Epicardial pulmonary vein isolation with a hook-shaped cryoprobe to treat atrial fibrillation Hiroshi Kubota, MD, Shinichi Takamoto, MD, Toshiya Ohtsuka,

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Epicardial pulmonary vein isolation with a hook-shaped cryoprobe to treat atrial fibrillation Hiroshi Kubota, MD, Shinichi Takamoto, MD, Toshiya Ohtsuka, MD, Hidehito Endo, MD, Masaya Sato, MD, Tatsuo Fujiki, MD, Kenichi Sudo, MD The Annals of Thoracic Surgery Volume 78, Issue 3, Pages 1056-1059 (September 2004) DOI: 10.1016/S0003-4975(03)01453-X

Fig 1 The hook-shaped cryoprobe. The hook is 20-mm long and 3-mm wide. The Annals of Thoracic Surgery 2004 78, 1056-1059DOI: (10.1016/S0003-4975(03)01453-X)

Fig 2 Diagram of the area where cryoablation is performed with the assistance of the probe. (LA = left atrium; PV = pulmonary vein.) The Annals of Thoracic Surgery 2004 78, 1056-1059DOI: (10.1016/S0003-4975(03)01453-X)

Fig 3 Procedure for creating a circumferential cryolesion. (A) The probe is passed behind the PV and pulled upward. (B) The PV is compressed and flattened by the probe. (C) Cryoablation is performed for 90 seconds. (PV =pulmonary vein.) The Annals of Thoracic Surgery 2004 78, 1056-1059DOI: (10.1016/S0003-4975(03)01453-X)

Fig 4 Atrial and PV potentials during ablation (spontaneously beating heart). Immediately after the start of cryoablation, the PV potential decreased rapidly and became almost flat. A couple of ectopic beats, which may have arisen from the cryosite, were observed. (LA = left atrium; LAA = left atrial appendage; PV = pulmonary vein; RA = right atrium.) The Annals of Thoracic Surgery 2004 78, 1056-1059DOI: (10.1016/S0003-4975(03)01453-X)

Fig 5 Atrial and PV potentials during ablation (pacing from the PV). Before ablation, pacing signals from the PV were conducted to both atria. Immediately after commencing the cryoablation, the cardiac rhythm converted from pacing rhythm to sinus rhythm. An ectopic potential (★), which may have arisen from the cryosite, is seen. (LA = left atrium; LAA = left atrial appendage; PV = pulmonary vein; RA = right atrium.) The Annals of Thoracic Surgery 2004 78, 1056-1059DOI: (10.1016/S0003-4975(03)01453-X)