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