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Fourth-Generation Cryoablation Based Left Atrial Appendage Isolation for the Treatment of Persistent Atrial Fibrillation: First Case Report

Unusual clinical course, Challenging differential diagnosis, Unusual or unexpected effect of treatment, Patient complains / malpractice

Roland Richard Tilz, Makoto Sano, Julia Vogler, Thomas Fink, Charlotte Eitel, Christian-H. Heeger

Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) – Campus Luebeck, Luebeck, Germany

Am J Case Rep 2019; 20:1830-1836

DOI: 10.12659/AJCR.918196

Available online:

Published: 2019-12-08


BACKGROUND: Pulmonary vein isolation (PVI) is an effective treatment strategy for patients with paroxysmal atrial fibrillation (AF), yet it is associated with limited success rates in patients with persistent AF (PersAF). The left atrial appendage (LAA) was recently identified as a target of catheter ablation especially in PVI non-responders and LAA-isolation (LAAI) by cryoballoon or radiofrequency was shown to be effective. Recently the fourth-generation cryoballoon (CB4) was introduced to clinical practice. Here we are demonstrating the first case report of CB4-based LAAI followed by LAA-closure in a patient with PersAF.
CASE REPORT: A 67-year-old male patient presented with symptomatic PersAF and thromboembolism due to LAA-thrombus. After resolving the LAA-thrombus cryoballoon based PVI and empirical LAAI was successfully performed. To prevent further thromboembolism LAA-closure was successfully performed after 6 weeks. On short-term follow-up (12 weeks) the patients stayed in stable sinus rhythm.
CONCLUSIONS: Fourth-generation cryoballoon based ablation seems to be an effective treatment strategy for LAAI.

Keywords: Ablation Techniques, Atrial Appendage, Atrial Fibrillation



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