Real time assessment of pulmonary vein isolation using the novel Achieve mapping catheter during cryoablation

Purpose: The Achieve inner lumen mapping catheter can be used with the cryoballoon to assess real-time isolation of pulmonary vein (PV) during cryoablation and to act as a supporting guidewire during balloon positioning. We sought to analyze the feasibility of this novel catheter and to assess real-time PV isolation during cryoablation. Methods: Patients undergoing 28-mm cryoballoon PVI using the Achieve catheter were included from two centers. Each application lasted 5 min. Real-time PV recording during freezing and time to PV isolation were analyzed. Lastly, the number of applications needed to achieve PV isolation was investigated. Results: 68 pts (47 male; 61±10 yo) were included. Averaged procedure duration and fluoroscopy times were 118±24 min and 29±10 min. During the first application, PV potentials could be detected during freezing in 95.2%, 75.0%, 81.5% and 31.2% of the left superior (LSPV), left inferior (LIPV), right superior (RSPV) and right inferior (RIPV) PVs, respectively. When PV potentials were detected, they appeared in 5±2, 4±2, 4±2, and 3±2 dipoles in and the first cryoenergy application was successful in 68.7%, 82.8%, 80.0% and 90.6% of the LSPVs, LIPVs, RSPVs, and RIPVs, respectively. PV deconnection occurred at -38.4±8.8°C/54.5±34.8sec, -33.3±10.5/46.9±30.4sec, -34.4±12.1/44.4±30.5sec and –37.4±18.0/52.7±27.1sec for the the LSPVs, LIPVs, RSPVs, and RIPVs, respectively. At the end of the procedure, 100% of the PVs were isolated after 1.2±0.6 applications (from 1 to 4). Conclusion: Cryoablation in conjunction with the novel Achieve catheter is feasible, leading to high acute PV isolation rates. Real-time PV recording during freezing can be performed in most of the left PVs and the RSPVs while recording of RIPV potentials is harder due to stability issues.