A 66-year-old female patient was admitted because of highly symptomatic drug-refractory paroxysmal atrial fibrillation (AF). The CHA2DS2-VASc score was 2 and HAS-BLED score was 2. The patient underwent pulmonary surgery and the right upper-lobe lung was resected 4 years ago because of pulmonary carcinoma. The patient has been in stable condition without evidence of progression. Transesophageal echocardiography (TEE) was performed at admission, and left atrial (LA) thrombus was ruled out. After multidisciplinary assessment, we suggested pulmonary vein isolation (PVI) using cryoballoon technology. Full consent of the patient was obtained.
Detailed procedural approach was published previously [1,2,3]. In this case, after single transseptal puncture, selective PV angiography was performed to identify the pulmonary vein. The right superior PV (RSPV) was shown as a “short-stub” anatomy due to the previous pulmonary surgery (Fig. 1). Therefore, a shorter-tip third-generation cryoballoon (CB 3, Arctic Front Advance Pro., Medtronic) was selected for PVI.
All four PVs were treated with time-to-effect guided freeze. Particularly, the short-tip CB 3 and spiral mapping catheter combination obtained a perfect occlusion for the operated RSPV. Figure 2 details the approaches, catheter maneuver, PV occlusion and electrophysiological tracing during RSPV ablation. Consequently, the RSPV was well occluded and real-time isolated using a “push-up” maneuver. In-hospital, 1, 3, 6 months’ follow-up showed favorable clinical outcome. 72-h Holter at each follow-up visit did not reveal AF/AT recurrence.