Co-Author(s):
Abington Memorial Hospital
1200 Old York Rd, Abington, PA 19001
Introduction | Objectives: Left common pulmonary veins (LCPV) are seen in roughly 10-20% of the
patient population with an increased prevalence in patients with AF as
compared to the control.1,2 The average size of LCPVs
has been recorded as 30 ± 7 mm, while, to date, the largest treated LCPV
with the second-generation visually guided laser balloon (VGLB) is 38
mm.3 Due to the large and variant size of LCPVs, they
are frequently difficult to treat using common modalities. The VGLB
allows for variable-sizing to accommodate various sizes and shapes of
pulmonary veins (PV), such as LCPVs. We report on a case study of a
41 mm LCPV that was successfully treated through the utilization of
variable balloon sizing with the second-generation VGLB.
Methods: N/A
Results: Patient presented for a redo AF ablation, having undergone a previous
procedure using the Medtronic Cryoballoon. The patient’s LCPV measured
41 mm on the computerized tomography scan. A pre-voltage map displayed
electrical re-connection in the LCPV and right inferior PV. The superior
branch of the long trunked LCPV was cannulated and the balloon was
dynamically sized until the superior, anterior, and posterior aspects of
the LCPV were displayed on the endoscopic image. The vein was ablated
using various dosing (ranging from 5.5 Watts to 12 Watts) and a WACA
“open 8” technique.4 Lower dosing was utilized on
the inferior and superior aspect due to incomplete occlusion. The LCPV
was successful electrically isolated on the first pass.
Conclusions: Variable-sizing and endoscopic visualization allowed for the safe and
successful electrical re-isolation of a 41 mm LCPV without needing to
segmentally isolate the vein.
AFS 2021-24