Michaël Peyrol, Pascal Sbragia, Morgane Orabona, Anne-Claire Casalta, Amandine Quatre, Zinedine Zerrouk, Gilles Boccara, Maxime Guenoun, Samuel Lévy, Franck Paganelli Department of Cardiology, Centre Hospitalier Universitaire Nord, Marseille, France

1. Annual Congress ECAS 2012 Munich Germany
The Use of Achieve Circular Mapping Catheter
Significantly Reduces Procedure Duration and
Fluoroscopy Time during Pulmonary Vein Isolation
with the Cryoballoon Technique
Michaël Peyrol, Pascal Sbragia, Morgane Orabona,
Anne-Claire Casalta, Amandine Quatre, Zinedine Zerrouk,
Gilles Boccara, Maxime Guenoun, Samuel Lévy, Franck Paganelli
Department of Cardiology,
Centre Hospitalier Universitaire Nord, Marseille, France

2. Dedicated Circular Mapping Catheter for PV Cryoablation
• Conflict of interest:
Drs Peyrol and Sbragia are consultants for
Medtronic Inc.
2

3. Dedicated Circular Mapping Catheter for PV Cryoablation
Background: PVI with the cryoballoon technique
- 23 or 28-mm double-coated cryoballoon chosen
according to PV anatomy
-‘’Over the wire’’ technique to navigate the balloon to the PVs
- At least two 240-sec cryoapplications per vein
- Fluoroscopic guidance
- Single (exchanges between ablation and mapping catheters)
or double transseptal access
Double transeptal approach
PAF
p=NS
Persistent AF
Neumann et al, JACC 2008 Kojodjojo et al, Heart 2010
23 or 28-mm double-coated cryoballoon 3

4. Dedicated Circular Mapping Catheter for PV Cryoablation
Background: Published studies
The cryoballoon technique is safe and effective for PVI, but with long procedure
duration and radiation exposure.
Nb of patients PVI rate, (%) Transeptal access Procedure Radiation Complications
duration (min) exposure (min) (%)
Van Belle et al. 57 185/220 (84%) Single 211 52 1 tamponade, 4
EHJ 2007 PNP (7%)
Neumann et al. 346 1360/1403 (97%) Double 170 40 2 tamponades, 26
JACC 2008 PNP (7% )
Van Belle et al. 141 NA NA 207 50 4 PNP (3%)
Europace 2008
Malmborg et al. 40 NA Single 240 57 2 PNP (5%)
Europace 2008
Chun et al. 27 97/99 (98%) Double 220 50 3 PNP (11%)
EHJ 2008
Siklody et al. 30 109/111 (98%) Single 180 40 4 PNP (13%)
JCE 2009
Chierchia et al 26 104/104 (100%) Single 175 42 1 PNP
Europace 2009
Packer et al. 163 NA NA 370 62 22 PNP (13.5%), 5
STOP-AF, ACC 2010 PV stenosis (3%)
Siklody et al. 12 50/51 (98%) Single 150 26 2 PNP (16 %)
JCE 2010
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5. Dedicated Circular Mapping Catheter for PV Cryoablation
Background: The Achieve (Cryocath, Medtronic Inc.) Circular Mapping Catheter
• 8-poles Achieve catheter replace the regular 0.035 inch stiff guidewire to navigate the
CB to the PVs.
• Allow real-time visualization of LA-PV conduction during or between cryoapplications.
• Has been demonstrated to be safe and effective to guide PVI with the CB technique.
Chierchia et al. Europace 2012
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6. Dedicated Circular Mapping Catheter for PV Cryoablation
Background: The Achieve catheter might simplify and speed-up the procedure.
Aim of the study: To evaluate the impact of the 20-mm 8-poles Achieve catheter on
procedural characteristics.
Design of the study: Monocentric, Case/Control study; initial experience with the Achieve
catheter.
32 consecutive patients with symptomatic drug-refractory PAF Exclusion criteria:
Among a cohort of 170 patients
 Valvular PAF
16 consecutive patients 16 consecutive patients  LA enlargment > 50 mm
Control group Achieve group
 LV hypertrophy > 15 mm
Single transseptal access Single transseptal access  Depressed < 50 % LVEF
Single size cryoballoon catheter Single size cryoballoon catheter  Prior LA ablation
Regular 0.035 inch guide 20-mm Achieve-guided PVI
Lasso mapping catheter No switch to 0.035 inch guide
Exchanges CB and Lasso required 240 sec. shots + 1 shot after PVI
Two 240 sec. shots with 4/4 occlusion PVI within 90 sec.
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7. Dedicated Circular Mapping Catheter for PV Cryoablation
Baseline characterisitics of enrolled patients:
Achieve group (n=16) Control group (n=16) p
Men (%) 14 (87.5) 12 (75) NS
Age (years) 58.4 ± 8.7 57.6 ± 8.5 NS
Hypertension (%) 5 (31.2) 6 (37.5) NS
Duration of AF (months) 47.4 44.4 NS
LA diameter (mm) 39.0 40.7 NS
Addtionnal Right PV
Atypical PV Anatomy None detected NS
in 2 patients
28-mm Cryoballoon catheter, (%) 13 (81.2) 9 (56.2) NS
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8. Dedicated Circular Mapping Catheter for PV Cryoablation
Results: Pulmonary Vein Isolation and Procedural Data
- Pulmonary vein isolation was obtained in 62/64 (97%) treated PVs in Achieve
group (single size of CB; no exchange to regular 0,035 inch guide; no focal ablation).
- Significant reduction of both procedure duration (-23%; p=0.003) and
fluoroscopy time (-25%; p=0.04) compared to the regular single transseptal approach.
- No Achieve-related complication
Achieve group (n=16) Control group (n=16) p
PV isolation, (%) 62/64 (97) 62/66 (94) NS
28-mm Cryoballoon catheter, (%) 13 (81) 9 (56) NS
Procedure duration, min 97 ± 26 126 ± 25 0.003
Fluoroscopy time, min 24 ± 10 32 ± 11 0.04
Real-time PV disconnection, (%) 21/62 (34) NA NS
Transient phrenic nerve palsy, (%) 2 0 NS
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9. Dedicated Circular Mapping Catheter for PV Cryoablation
Results: Pulmonary Vein Isolation and Procedural Data
140 *125,9 120 107
120
100 85
97 94 96,6
100
80
80 Achieve First 8
Achieve 60 patients
60 Control Achieve Last 8
40 30.7* patients
40
*32,6 * p<0,05
24,4 18
* p<0,05
20
20
0 0
PVI, % Procedure Radiation Procedure Radiation
duration, min exposure, min duration, min exposure, min
In Achieve group, we noticed a significant reduction of fluoroscopy time between the first 8
procedures and the 8 followings (30.7 ± 10.4 min vs 18.0 ± 3.6 min respectively; p =0.005).
The procedure duration tended to be reduced but without statistical difference
(107 ± 23 min vs 85 ± 26 min; p=0.10). Tang et al. JCE 2010
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10. Dedicated Circular Mapping Catheter for PV Cryoablation
Results: Real-Time PV Potentials Recording
- Rate of real-time PV potential visualization during
cryoapplications: 34 % (21/62 isolated PVs)
Pre Ablation PVP recording LA-PV conduction delay during Cryo LA-PV conduction block during Cryo
t=35 sec, Temp= -35°C t= 45 sec, Temp= -40°C
Real-time PVP recording during cryoapplication at LSPV, 20-mm Achieve catheter/28-mm Cryoballoon
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11. Dedicated Circular Mapping Catheter for PV Cryoablation
Results: Real-Time PV Potentials Recording
Real-time PVI in each vein: Causes of failed PVP recording:
 8/16 Left Superior PV  Distal position of the Achieve
 6/16 Left Inferior PV
 6/15 Right Superior PV  Loss of wall contact (15-mm loop)
1/15 Right Inferior PV  Inferior PVs: shorter sleeves
Complete LSPV occlusion obtained with distal location of the AC – Inability of real-time PVP recording
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12. Dedicated Circular Mapping Catheter for PV Cryoablation
Conclusion
- The Achieve catheter is both safe and effective to guide PV ablation in
cunjunction with the cryoballoon.
- The use of the 20-mm Achieve catheter significantly reduces the procedure
duration and fluoroscopy time.
- Real-time LA-PV disconnection was observed in a low rate of 34% of isolated
PVs.
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13. Annual Congress ECAS 2012 Munich Germany
The Use of Achieve Circular Mapping Catheter
Significantly Reduces Procedure Duration and
Fluoroscopy Time during Pulmonary Vein Isolation
with the Cryoballoon Technique
Michaël Peyrol, Pascal Sbragia, Morgane Orabona,
Anne-Claire Casalta, Amandine Quatre, Zinedine Zerrouk,
Gilles Boccara, Maxime Guenoun, Samuel Lévy, Franck Paganelli
Department of Cardiology,
Centre Hospitalier Universitaire Nord, Marseille, France