endocarditis requiring open-heart surgery and replacement of her mitral valve with a St. Jude Medical bi-leaflet mechanical valve.
• Paroxysmal atrial fibrillation failing treatment for a year with antiarrhythmic medications.

The evaluation

The patient was obese but otherwise in good health with a BMI of 46.1.

By transesophageal echocardiography, she had:

• A normal left ventricular ejection fraction.
• A well-seated mechanical mitral valve with normal function.
• No clots in the left atrial appendage (figure 1).

Figure 1: Transesophageal echocardiography

The CT scan of her chest (figure 2) showed normal pulmonary venous anatomy with a right intermediate pulmonary vein emptying ostially into the right superior pulmonary vein.

Figure 2: CT scan

The procedure

The patient was taken into the lab and underwent trans-septal left atrial catheterization under intracardiac echocardiographic guidance.

She underwent pulmonary vein isolation using the 23 mm Arctic Front cryoballoon catheter (figure 3).

Figure 3: Cryoballoon catheter deployment

The results

At the end of the procedure, all four pulmonary veins were completely isolated.

She was restated on her anticoagulation with Coumadin® and was discharged home as soon as her anticoagulation was therapeutic.

© 2011 UPMC