Published Online
on April 2, 2009

A more recent version of this article appeared on June 1, 2009

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Original Article

Feasibility of the Radiofrequency Hot Balloon Catheter for Isolation of the Posterior Left Atrium and Pulmonary Veins for the Treatment of Atrial Fibrillation

Hiroshi Sohara; Hiroshi Takeda; Hideki Ueno; Toshiyuki Oda and Shutaro Satake¹

Hayama Heart Center, Kanagawa, Japan

¹ E-mail: satake{at}hayamaheart.gr.jp

Background—Atrial fibrillation (AF) originates mostly from the pulmonary vein (PV) foci or non-PV foci in the posterior left atrium (LA). The present study was designed to evaluate the feasibility and safety of a novel radiofrequency Hot balloon catheter (RHB) for the treatment of patients with AF, by electrically isolating the posterior LA including all PVs.

Methods and Results—One hundred consecutive patients with drug-resistant AF (63 paroxysmal, 37 persistent) were enrolled. The isolation of the PVs was performed by wedging the balloon at each PV antrum to create circumferential lesions in each case. Contiguous linear lesions were also created at the roof between the superior PVs and at the bottom of the posterior LA between the inferior PVs by dragging the balloon along the endocardium. Complete elimination of the posterior LA and PV potentials was achieved in all 100 cases, confirmed by either conventional or electro-anatomical mapping system. The total procedure time was 129±26 minutes inclusive of 29.9±7.3 minutes fluoroscopy time. Follow-up during 11.0±4.8 months confirmed that ninety-two patients (60 paroxysmal, 32 persistent) were free from AF without antiarrhythmic drugs, and in the remaining patients except for two with LA tachycardia, sinus rhythm was maintained with antiarrhythmic drugs. With precautions of esophageal cooling by irrigation dictated by temperature monitoring, and monitoring phrenic nerve pacing, no LA-esophageal fistula or permanent phrenicnerve injury occurred.

Conclusion—This feasibility study supports the safety and efficacy of RHB for complete isolation of the posterior LA and pulmonary veins.

Key Words: ablation • arrhythmia • balloon • electrophysiology • atrial fibrillation • radiofrequency • posterior left atrium