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
