1
|
Incidence of Long-Term Pulmonary Vein Reconnection after a 2-Minute Cryoballoon Freeze for Pulmonary Vein Isolation—Invasive Insights of TTI-Dependent Cryoenergy Titration. J Cardiovasc Dev Dis 2022; 9:jcdd9090284. [PMID: 36135429 PMCID: PMC9505807 DOI: 10.3390/jcdd9090284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: The optimal freeze duration in cryoballoon pulmonary vein isolation (PVI) is unknown. TTI-based titration of cryoenergy allows individualized freeze duration and has emerged as a favorable ablation strategy in PV cryoablation. In a recent study, we demonstrated that omission of a bonus freeze and reduction in freeze duration to a minimum of 2 min in the case of short TTI led to comparable arrhythmia recurrence rates. Whereas clinical outcome seems to be comparable to fixed freeze duration, evidence of long-term PV reconnection rates in patients undergoing TTI-based cryoballoon ablation is sparse. Aim of the study: To evaluate the procedural efficacy of a single 2-min freeze for PVI, we assessed PV conduction recovery after cryoballoon PVI with a TTI-guided titration of freeze duration compared to a fixed ablation protocol. Methods and Results: We included consecutive patients with atrial fibrillation (AF) recurrence undergoing a second ablation procedure after the initial cryoballoon procedure. The second AF ablation procedure was performed by the 3D-mapping system and radiofrequency ablation technique. A total of 219 patients (age: 66.2 ± 10.8 years, 53% female, paroxysmal AF: 53%) treated with the TTI-guided protocol (174 patients, 685 PV) or fixed protocol (45 patients, 179 PV) showed comparable total reconnection rates (TTI: 36.9% vs. fixed: 31.8%, p = 0.21). The PV reconnection rate was not statistically different for PVs treated with a 2-min freeze in case of short TTI, compared to longer freeze duration. Interestingly, the PV reconnection rate was lower in LIPVs treated with the fixed protocol (13% vs. 31%, p = 0.029). In the TTI group, 17 out of 127 patients (15%) had durable isolation of all PVs, whereas in 8 out of 40 patients (20%) in the fixed group, all PVs were still isolated (p = 0.31). Conclusions: overall reconnection rate was not different using a TTI-guided ablation protocol compared to a fixed ablation protocol, whereas the LIPV reconnection rate was significantly lower in patients treated with a fixed ablation protocol.
Collapse
|
2
|
Cryoballoon atrial fibrillation ablation experience in Japan. Curr Opin Cardiol 2022; 37:68-73. [PMID: 34857716 DOI: 10.1097/hco.0000000000000910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In Japan, cryoballoon ablation has been widely accepted and more than 70 000 patients have undergone pulmonary vein isolation using this novel technology since the introduction. This review focused on the current status of cryoballoon ablation in Japan and clarified the characteristics as compared to Europe and the United States. RECENT FINDINGS The number of atrial fibrillation patients undergoing cryoballon ablation has rapidly increased over the last 6 years. Most of the Japanese physicians consider the indication of cryoballoon ablation based on the anatomy of the pulmonary veins and left atrium evaluated on preprocedural computed tomography, and often perform adjunctive radiofrequency ablation after the pulmonary vein isolation. The reported overall efficacy and safety were similar to that in Europe and the United States; however, there are some distinctive complications of the cryoballoon procedure in Japan, such as air embolisms, gastric hypomotility and coronary artery spasms. SUMMARY Currently, the cryoballoon pulmonary vein isolation is widely accepted in Japan owing to the low incidence of lethal complications, shorter procedure time and acceptable single procedure atrial fibrillation freedom.
Collapse
|
3
|
Nakamura Y, Sohara H, Ihara M. Pulmonary vein stenosis after HotBalloon pulmonary vein isolation of paroxysmal atrial fibrillation. Heart Vessels 2021; 36:1739-1745. [PMID: 33929574 DOI: 10.1007/s00380-021-01862-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 04/23/2021] [Indexed: 11/25/2022]
Abstract
HotBalloon-based pulmonary vein isolation (HBPVI) has yielded encouraging clinical results in the treatment of paroxysmal atrial fibrillation (PAF). However, pulmonary vein (PV) stenosis remains a concern. The influence of longer application duration on PV stenosis has not yet been systematically evaluated. All patients who underwent first HBPVI of PAF with pre- and post-ablation computed tomography (CT) were included. We used single-shot technique with application duration of 180 s in the RSPV, 180-240 s in the LSPV, and 120 s in the lower PV procedures. PV stenosis was analyzed using CT and categorized as moderate (50-70%), and severe (> 70%) reduction in PV diameter. We analyzed imaging of the PV anatomy before ablation and during follow-up in 84 patients. Among them, 7 (8.3%) showed moderate stenosis, and 3 (3.6%) had severe stenosis including one total occlusion patient. All severe stenosis and total occlusion occurred in RSPV and LSPV procedures with longer application duration. No severe stenosis nor total PV occlusion occurred in inferior PV procedures with shorter application duration. The incidence of PV stenosis ≥ 50% or total PV occlusion was significantly lower in inferior PV than RSPV and LSPV procedures (0.6%, 6.0%, 8.0%, p = 0.01, respectively). All cases of PV stenosis including total PV occlusion patients were asymptomatic. No intervention for PV stenosis was performed. The risk of PV stenosis in HBPVI was rare in lower PV procedure with shorter application duration. An application duration setting of 120 s in lower PV procedure might be effective to prevent PV stenosis.
Collapse
Affiliation(s)
- Yoshinori Nakamura
- The Heart Rhythm Center, Tokyo Heart Center, 5-4-12 Kitashinagawa, Shinagawa-ku, Tokyo, 141-0001, Japan.
| | - Hiroshi Sohara
- The Heart Rhythm Center, Tokyo Heart Center, 5-4-12 Kitashinagawa, Shinagawa-ku, Tokyo, 141-0001, Japan
| | - Minoru Ihara
- The Heart Rhythm Center, Tokyo Heart Center, 5-4-12 Kitashinagawa, Shinagawa-ku, Tokyo, 141-0001, Japan
| |
Collapse
|
4
|
Kurose J, Kiuchi K, Fukuzawa K, Takami M, Mori S, Suehiro H, Nagamatsu YI, Akita T, Takemoto M, Yatomi A, Nakamura T, Sakai J, Watanabe Y, Shimoyama S, Negi N, Kyotani K, Hirata KI. Lesion characteristics between cryoballoon ablation and radiofrequency ablation with a contact force-sensing catheter: Late-gadolinium enhancement magnetic resonance imaging assessment. J Cardiovasc Electrophysiol 2020; 31:2572-2581. [PMID: 32648326 DOI: 10.1111/jce.14664] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) lesions after cryoballoon ablation (CBA) are characterized as a wider and more continuous than that after conventional radiofrequency catheter ablation (RFCA) without the contact force (CF)-sensing technology. However, the impact on the lesion characteristics of ablation with a CF-sensing catheter has not been well discussed. We sought to assess the lesions using late-gadolinium enhancement magnetic resonance imaging (LGE-MRI) and to compare the differences between the two groups (CB group vs. RF group). METHODS A total of 30 consecutive patients who underwent PVI were enrolled (CB group, 18; RF group, 12). The RF applications were delivered with a target lesion size index (LSI) of 5. The PVI lesions were assessed by LGE-MRI 3 months after the PVI. The region around the PV was divided into eight segments: roof, anterior-superior, anterior carina, anterior inferior, bottom, posterior inferior, posterior carina, and posterior superior segment. The lesion width and visual gap of each segment were compared between the two groups. The visual gaps were defined as no-enhancement site of >4 mm. RESULTS The mean LSI was 4.7 ± 0.7. The lesion width was significantly wider but the visual gaps were more frequently documented at the bottom segment of right PV in the CBA group (lesion width: 8.1 ± 2.2 vs. 6.3 ± 2.2 mm; p = .032; visual gap at the bottom segment or right PV: 39% vs. 0%; p = .016). CONCLUSIONS The PVI lesion was wider after CBA, while the visual gaps were fewer after RFCA with a CF-sensing catheter.
Collapse
Affiliation(s)
- Jun Kurose
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kunihiko Kiuchi
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Koji Fukuzawa
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsuru Takami
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shumpei Mori
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideya Suehiro
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yu-Ichi Nagamatsu
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomomi Akita
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Makoto Takemoto
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Atsusuke Yatomi
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiro Nakamura
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Jun Sakai
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshiaki Watanabe
- Department of Internal Medicine, Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinsuke Shimoyama
- Department of Internal Medicine, Division of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Noriyuki Negi
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, Kobe University Hospital, Kobe, Japan
| | - Katsusuke Kyotani
- Division of Diagnostic Imaging, Department of Diagnostic Radiology, Kobe University Hospital, Kobe, Japan
| | - Ken-Ichi Hirata
- Section of Arrhythmia, Department of Internal Medicine, Division of Cardiovascular Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| |
Collapse
|
5
|
Miyazaki S, Horie T, Hachiya H, Hasegawa K, Kajiyama T, Watanabe T, Nakamura H, Ishikawa E, Mukai M, Aoyama D, Nodera M, Kaseno K, Iesaka Y, Tada H. The mechanisms of recurrent atrial arrhythmias after second-generation cryoballoon ablation. Am Heart J 2020; 221:29-38. [PMID: 31901798 DOI: 10.1016/j.ahj.2019.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Accepted: 12/06/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with paroxysmal atrial fibrillation (PAF), 10%-15% of patients require repeat procedures after second-generation cryoballoon pulmonary vein isolation (CB-PVI). We sought to explore the mechanisms of recurrences after cryoballoon ablation. METHODS The data of 122 PAF patients who underwent second procedures for recurrent arrhythmias 7.0 (4.0-12.0) months after the CB-PVI were analyzed. During second procedures, non-PV AF foci were explored with isoproterenol, adenosine, and repetitive cardioversions. RESULTS In total, 378/487 (77.6%) PVs remained isolated, and reconnections were not observed in any PVs in 59 (48.4%) patients. PV reconnections were associated with recurrences in 38 (31.1%) patients, of whom 33 (86.8%) had reconnections of at least 1 upper PV. In 6 (4.9%) patients, non-PV AF foci were identified in the upper PV antra where cryoballoons cannot isolate but within the circumferential radiofrequency PVI line. Non-PV AF foci were identified in the superior vena cava, right atrial body, left atrial body, and atrial septum in 28 (23.0%), 18 (14.7%), 4 (3.3%), and 5 (4.1%) patients, respectively. Twelve (9.8%) patients had multiple non-PV AF foci. Four (3.3%), 3 (2.4%), and 8 (6.5%) patients underwent second procedures for atrioventricular nodal reentrant tachycardia, atrial flutter, and atrial tachycardias. During 16.0 (8.0-24.0) months of follow-up, freedom from any atrial arrhythmia at 1 year and 2 years after the second procedure was 79.2% and 60.6%. Nineteen (15.5%) patients had antiarrhythmic drug therapy at the last follow-up. CONCLUSIONS Our study suggested that improvement in the upper PV PVI durability, eliminating arrhythmogenic superior vena cavae and coexisting atrial arrhythmias, and bonus cryoballoon applications at PV antra might improve the single procedure outcome in cryoballoon ablation.
Collapse
Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan.
| | - Tomoki Horie
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hitoshi Hachiya
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan
| | - Takatsugu Kajiyama
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Tomonori Watanabe
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroaki Nakamura
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Eri Ishikawa
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan
| | - Moe Mukai
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan
| | - Minoru Nodera
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan
| | - Kenichi Kaseno
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Hiroshi Tada
- Department of Cardiovascular medicine, Fukui University, Fukui, Japan
| |
Collapse
|
6
|
Wei HQ, Guo XG, Zhou GB, Sun Q, Yang JD, Xie HY, Zhang S, Liang JJ, Ma J. Procedural findings and clinical outcome of second-generation cryoballoon ablation in patients with variant pulmonary vein anatomy. J Cardiovasc Electrophysiol 2018; 30:32-38. [PMID: 30288848 DOI: 10.1111/jce.13768] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/17/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Gong-Bu Zhou
- Department of Cardiology; Peking University Third Hospital; Beijing China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Hai-Yang Xie
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Shu Zhang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| | - Jackson J. Liang
- Electrophysiology Section, Cardiovascular Division; Hospital of the University of Pennsylvania; Philadelphia Pennsylvania
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center; Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing China
| |
Collapse
|
7
|
Novel spiral mapping catheter facilitates observation of the time-to-pulmonary vein isolation during cryoballoon ablation. Heart Vessels 2018; 34:496-502. [PMID: 30302548 PMCID: PMC6373539 DOI: 10.1007/s00380-018-1254-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
Observation of the time-to-pulmonary vein isolation (TTI) by a spiral mapping catheter has emerged as a valuable procedural parameter in cryoballoon pulmonary vein isolation (PVI). The 1st generation spiral mapping catheter (Achieve, SMC1) has been available as an 8-polar catheter with a distal loop diameter of 15 or 20 mm. The novel spiral mapping catheter (Achieve Advance, SMC2) was designed as a true guidewire and is available, in addition to the sizes of the SMC1, as a 10-polar mapping catheter with a distal loop diameter of 25 mm. Whether these novel features of SMC2 influence procedural characteristics of Cryo-PVI in comparison to SMC1 has not been reported. In this prospective cohort study 158 patients (age 65.1 ± 12.4 years, female 39%, paroxysmal AF 60%) undergoing PVI with the 2nd generation cryoballoon were included. SMC1 was used in 57 patients (36%), whereas 101 patients (64%) underwent Cryo-PVI with the SMC2. All PVs (623/623, 100%) were isolated successfully. Mean procedure duration was 72.0 ± 18.9 min in the SMC1 group and 74.4 ± 19.1 min in the SMC2 group (p = 0.432). Mean fluoroscopy time was also not different between both study groups (SMC1 15.7 ± 6.6 min, SMC2 15.7 ± 7.3 min, p = 0.593). TTI was observed in 68.6% of pulmonary veins in the SMC1 group, whereas TTI observation rate was 82.6% in the SMC2 group (p < 0.001). Number of freezes (5.5 ± 1.5 vs. 6.5 ± 1.9; p = 0.001) and total freeze duration (14.1 ± 4.5 vs. 17.6 ± 5.6; p < 0.001) were increased in the SMC2 group. SMC2 significantly increases TTI observation rate during Cryo-PVI. Procedure duration and fluoroscopy time are similar and number of freezes and total freeze duration are increased compared to PVI with SMC1 due to decreased stability and maneuverability of SMC2.
Collapse
|
8
|
Su W, Aryana A, Passman R, Singh G, Hokanson R, Kowalski M, Andrade J, Wang P. Cryoballoon Best Practices II: Practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective of experienced users. Heart Rhythm 2018; 15:1348-1355. [PMID: 29684571 DOI: 10.1016/j.hrthm.2018.04.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Indexed: 10/17/2022]
Abstract
Since the evaluation of the cryoballoon in the Sustained Treatment Of Paroxysmal Atrial Fibrillation trial, more than 350,000 patients with atrial fibrillation have been treated. Several studies have reported improved outcomes using the second-generation cryoballoon, and recent publications have evaluated modifications, refinements, and improvements in procedural techniques. Here, peer-reviewed articles published since the first cryoballoon best practices review were summarized against the technical practices of physicians with a high level of experience with the cryoballoon (average ≥6 years of experience in ≥900 cases). This summary includes a comprehensive literature review along with practical usage guidance from physicians using the cryoballoon to facilitate safe, efficient, and effective outcomes for patients with atrial fibrillation.
Collapse
Affiliation(s)
- Wilber Su
- Banner University Medical Center, Phoenix, Arizona; Stanford Health Care, Stanford, California.
| | - Arash Aryana
- Mercy Medical Group, Dignity Health Heart & Vascular Institute, Sacramento, California
| | - Rod Passman
- Northwestern Feinberg School of Medicine, Chicago, Illinois
| | | | | | | | - Jason Andrade
- Montreal Heart Institute, Montreal, Quebec, Canada; University of British Columbia, Vancouver, British Columbia, Canada
| | - Paul Wang
- Stanford Health Care, Stanford, California
| |
Collapse
|