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Patel T, Li C, Raissi F, Kassab GS, Gao T, Lee LC. Coupled thermal-hemodynamics computational modeling of cryoballoon ablation for pulmonary vein isolation. Comput Biol Med 2023; 157:106766. [PMID: 36958236 DOI: 10.1016/j.compbiomed.2023.106766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 02/26/2023] [Accepted: 03/07/2023] [Indexed: 03/15/2023]
Abstract
Cryoballoon ablation (CBA) is a cryo-energy based minimally invasive treatment procedure for patients suffering from left atrial (LA) fibrillation. Although this technique has proved to be effective, it is prone to reoccurrences and some serious thermal complications. Also, the factors affecting thermal distribution at the pulmonary vein-antrum junction that are critical to the treatment success is poorly understood. Computer modeling of CBA can resolve this issue and help understand the factors affecting this treatment. To do so, however, numerical challenges associated with the simulation of advection-dominant transport process must be resolved. Here, we describe the development of a thermal-hemodynamics computational framework to simulate incomplete occlusion in a patient-specific LA geometry during CBA. The modeling framework uses the finite element method to predict hemodynamics, thermal distribution, and lesion formation during CBA. An incremental pressure correction scheme is used to decouple velocity and pressure in the Navier-Stokes equation, whereas several stabilization techniques are also applied to overcome numerical instabilities. The framework was implemented using an open-source FE library (FEniCS). We show that model predictions of the hemodynamics in a realistic human LA geometry match well with measurements. The effects of cryoballoon position, pulmonary vein blood velocity and mitral regurgitation on lesion formation during CBA was investigated. For a -700C cryoballoon temperature, the model predicts lesion formation for gaps less than 2.5 mm and increasing efficiency of CBA for higher balloon tissue contact areas. The simulations also predict that lesion formation is not sensitive to variation in pulmonary vein blood velocity and mitral regurgitation. The framework can be applied to optimize CBA in patients for future clinical studies.
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Affiliation(s)
- Tejas Patel
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Chris Li
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA
| | - Farshad Raissi
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
| | | | - Tong Gao
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA; Department of Computational Mathematics, Science and Engineering, Michigan State University, East Lansing, MI, USA
| | - Lik Chuan Lee
- Department of Mechanical Engineering, Michigan State University, East Lansing, MI, USA.
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2
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Kim JA, Chelu MG. Comparison of cryoballoon and radiofrequency ablation for persistent atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 66:585-595. [PMID: 36089635 DOI: 10.1007/s10840-022-01369-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND There is limited data comparing radiofrequency (RF) and cryoballoon (CB) ablation for persistent atrial fibrillation (AF), which tends to have higher recurrence rates following ablation compared to paroxysmal AF. METHODS A systematic search of the Embase, PubMed, and Cochrane database was performed for studies comparing RF vs CB ablation for persistent AF. An inverse-variance random-effects model was used to calculate the composite effects. RESULTS One randomized and 9 observational studies were identified, with 1650 patients receiving CB and 1706 patients receiving RF ablation. Mean follow-up time ranged from 12 to 48 months. Freedom from recurrent atrial tachyarrhythmia was similar with the two modalities (HR 0.93, 95% CI 0.80 to 1.08, I2 0%). Total complications were similar in both groups (RR 1.05, 95% CI 0.73 to 1.53, I2 0%) although rates of phrenic nerve palsy (PNP) were greater with CB (RR 4.13, 95% CI 1.49 to 11.46, I2 0%). Shorter procedure times were observed with CB (mean reduction 43.77 min, 95% CI 66.45 to 21.09 min, I2 96%) with no difference in fluoroscopy time (mean difference 0.82 min, 95% CI - 11.92 to 13.55 min, I2 100%). CONCLUSIONS In persistent AF patients, CB ablation has similar efficacy and overall safety as compared to RF ablation. While CB is associated with significantly shorter procedure times, the improved procedural efficiency with CB is offset by increased rates of PNP and the potential need for touch-up RF ablation.
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Affiliation(s)
- Jitae A Kim
- Department of Internal Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Mihail G Chelu
- Division of Cardiology, Baylor College of Medicine, 7200 Cambridge Suite A6.137, MS: BCM621, Houston, TX, 77030, USA.
- Baylor St. Luke's Medical Center, Houston, TX, USA.
- Texas Heart Institute, Houston, TX, USA.
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3
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Abstract
PURPOSE OF REVIEW The cryoballoon catheter has been an option for the treatment of atrial fibrillation for over a decade. The most widely used device is the Medtronic Arctic Advance cryoballoon catheter. Recently, Boston Scientific has released the POLARx cryoballoon catheter. Here we review the major changes in the catheter system's design and its implications for procedural practice. RECENT FINDINGS The POLARx cryoballoon catheter has been approved for use in Europe. Some studies have been published detailing the first clinical experiences in vivo with this newest technology. SUMMARY The changes to the POLARx cryoballoon catheter, particularly its ability to maintain balloon size and pressure, will improve occlusion and theoretically improve procedural outcomes.
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Affiliation(s)
| | - Rong Bai
- Banner University Medical Center Phoenix
| | - Mateen Khokhar
- Dignity Health St. Joseph's Hospital Phoenix, Phoenix, Arizona
| | - Wilber W. Su
- Banner University Medical Center Phoenix
- Stanford University, Stanford, California, USA
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4
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Heeger CH, Sohns C, Pott A, Metzner A, Inaba O, Straube F, Kuniss M, Aryana A, Miyazaki S, Cay S, Ehrlich JR, El-Battrawy I, Martinek M, Saguner AM, Tscholl V, Yalin K, Lyan E, Su W, Papiashvili G, Botros MSN, Gasperetti A, Proietti R, Wissner E, Scherr D, Kamioka M, Makimoto H, Urushida T, Aksu T, Chun JKR, Aytemir K, Jędrzejczyk-Patej E, Kuck KH, Dahme T, Steven D, Sommer P, Richard Tilz R. Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry. Circ Arrhythm Electrophysiol 2021; 15:e010516. [PMID: 34962134 PMCID: PMC8772436 DOI: 10.1161/circep.121.010516] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. Methods: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. Results: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was −49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. Conclusions: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (C.-H.H., R.R.T.)
| | - Christian Sohns
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., P.S.)
| | - Alexander Pott
- Department of Cardiology, University of Ulm, Germany (A.P., T.D.)
| | - Andreas Metzner
- Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.).,Asklepios Klinik Harburg, Hamburg, Germany (A.M.).,University Heart Center Hamburg, Germany (A.M.)
| | - Osamu Inaba
- Japanese Red Cross Saitama Hospital, Saitama, Japan (O.I.)
| | - Florian Straube
- München Klinik Bogenhausen und Schwabing, Klinik für Kardiologie und Internistische Intensivmedizin, München, Germany (F.S.).,Ludwig-Maximilians-University, Faculty Munich University Clinic, Germany (F.S.)
| | | | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA (A.A.)
| | | | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Ankara City Hospital, Turkey (S.C.)
| | | | | | | | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (A.M.S.)
| | - Verena Tscholl
- Charité Campus Benjamin Franklin, Berlin, Germany (V.T.)
| | - Kivanc Yalin
- #x0130;stanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey (K.Y.)
| | | | - Wilber Su
- Division of Cardiology, University of Illinois at Chicago (E.W.)
| | | | | | - Alessio Gasperetti
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,Department of Cardiology, Johns Hopkins University, Baltimore (A.G.).,Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, IT, Italy (A.G.)
| | - Riccardo Proietti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy (R.P.)
| | | | | | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan (M.K.)
| | - Hisaki Makimoto
- Universitätsklinik Düsseldorf, Abteilung für Kardiologie, Germany (H.M.)
| | | | - Tolga Aksu
- Kocaeli Derince Training and Research, Turkey (T.A.)
| | - Julian K R Chun
- CCB / Med. Klinik III, Kardiologie, Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C.)
| | - Kudret Aytemir
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey (K.A.)
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland (E.J.-P.)
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.).,LANS Cardio, Hamburg, Germany (K.-H.K.)
| | - Tillman Dahme
- Department of Cardiology, University of Ulm, Germany (A.P., T.D.)
| | - Daniel Steven
- Universität zu Köln, Abteilung für Elektrophysiologie, Köln, Germany (D.S.)
| | - Philipp Sommer
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., P.S.)
| | - Roland Richard Tilz
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (C.-H.H., R.R.T.)
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5
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Akhtar T, Wallace R, Daimee UA, Sivasambu B, Hart E, Yang E, Marine JE, Berger R, Calkins H, Spragg D. Safety and efficacy of cryoballoon versus radiofrequency ablation for atrial fibrillation in elderly patients: A real-world evidence. Indian Pacing Electrophysiol J 2021; 22:24-29. [PMID: 34838748 PMCID: PMC8811282 DOI: 10.1016/j.ipej.2021.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/11/2021] [Accepted: 11/21/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND There are limited data describing the experience of radiofrequency (RF) vs. cryoballoon (CB) ablation for atrial fibrillation (AF) among elderly patients in the United States. METHODS We conducted a retrospective analysis of patients ≥75 years of age undergoing index RF vs. CB ablation between January 2014 and May 2020 at our center. The choice of ablation technique was left to the operator's discretion. Major complications and efficacy, defined as freedom from any atrial tachyarrhythmia (ATA) lasting ≥30 s after one year of follow-up, were assessed in patients with index RF vs. CB ablation. RESULTS In our cohort of 186 patients, the median age was 78 (76-81) years, 54.8% were men, and 39.2% had persistent AF. The median CHA2DS2-VASc score was 4 (3-4), while the median duration of AF was 3 (1-7) years. The majority (n = 112, 60.2%) underwent RF ablation. The median procedure time was significantly lower in CB group (197 vs 226.5 min, p=<0.01). The incidence of complications was similar in the two sub-groups (RF: 1.8% vs. CB: 2.7%, p = 0.67). Similarly, arrhythmia-free survival rate on antiarrhythmic drugs at 1-year follow-up remained statistically comparable (63.4% vs. 68.9%, p = 0.33) between patients receiving RF vs. CB ablation. CONCLUSION The safety and efficacy of RF vs. CB ablation for AF remained comparable in our cohort of patients older than 75 years. CB ablation was associated with a shorter procedure time.
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Affiliation(s)
- Tauseef Akhtar
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| | - Ryan Wallace
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Usama A Daimee
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Bhradeev Sivasambu
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Erica Hart
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eunice Yang
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Joseph E Marine
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Ronald Berger
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - David Spragg
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
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6
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Nakano T, Suenari K, Okada A, Hyodo Y, Tomomori S, Higaki T, Oi K, Dai K, Kawase T, Nakama Y, Nishioka K, Otsuka M, Masaoka Y, Shiode N, Nakano Y. New Minimally Invasive and Tailor-Made Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation. Heart Lung Circ 2021; 31:530-536. [PMID: 34753660 DOI: 10.1016/j.hlc.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 09/14/2021] [Accepted: 10/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND The optimal dosage for cryoballoon ablation (CBA) of atrial fibrillation (AF) is still unknown. OBJECTIVE This study aimed to evaluate the clinical implications of a reduction in the freezing duration to <180 seconds during CBA guided by the time to the target temperature. METHODS This study enrolled 325 consecutive paroxysmal AF patients who underwent CBA. It was a retrospective observational study in a single centre. It compared 164 patients who underwent a tailor-made CBA procedure (group T) with 161 who had a standard CBA procedure (group S). In group T, the freezing duration was reduced to 150 seconds when the temperature reached ≤ -40 °C within 40 seconds. Furthermore, it was reduced to 120 seconds when it reached ≤ -50 °C within 60 seconds. In the other patients, the freezing duration was 180 seconds, except for excessive freezing of ≤ -60 °C and/or emergent situations while monitoring the oesophageal temperature, and for phrenic nerve injury, as in group S. RESULTS In group T, 89 patients (83%) underwent CBA with a reduction in the freezing duration. The total freezing time for each pulmonary vein was significantly shorter in group T than group S, and the total procedure time in group T decreased by an average of 4 minutes compared with group S. The rate of requiring additional radio frequency ablation following the CBA was significantly lower in group T than group S. The AF-free survival rate during the follow-up period (median, 366 days) was similar between the two groups. CONCLUSION The safety and efficacy of the new CBA strategy were non-inferior to the standard procedure.
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Affiliation(s)
- Takayuki Nakano
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuyoshi Suenari
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan.
| | - Akira Okada
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yohei Hyodo
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Shunsuke Tomomori
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tadanao Higaki
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kuniomi Oi
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kazuoki Dai
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Tomoharu Kawase
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuharu Nakama
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Kenji Nishioka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masaya Otsuka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshiko Masaoka
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Nobuo Shiode
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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7
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Chun J, Maurer T, Rillig A, Bordignon S, Iden L, Busch S, Steven D, Tilz RR, Shin DI, Estner H, Bourier F, Duncker D, Sommer P, Ewertsen NC, Jansen H, Johnson V, Bertagnolli L, Althoff T, Metzner A. [Practical guide for safe and efficient cryoballoon ablation for atrial fibrillation : Practical procedure, tips and tricks]. Herzschrittmacherther Elektrophysiol 2021; 32:550-562. [PMID: 34735629 DOI: 10.1007/s00399-021-00820-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
Abstract
In the current guidelines on treatment of atrial fibrillation, cryoballoon-based catheter ablation of atrial fibrillation is recommended in addition to radiofrequency ablation and has become established as a standard procedure in the clinical routine of many centers for index pulmonary vein isolation. A safe, simplified and often durable pulmonary vein isolation can be achieved by a systematic approach. This review article provides a practical guide for all steps of cryoballoon-based pulmonary vein isolation, including preprocedural preparation and postinterventional follow-up. Both cryoballoon systems currently available on the market are considered.
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Affiliation(s)
- Julian Chun
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland. .,Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland.
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Stefano Bordignon
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Medizinische Klinik II, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Felix Bourier
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Nils-Christian Ewertsen
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berliner-Herzrhythmus-Zentrum, Berlin, Deutschland
| | | | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
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8
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Left Atrial Fibrosis after Single Shot Guided Pulmonary Vein Isolation. J Clin Med 2021; 10:jcm10194478. [PMID: 34640495 PMCID: PMC8509823 DOI: 10.3390/jcm10194478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment modality for patients with atrial fibrillation (AF) with encouraging acute and long-term outcome data. However, the size of collaterally created lesion sets adjacent to the pulmonary veins (PVs) remains unclear, especially when CB ablation is performed with individualized time-to-isolation (TTI) protocols. This study seeks to investigate the extension of lesions at the posterior wall and the roof of the left atrium (LA). Thirty patients with paroxysmal or persistent AF underwent ablation with a fourth-generation CB. The individual freeze-cycle duration was set at TTI + 120 s. A total of 120 PVs were identified, and all were successfully isolated. A three-dimensional electroanatomical high-density (HD) mapping of the LA was performed in every patient before and after PVI. The surface areas of the posterior wall and LA roof were measured and compared with lesion extension after PVI. After CB ablation, 65.6 ± 16.9% of the posterior wall and 75.4 ± 18.4% of the LA roof remained unablated. In addition, non-antral lesion formation was observed in every patient in at least one PV. After CB ablation, anterior antral parts of the superior PVs showed the greatest unablated areas compared with the other antral areas. HD re-mapping after CB-based PVI demonstrated that major regions of the posterior wall and roof remained electrically normal and unaffected. Unablated antral areas were localized predominantly in the anterior segments of the superior PVs and may be partly responsible for AF recurrence.
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9
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Mizutani Y, Yanagisawa S, Kanashiro M, Yamashita D, Yonekawa J, Makino Y, Hiramatsu T, Ichimiya H, Uchida Y, Watanabe J, Ichimiya S, Inden Y, Murohara T. Earliest pulmonary vein potential-guided cryoballoon ablation is associated with better clinical outcomes than conventional cryoballoon ablation: A result from two randomized clinical studies. J Cardiovasc Electrophysiol 2021; 32:2933-2942. [PMID: 34535938 DOI: 10.1111/jce.15246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/20/2021] [Accepted: 09/06/2021] [Indexed: 12/20/2022]
Abstract
INTRODUCTION With regard to short-term outcome in atrial fibrillation (AF), the benefit of cryoballoon ablation (CBA) by pressing a balloon against the earliest pulmonary vein (PV) potential site during PV isolation (earliest potential [EP]-guided CBA) has been previously demonstrated. The present study aimed to evaluate the long-term outcome of the EP-guided CBA. METHODS AND RESULTS This study included 136 patients from two randomized studies, who underwent CBA for paroxysmal AF for the first time. Patients were randomly assigned to the EP-guided and conventional CBA groups in each study. In the EP-guided CBA group, we pressed a balloon against the EP site when the time-to-isolation (TTI) after cryoapplication exceeded 60 and 45 s in the first and second studies, respectively. We compared the clinical outcomes for 1 year after the procedure between the EP-guided CBA group (68 patients) and the conventional CBA group (68 patients). The primary endpoint was the recurrence of atrial arrhythmia after ablation. No significant differences in baseline characteristics were observed between the two groups. Compared with the conventional CBA group, the EP-guided CBA group had a significantly higher success rate at TTI ≤ 90 s (98.5% vs. 90.0%, p < .001); lower touch-up rate and total cryoapplication; and shorter procedure time, and fluoroscopy time. The recurrence at 1 year after ablation was significantly lower in the EP-guided CBA group than in the conventional CBA group (6.0% vs. 19.4%; p = .019). CONCLUSIONS The EP-guided CBA approach can facilitate the ablation procedure and achieve low recurrence at 1 year after ablation.
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Affiliation(s)
- Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan.,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Daiki Yamashita
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Jun Yonekawa
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yuichiro Makino
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Takatsugu Hiramatsu
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Hitoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yasuhiro Uchida
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Junji Watanabe
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Satoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, Yokkaichi, Mie, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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10
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Second-generation cryoballoon versus contact force radiofrequency ablation for atrial fibrillation: an updated meta-analysis of evidence from randomized controlled trials. Sci Rep 2021; 11:17907. [PMID: 34504121 PMCID: PMC8429450 DOI: 10.1038/s41598-021-96820-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 08/12/2021] [Indexed: 11/08/2022] Open
Abstract
Catheter ablation has been recommended for patients with symptomatic atrial fibrillation (AF), with pulmonary vein isolation being the cornerstone of the ablation procedure. Newly developed technologies, such as cryoballoon ablation with a second-generation cryoballoon (CB2) and the contact force radiofrequency (CF-RF) ablation, have been introduced in recent years to overcome the shortcomings of the widely used RF ablation approach. However, high-quality results comparing CB2 and CF-RF remain controversial. Thus, we conducted this meta-analysis to assess the efficacy and safety between CB2 and CF-RF using evidence from randomized controlled trials (RCTs). Databases including Embase, PubMed, the Cochrane Library, and ClinicalTrials.gov were systematically searched from their date of inception to January 2021. Only RCTs that met the inclusion criteria were included for analysis. The primary outcome of interest was freedom from atrial tachyarrhythmia (AT) during follow-up. Secondary outcomes included procedure-related complications, procedure time and fluoroscopy time. Six RCTs with a total of 987 patients were finally enrolled. No significant differences were found between CB2 and CF-RF in terms of freedom from AT (relative risk [RR] = 1.03, 95% confidence interval [CI] 0.92-1.14, p = 0.616) or total procedural-related complications (RR = 1.25, 95% CI 0.69-2.27, p = 0.457). CB2 treatment was associated with a significantly higher risk of phrenic nerve palsy (PNP) than CF-RF (RR = 4.93, 95% CI 1.12-21.73, p = 0.035). The occurrences of pericardial effusion/tamponade and vascular complications were comparable between the CB2 and CF-RF treatments (RR = 0.41, p = 0.398; RR = 0.82, p = 0.632). In addition, CB2 treatment had a significantly shorter procedure time than CF-RF (weighted mean difference [WMD] = - 20.75 min, 95% CI - 25.44 ~ - 16.05 min, P < 0.001), whereas no difference was found in terms of fluoroscopy time (WMD = 4.63 min, p = 0.179). CB2 and CF-RF treatment are comparable for AF patients regarding freedom from AT and procedure-related complications. Compared to CF-RF, CB2 treatment was associated with a shorter procedure time but a higher incidence of PNP. Further large-scale studies are warranted to compare these two techniques and provide an up-to-date recommendation.
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11
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Miyama H, Takatsuki S. Less Invasive Ablation of Atrial Fibrillation Achieved by Contrast-Free Cryoballoon Ablation. Circ J 2021; 86:266-267. [PMID: 34497161 DOI: 10.1253/circj.cj-21-0674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine
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12
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Katsume Y, Miwa Y, Ueda A, Soejima K. Underdiagnosis of phrenic nerve palsy caused by cryoballoon ablation for atrial fibrillation with upright position chest radiography: usefulness of supine position dynamic chest radiography. Europace 2021; 23:1567. [PMID: 34352087 DOI: 10.1093/europace/euab173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Yumi Katsume
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Yosuke Miwa
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Akiko Ueda
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan
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13
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Mao YJ, Feng WY, Huang QY, Yu FL, Chen JX, Wang H. Meta-analysis of cryoballoon ablation versus antiarrhythmic drugs as initial therapy for symptomatic atrial fibrillation. Clin Cardiol 2021; 44:1393-1401. [PMID: 34327708 PMCID: PMC8495081 DOI: 10.1002/clc.23695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 07/04/2021] [Accepted: 07/15/2021] [Indexed: 12/04/2022] Open
Abstract
Background The optimal first‐line approach for patients with symptomatic atrial fibrillation (AF) remains unclear. We compared the efficacy and safety of cryoballoon ablation (CBA) and antiarrhythmic drugs (AADs) in the initial management of symptomatic AF. Hypothesis CBA is superior to AAD as initial therapy for symptomatic AF. Methods We searched the EMBASE, PubMed, and Cochrane Library databases for randomized controlled trials (RCTs) that compared CBA with AAD as first‐line treatment for AF from the date of database establishment until March 18, 2021. The risk ratio (RR) with a 95% confidence interval (CI) was used as a measure of treatment effect. Results Three RCTs that enrolled 724 patients in total were included in this meta‐analysis. Majority of the patients were relatively young and had paroxysmal AF. CBA was associated with a significant reduction in the recurrence of atrial arrhythmia compared with AAD therapy, with low heterogeneity (RR, 0.59; 95% CI, 0.49–0.71; p < .00001; I2 = 0%). There was a significant difference in the rate of symptomatic atrial arrhythmia recurrence (RR, 0.44; 95% CI, 0.29–0.65; p < .0001; I2 = 0%); however, the rate of serious adverse events was similar between the two treatment groups (RR: 1.18; 95% CI: 0.71–1.97, p = .53; I2 = 0%). Transient phrenic nerve palsy occurred in four patients after the CBA procedure. Conclusion The current meta‐analysis suggests that CBA is more effective than AAD as initial therapy in patients with symptomatic paroxysmal AF. Serious iatrogenic adverse events are uncommon in CBAs.
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Affiliation(s)
- Yin-Jun Mao
- Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Wei-Ye Feng
- Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qun-Ying Huang
- Department of Cardiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Fu-Ling Yu
- Department of Cardiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jian-Xing Chen
- Department of Anesthesiology, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Hang Wang
- Department of Pharmacy, First Affiliated Hospital of Fujian Medical University, Fuzhou, China
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14
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Tilz RR, Meyer-Saraei R, Eitel C, Fink T, Sciacca V, Lopez LD, Kirstein B, Schlüter M, Vogler J, Kuck KH, Heeger CH. Novel Cryoballoon Ablation System for Single Shot Pulmonary Vein Isolation - The Prospective ICE-AGE-X Study. Circ J 2021; 85:1296-1304. [PMID: 33854004 DOI: 10.1253/circj.cj-21-0094] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The arctic front cryoballoon (AF-CB) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome. The POLARx cryoballoon incorporates unique features and design changes that may translate into improved efficacy, safety and further simplified balloon-based procedures. Efficacy and safety of the novel POLARx cryoballoon was compared to the fourth generation AF-CB (AF-CB4).Methods and Results:Twenty-five consecutive patients with paroxysmal or persistent atrial fibrillation were prospectively enrolled, underwent POLARx-based PVI (POLARx group) and were compared to 25 consecutive patients treated with the AF-CB4 (AF-CB4 group). All PVs were successfully isolated utilizing the POLARx and AF-CB4. A significant difference regarding the mean minimal cryoballoon temperatures reached using the AF-CB4 and POLARx (-50±6℃ vs. -57±7℃, P=0.004) was observed. Real-time PVI was visualized in 81% of POLARx patients and 42% of AF-CB4 patients (P<0.001). Utilizing the POLARx, a trend towards shorter median procedure time (POLARx: 45 [39, 53] min vs. AF-CB4: 55 [50, 60] min; P=0.062) was found. No differences were observed between AF-CB4 and POLARx concerning catheter maneuverability, catheter stability and periprocedural complications. CONCLUSIONS The novel POLARx showed similar safety and efficacy compared to the AF-CB4. A higher rate of real-time PV recordings and significantly lower minimal balloon temperatures were observed using the POLARx.
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Affiliation(s)
- Roland Richard Tilz
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck
| | - Roza Meyer-Saraei
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Charlotte Eitel
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Thomas Fink
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Vanessa Sciacca
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Lisbeth Delgado Lopez
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Bettina Kirstein
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | | | - Julia Vogler
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein.,LANS Cardio
| | - Christian-H Heeger
- University Heart Center Lübeck, Division of Electrophysiology, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck
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15
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Mathew S, Rottner L, Warneke L, Maurer T, Lemes C, Hashiguchi N, Reißmann B, Goldmann B, Ouyang F, Kuck KH, Metzner A, Rillig A. Initial experience and procedural efficacy of pulmonary vein isolation using the fourth-generation cryoballoon - a step forward? Acta Cardiol 2020; 75:754-759. [PMID: 31630633 DOI: 10.1080/00015385.2019.1677373] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an established treatment modality for patients suffering from paroxysmal or persistent atrial fibrillation (AF). Recently, the novel fourth-generation cryoballoon (CB4) was introduced which mainly provides a 40% shorter distal tip as compared to the second-generation cryoballoon (CB2). This two-centre analysis sought to assess the primary efficacy of the 28 mm CB4 for PVI and the feasibility of real-time signal recordings from the PVs considering the time-to-isolation (TTI).Methods and results: Eighty-four patients with paroxysmal or short-standing persistent AF underwent CB4-based PVI at two different hospitals. Individual freeze-cycle duration was set at TTI + 120 seconds. No bonus freeze was applied. A total of 331 pulmonary veins (PVs) including five left common PVs were identified and all PVs were successfully isolated. Mean freeze-cycle duration was 165.7 ± 31.5 seconds. The mean minimal CB temperature was -45.6 ± 7.6 °C with a real-time PVI visualisation rate of 78% (67/84 (79.8%) RSPVs, 55/84 (65.5%) RIPVs, 67/79 (84.8%) LSPVs, 66/79 (83.5%) LIPVs and 2/5 (40%) LCPV). Transient phrenic nerve palsy occurred in 2/84 (2.4%) patients during cryo-application along the RSPV.Conclusions: The novel CB4 provides both, a high acute efficacy and a high rate of real time electrical PV-recordings, thus facilitating individual ablation strategies based on TTI.
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Affiliation(s)
- Shibu Mathew
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Laura Rottner
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Laura Warneke
- Department of Cardiology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | | | - Bruno Reißmann
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Britta Goldmann
- Department of Cardiology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
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16
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Keeping it Simple: Balloon Devices for Atrial Fibrillation Ablation Therapy. JACC Clin Electrophysiol 2020; 6:1577-1596. [PMID: 33213820 DOI: 10.1016/j.jacep.2020.08.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation is a common disease of increasing prevalence. Catheter ablation has evolved into an established therapeutic option that mainly aims to electrically isolate the pulmonary veins from atrial myocardium. The traditional method comprises point-by-point radiofrequency current ablation guided by electroanatomical mapping and has proven to be effective and safe in experienced hands. However, this approach is technically highly demanding and associated with a long learning curve, limiting its widespread utilization. To address these shortcomings, simplified ablation tools for pulmonary vein isolation are needed. In this context, balloon devices promise to ease the procedure by approaching the entire orifice of a targeted pulmonary vein in a single maneuver. This requires less catheter manipulation in the left atrium and often allows ablation of a large volume of tissue with a single application of ablative energy. Two balloon devices-one using cryoenergy, the other laser energy-have already been established in clinical routine and have demonstrated noninferiority when compared with radiofrequency ablation in large randomized trials. More balloon devices are on the verge of being introduced into clinical practice and bear the potential to expand the interventional electrophysiologist's armamentarium when treating atrial fibrillation. The authors review the use of the established balloon devices available for atrial fibrillation ablation and provide a detailed outlook on upcoming balloon technologies, including 3 different balloons utilizing radiofrequency energy as well as a novel cryoballoon.
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17
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Molenaar MMD, Hesselink T, Scholten MF, Kraaier K, Bouman DE, Brusse-Keizer M, Stevenhagen YJ, van Dessel PFHM, Ten Haken B, Grandjean JG, van Opstal JM. High incidence of (ultra)low oesophageal temperatures during cryoballoon pulmonary vein isolation for atrial fibrillation. Neth Heart J 2020; 28:662-669. [PMID: 33170441 PMCID: PMC7683692 DOI: 10.1007/s12471-020-01493-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background Low oesophageal temperatures (OTs) during cryoballoon pulmonary vein isolation (PVI) have been associated with complications. This study assessed the incidence of low OT in clinical practice during cryoballoon PVI and verified possible predictive values for low OT. Methods Consecutive patients who underwent PVI using the second-generation cryoballoon were retrospectively included. The distance from the oesophagus to the different pulmonary veins (PVs) (OP distance), body mass index (BMI), sex, age, balloon temperature and application time were studied as potential predictors of low OTs. Computed tomography was performed before the procedure to determine the OP distance. OT was measured using an oesophageal temperature probe. Applications were ended prematurely if the OT reached <16 °C. Low and ultralow OT were defined as OT <20 and <16 °C respectively. Results Two hundred and four patients were included. Low OT was observed in 54 patients (26%) and 27 patients (13%) reached ultralow OTs. OP distance was the only predictor of low OTs after multivariate analysis. A cut-off value of 19 mm showed 96.2% sensitivity and 37.8% specificity in predicting low OTs. No clinically relevant relation was found between low OTs and BMI, age, sex, balloon temperature or application duration. Conclusions The incidence of low OT was 26% for cryoballoon PVI. OP distance was the only predictor of low OTs. Since an OP distance <19 mm was present in all patients in at least one PV, we recommend routine OT measurement during PVI cryoballoon therapy to prevent oesophagus-related complications.
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Affiliation(s)
- M M D Molenaar
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands. .,Department of Magnetic Detection and Interventions, University of Twente, Enschede, The Netherlands.
| | - T Hesselink
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M F Scholten
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - K Kraaier
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - D E Bouman
- Radiology Department, Medisch Spectrum Twente, Enschede, The Netherlands
| | - M Brusse-Keizer
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Y J Stevenhagen
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | | | - B Ten Haken
- Department of Magnetic Detection and Interventions, University of Twente, Enschede, The Netherlands
| | - J G Grandjean
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
| | - J M van Opstal
- Thoraxcenter Twente, Medisch Spectrum Twente, Enschede, The Netherlands
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18
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Zhou X, Dai J, Xu X, Lian M, Lou Y, Lv Z, Wang Z, Mao W. Comparative efficacy and safety of catheter ablation interventions for atrial fibrillation: comprehensive network meta-analysis of randomized controlled trials. J Interv Card Electrophysiol 2020; 62:199-211. [PMID: 33011920 DOI: 10.1007/s10840-020-00878-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 09/14/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE Point-by-point radiofrequency (RF) ablation has been the cornerstone of pulmonary vein isolation (PVI) for patients with atrial fibrillation (AF); however, it remains a complex and time-consuming procedure. Many novel AF catheter ablation (CA) techniques have been introduced, but whether they represent valuable alternatives remains controversial. Thus, we conducted a network meta-analysis to comprehensively evaluate the efficacy and safety of different CA interventions. METHODS We systematically searched several databases (Embase, PubMed, the Cochrane Library, and ClinicalTrials.gov ) from inception to March, 2020. The primary outcomes of interest were freedom from atrial tachyarrhythmia (AT) and procedure-related complications; secondary outcomes included procedure time and fluoroscopy time. RESULTS Finally, 33 randomized controlled trials (RCTs) with a total of 4801 patients were enrolled. No significant differences were found among the different interventions in terms of primary efficacy or safety outcomes. PVAC was most likely to have the shortest procedure time (Prbest = 61.5%) and nMARQ the shortest fluoroscopy time (Prbest = 60.6%); compared with conventional irrigated RF (IRF) ablation, cryoballoon ablation (CBA) showed comparable clinical efficacy and safety; CBA with second-generation CB (CB2) had a significantly shorter procedure time than IRF with contact force technology (CF-IRF) (WMD = - 20.75; p = 0.00). CONCLUSION There is insufficient evidence to suggest that one CA technique is superior to another. However, PVAC may be associated with a shorter procedural duration, and the CB2 catheters also seemed to reduce the procedure time compared with that of CF-IRF. Further large-scale studies are warranted to compare the available CA techniques and provide an up-to-date optimum recommendation.
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Affiliation(s)
- Xinbin Zhou
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Jin Dai
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Xiaoming Xu
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Miaojun Lian
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Yang Lou
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhengtian Lv
- The First College of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhijun Wang
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China
| | - Wei Mao
- Department of Cardiology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, 310006, China.
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19
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M K, M M, G K, K B, W P, J W, J L. Tracing the Right Phrenic Nerve - A Systematic Review and Meta-Analysis. J Atr Fibrillation 2020; 13:2305. [PMID: 34950302 DOI: 10.4022/jafib.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/12/2020] [Accepted: 06/20/2020] [Indexed: 11/10/2022]
Abstract
Background The Right phrenic nerve (RPN) is vulnerable to injury during the isolation of the right pulmonary veins (RPV). The study aimed to provide a comprehensive meta-analysis of the overall prevalence of right phrenic nerve injury (RPNI), its course and its association with the superior and inferior pulmonary veins. Methods Through December 2017, a database search was performed on PubMed, Science Direct, EMBASE, SciELO, and Web of Science. The references were also extensively searched in the included articles. Results Detection of the RPN may vary according to the identification method. It ranges from 100% in postmortem studies, 93% in intraoperative, to 57.88% in computer tomography (CT) imaging. Based on the included studies (n-507), the distance from the right superior pulmonary vein (RSPV) ostium to the RPN was 12.48mm (±6.21). In postmortem studies, the distance was 6.92mm (±3.94); in pre or intraoperative techniques, 13.32mm (±5.96) if noninvasive, 13.97mm (±7.8) if invasive. Distances ranged from 0DC342.6 mm. For the right inferior pulmonary vein (RIPV) (n-125) the mean distance was 16.53mm (±8.92) with distances from 0.4 68mm. The risk of RPNI with distance-included studies was 12.46% (47 RPNI in 377 cases). In the meta-analysis, the distance from the RSPV to the RPN that was associated with an increased risk of RPNI was 7.36mm. Conclusions RPNI is a relatively rare complication. A firm understanding of its course, relation to the PV ostium, and detection are vital for preventing future injuries and complications.
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Affiliation(s)
- Kuniewicz M
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland.,Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Mazur M
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Karkowski G
- Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
| | - Budnicka K
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Przybycień W
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Walocha J
- Department of Anatomy, Jagiellonian University Medical College, Krakow, Poland
| | - Lelakowski J
- Department of Electrocardiology, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Krakow, Poland
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Cryoballoon ablation of atrial fibrillation in patients with atypical right pulmonary vein anatomy. Arch Cardiovasc Dis 2020; 113:690-700. [PMID: 32896517 DOI: 10.1016/j.acvd.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/23/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cryoballoon ablation is widely used for pulmonary vein isolation in patients with atrial fibrillation. There are no data regarding the clinical efficacy of cryoballoon ablation in patients with atypical right pulmonary vein anatomy. AIM We aimed to evaluate the impact of right pulmonary vein anatomy on the safety and efficacy of cryoballoon ablation. METHODS Patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. Left atrial computed tomography was performed before cryoballoon ablation to determine whether the right pulmonary vein anatomy was "normal" or "atypical". For patients with atypical anatomy, cryoballoon ablation was only performed for right superior and right inferior pulmonary veins, neglecting accessory pulmonary veins. RESULTS Overall, 303 patients were included: 254 (83.8%) with normal and 49 (16.2%) with atypical right pulmonary vein anatomy. First-freeze isolation for right superior and right inferior pulmonary veins occurred in 44 (89.8%) and 37 (75.5%) patients with atypical pulmonary vein anatomy, and in 218 (85.8%) and 217 (85.4%) patients with typical pulmonary vein anatomy, respectively (P not significant). Phrenic nerve palsies were only observed in patients with normal anatomy (0 vs. 26 [8.6%]; P=0.039). Mid-term survival free from atrial arrhythmia was similar, regardless of right pulmonary vein anatomy. CONCLUSIONS A significant proportion of patients have atypical right pulmonary vein anatomy. Procedural characteristics, acute pulmonary vein isolation success and mid-term procedural efficacy were similar, regardless of right pulmonary vein anatomy. In addition to left-side pulmonary vein isolation, cryoballoon ablation of right superior and right inferior pulmonary veins only, neglecting accessory pulmonary veins, is sufficient to obtain acute right-side pulmonary vein isolation and mid-term sinus rhythm maintenance in patients with atypical anatomy.
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21
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Anwar O, Gunawardene MA, Dickow J, Scherschel K, Jungen C, Münkler P, Eickholt C, Willems S, Gessler N, Meyer C. Contemporary analysis of phrenic nerve injuries following cryoballoon-based pulmonary vein isolation: A single-centre experience with the systematic use of compound motor action potential monitoring. PLoS One 2020; 15:e0235132. [PMID: 32584880 PMCID: PMC7316283 DOI: 10.1371/journal.pone.0235132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Phrenic nerve injury (PNI) remains one of the most frequent complications during cryoballoon-based pulmonary vein isolation (CB-PVI). Since its introduction in 2013, the use of compound motor action potential (CMAP) for the prevention of PNI during CB-PVI is increasing; however, systematic outcome data are sparse. METHODS The CMAP technique was applied in conjunction with abdominal palpation during pacing manoeuvres (10 mV, 2 ms) from the superior vena cava for 388 consecutive patients undergoing CB-PVI between January 2015 and May 2017 at our tertiary arrhythmia centre. Cryoablation was immediately terminated when CMAP amplitude was reduced by 30%. RESULTS Reductions in CMAP amplitude were observed in 16 (4%) of 388 patients during isolation of the right veins. Of these, 11 (69%) patients did not manifest a reduction in diaphragmatic excursions. The drop in CMAP amplitude was observed in 10 (63%) patients during ablation of the right superior pulmonary veins (PVs) and in 7 (44%) patients during ablation of the right inferior PVs. Postprocedural persistent PNI was observed in three of four patients for a duration of 6 months, with one of these patients remaining symptomatic at the 24-month follow-up. One of the four patients was lost to long-term follow-up. CONCLUSIONS All PNIs occurred during right-sided CB-PVI and were preceded by a reduction in CMAP amplitude. Thus, the standardized use of CMAP surveillance during CB-PVI is easily applicable, reliable and compared with other studies, results in a lower number of PNIs.
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Affiliation(s)
- Omar Anwar
- Department of Cardiology, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Melanie A. Gunawardene
- Department of Cardiology, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
| | - Jannis Dickow
- Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, Hamburg, Germany
| | - Katharina Scherschel
- Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany
- Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Düsseldorf, Germany
| | - Christiane Jungen
- Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Paula Münkler
- Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Eickholt
- Department of Cardiology, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Stephan Willems
- Department of Cardiology, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Nele Gessler
- Department of Cardiology, Asklepios Clinic St. Georg, Faculty of Medicine, Semmelweis University Campus Hamburg, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany
| | - Christian Meyer
- Department of Cardiac Electrophysiology, Heart and Vascular Centre, University Hospital Hamburg Eppendorf, Hamburg, Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Berlin, Germany
- Division of Cardiology, cardiac Neuro- and Electrophysiology Research Consortium (cNEP), EVK Düsseldorf, Düsseldorf, Germany
- Cardiac Neuro- and Electrophysiology Research Consortium (cNEP), Institute for Neural and Sensory Physiology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
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Aryana A, Braegelmann KM, Lim HW, Ellenbogen KA. Cryoballoon ablation dosing: From the bench to the bedside and back. Heart Rhythm 2020; 17:1185-1192. [PMID: 32142876 DOI: 10.1016/j.hrthm.2020.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/24/2020] [Indexed: 11/16/2022]
Abstract
To date, multiple modes of research have been leveraged to study the optimal cryoballoon ablation parameters to safely, effectively, and efficiently isolate the pulmonary veins for the treatment of atrial fibrillation. Basic scientific investigation, preclinical studies, clinical observations, trials, and, more recently, computational modeling have helped to generate and test new hypotheses for the advancement of cryoballoon treatment in patients with atrial fibrillation. In this review, we examine the data and evidence that have contributed to the development of patient-tailored dosing strategies that are currently used for pulmonary vein isolation by using the Arctic Front series of cryoballoon ablation catheters.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
| | | | - Hae W Lim
- Medtronic, Inc, Minneapolis, Minnesota
| | - Kenneth A Ellenbogen
- Division of Clinical Cardiac Electrophysiology and Pacing, Virginia Commonwealth University Health System, Richmond, Virginia
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Maj R, Borio G, Ströker E, Sieira J, Rizzo A, Galli A, Varnavas V, Al Housari M, Sofianos D, Kazawa S, Terasawa M, Bala G, Cecchini F, Iacopino S, Osório TG, Sora N, Brugada P, De Asmundis C, Chierchia GB. Phrenic nerve palsy during right-sided pulmonary veins cryoapplications: new insights from pulmonary vein anatomy addressed by computed tomography. J Interv Card Electrophysiol 2020; 60:85-92. [PMID: 32060817 DOI: 10.1007/s10840-020-00713-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/09/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE There is still sparse information regarding phrenic nerve palsy (PNP) during the cryoablation of both right-sided pulmonary vein (PV) and its anatomical predictors. METHODS Consecutive patients who had undergone pulmonary vein isolation (PVI) using CB-A and suffered PNP during both right-sided PVs were retrospectively included in our study. Two other groups were then selected among patients who experienced PNP during RIPV application only (group 2) and RSPV application only (group 3). RESULTS The incidence of PNI during both right-sided PVs cryoapplications was 2.1%, (32 of 1542 patients). There were no significant clinical differences between the 3 groups. Time from basal temperature to -40 °C significantly differed among the groups for both RIPV (p = 0.0026) and RSPV applications (p = 0.0382). Patients with PNP occurring during RSPV applications had significantly larger RSPV cross-sectional area compared to patients without PNP (p = 0.0116), while in patients with PNP during RIPV application, the angle of RIPV ostium on the transverse plane was significantly smaller compared to patients without PNP (p = 0.0035). The carina width was significantly smaller in patients with PNP occurring during both right-sided PVs cryoapplications compared to patients in which PNP occurred only during one right-sided PV application (p < 0.0001); a cutoff value of 8.5 mm had a sensitivity of 87.3% and a specificity of 75.0%. CONCLUSION PNP in both right-sided PVs applications is a complication that occurred in 2.1% of cases during CB-A. Pre-procedural evaluation of right PVs anatomy might be useful in evaluating the risk of PNP.
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Affiliation(s)
- Riccardo Maj
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium.
| | - Gianluca Borio
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alessandro Rizzo
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Alessio Galli
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Varnavas Varnavas
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Dimitrios Sofianos
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Shuichiro Kazawa
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Muryo Terasawa
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Federico Cecchini
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Villa Maria Cecilia, Via Corriera, 1, 48033, Cotignola, RA, Italy
| | | | - Nicoleta Sora
- Thoraxcentrum, Blekingesjukhuset, Karlskrona, Sweden
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090, Brussels, Belgium
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Maj R, Iacopino S, Ströker E, Paparella G, Coutiño HE, Terasawa M, Varnavas V, Salghetti F, Osório T, Abugattas JP, Sieira J, Capulzini L, Brugada P, de Asmundis C, Chierchia GB. Mid-term outcome following second-generation cryoballoon ablation for atrial fibrillation in heart failure patients. J Cardiovasc Med (Hagerstown) 2019; 20:667-675. [DOI: 10.2459/jcm.0000000000000845] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Kanda T, Masuda M, Kurata N, Asai M, Iida O, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Okuno S, Matsuda Y, Hata Y, Mano T. Efficacy and safety of the cryoballoon-based atrial fibrillation ablation in patients aged ≥80 years. J Cardiovasc Electrophysiol 2019; 30:2242-2247. [PMID: 31507014 DOI: 10.1111/jce.14166] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/06/2019] [Accepted: 08/25/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The prevalence of atrial fibrillation (AF) increases with age. Although the efficacy of cryoballoon ablation (CB-A) in patients with AF has been demonstrated, data on the efficacy of this CB-A in elderly patients are limited. The aim of this study was to evaluate the 1-year efficacy and safety of CB-A in patients aged ≥80 years compared with those less than 80 years. METHODS A total of 49 consecutive patients ≥80 years with paroxysmal AF (PAF) who underwent CB-A were compared with 241 patients aged <80 years. AF-free survival rate at 1 year and procedural data were compared between the groups. RESULTS Median (25th, 75th quartile) age was 83 (82, 85) years in the older group and 68 (61, 73) years in the younger group. At 1-year follow-up, the success rate did not significantly differ between the groups. In Cox regression analysis, age ≥80 years was not significantly related to AF recurrence. Low-voltage areas were more frequently observed in the elderly group than the control group (39% vs 17%; P = .01). Fluoroscopy time and procedure time did not differ significantly. There was no significant difference in the occurrence rate of transient phrenic nerve palsy. No severe complications occurred in either group, including procedure-related deaths, atrioesophageal fistula, cardiac tamponade, and cerebrovascular embolic events. CONCLUSION The results of our study showed that CB-A for PAF is a feasible and safe procedure even in elderly patients, with similar success and complication rates when compared with a younger population.
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Affiliation(s)
- Takashi Kanda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Masaharu Masuda
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Naoya Kurata
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Mitsutoshi Asai
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Osamu Iida
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | - Kiyonori Nanto
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | - Shota Okuno
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | | | - Yosuke Hata
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital, Cardiovascular Center, Amagasaki, Japan
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Osório TG, Coutiño HE, Brugada P, Chierchia GB, De Asmundis C. Recent advances in cryoballoon ablation for atrial fibrillation. Expert Rev Med Devices 2019; 16:799-808. [PMID: 31389263 DOI: 10.1080/17434440.2019.1653181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Pulmonary vein isolation (PVI), by catheter ablation, represents the current treatment for drug-resistant atrial fibrillation (AF). Nowadays cryoballoon (CB) is a recognized ablation method in patients with atrial fibrillation, mainly due to its ease of use, leading to reproducible and fast procedures. This novel single shot technology literally revolutionized the approach to AF ablation. Areas covered: The historical development of the cryoballoon, ablation techniques and new approaches beyond the ordinary PVI and complications are summarized here. Expert opinion: Although cryoballoon ablation has greatly standardized the approach to PVI a few critical points still need to be clarified scientifically in order to further uniform this procedure in cath labs worldwide. Duration and dosage of the cryoapplication is undoubtedly a topic of great interest.
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Affiliation(s)
- Thiago Guimarães Osório
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Hugo-Enrique Coutiño
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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Ikenouchi T, Nitta J, Nitta G, Kato S, Iwasaki T, Murata K, Junji M, Hirao T, Kanoh M, Takamiya T, Kato N, Inamura Y, Negi K, Sato A, Yamato T, Matsumura Y, Takahashi Y, Goya M, Hirao K. Propensity-matched comparison of cryoballoon and radiofrequency ablation for atrial fibrillation in elderly patients. Heart Rhythm 2019; 16:838-845. [DOI: 10.1016/j.hrthm.2018.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Indexed: 11/29/2022]
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Chun KJ. Impact of Cryoballoon Freeze Duration on Long-Term Durability of Pulmonary Vein Isolation. JACC Clin Electrophysiol 2019; 5:551-559. [DOI: 10.1016/j.jacep.2019.03.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 01/27/2023]
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Davies A, Mahmoodi E, Emami M, Leitch J, Wilsmore B, Jackson N, Barlow M. Comparison of Outcomes Using the First and Second Generation Cryoballoon to Treat Atrial Fibrillation. Heart Lung Circ 2019; 29:452-459. [PMID: 31005408 DOI: 10.1016/j.hlc.2019.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein isolation using cryoballoon ablation is an effective treatment for patients with atrial fibrillation. We sought to compare outcomes with the first and second generation cryoballoon, with the second generation balloon incorporating the Achieve Lasso catheter, in terms of freedom from symptomatic recurrence and major complications. METHODS The first 200 patients who underwent cryoballoon ablation with the first generation balloon were compared with the first 200 patients using the second-generation balloon. All patients had symptomatic atrial fibrillation and had failed at least one antiarrhythmic drug. The primary efficacy endpoint was freedom from symptomatic recurrence of atrial fibrillation (AF) after a single pulmonary vein isolation (PVI) procedure using the cryoballoon. The primary safety endpoint was major procedural complications. RESULTS At 12 months, freedom from symptomatic AF after a single procedure in the first generation cohort was 64.3% compared with 78.6% in the second-generation cohort (p = 0.002). At 24 months, freedom from symptomatic AF in the first generation cohort was 51.3% compared with 72.6% in the second-generation cohort (p < 0.001). Procedural time (150 min vs 101 min; p < 0.001) and fluoroscopy time (32.5 min vs 21.4 min; p < 0.001) was lower in the second-generation group. The rate of major complications was comparably low in both groups. CONCLUSIONS The second-generation cryoballoon was associated with improved freedom from symptomatic AF with reduction in procedure and fluoroscopy time, with a similar low rate of major complications.
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Affiliation(s)
- Allan Davies
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia.
| | - Ehsan Mahmoodi
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - Mehrdad Emami
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia
| | - James Leitch
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
| | - Bradley Wilsmore
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
| | - Nick Jackson
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
| | - Malcolm Barlow
- Cardiovascular Department, John Hunter Hospital, Newcastle, NSW, Australia; Lake Macquarie Private Hospital, Gateshead, NSW, Australia
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Shao M, Shang L, Shi J, Zhao Y, Zhang W, Zhang L, Li Y, Tang B, Zhou X. The safety and efficacy of second-generation cryoballoon ablation plus catheter ablation for persistent atrial fibrillation: A systematic review and meta-analysis. PLoS One 2018; 13:e0206362. [PMID: 30359452 PMCID: PMC6201921 DOI: 10.1371/journal.pone.0206362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 10/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Growing evidence suggests that second-generation cryoballoon ablation (2G-CB) is effective in patients with persistent atrial fibrillation (PerAF). The cornerstone of atrial fibrillation (AF) ablation is pulmonary vein isolation (PVI). The purpose of this study was to summarize the available data on the safety and mid-term (≥ 12 months) effectiveness of a 'PVI-only' strategy vs. a 'PVI-plus' strategy using 2G-CB in patients with PerAF. METHODS We searched the PubMed, EMBASE and Cochrane library databases for studies on 2G-CB for PerAF. Group analysis was based on the ablation approach: 'PVI-only' versus 'PVI-plus', the latter of which involved PVI plus other substrate modifications. Studies showing clinical success rates at a follow-up (FU) of ≥ 12 months were included. Complication rates were also assessed. Data were analyzed by applying a fixed effects model. RESULTS A total of 879 patients from 5 studies were analyzed. After a mid-term FU of 27 months, the overall success rate of 2G-CB for PerAF was 66.1%. In the 'PVI-plus' group, the success rate was 73.8%. In the 'PVI-only' group, the success rate was 53.6%. No heterogeneity was noted among studies (I2 = 0.0%, P = 0.82). Complications occurred in 5.2% of patients (P = 0.93), and the rate of phrenic nerve (PN) injury was 2.8% (P = 0.14). Vascular assess complications were the most frequent at 1.6% (P = 0.33). No death or myocardial infarction was reported. CONCLUSION 'PVI-plus' involving 2G-CB seems to be safe and effective for treating PerAF.
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Affiliation(s)
- Mengjiao Shao
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Luxiang Shang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Jia Shi
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yang Zhao
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Wenhui Zhang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Ling Zhang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Yaodong Li
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Baopeng Tang
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Xianhui Zhou
- Department of Pacing and Electrophysiology, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Five-year outcome and predictors of success after second-generation cryoballoon ablation for treatment of symptomatic atrial fibrillation. Int J Cardiol 2018; 266:106-111. [DOI: 10.1016/j.ijcard.2018.03.069] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 11/21/2022]
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Nishimura T, Okishige K, Yamauchi Y, Aoyagi H, Ito N, Tsuchiya Y, Shigeta T, Nakamura R, Asano M, Yamashita M, Nakamura T, Suzuki H, Shimura T, Kurabayashi M, Keida T, Sasano T, Hirao K. "Clinical Impact of the Cryoballoon Temperature and Occlusion Status on the Success of Pulmonary Vein Isolation". J Atr Fibrillation 2018; 11:2065. [PMID: 30505382 DOI: 10.4022/jafib.2065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/19/2018] [Accepted: 08/14/2018] [Indexed: 11/10/2022]
Abstract
Background Complete occlusion of the pulmonary veins (PVs) with the cryoballoon (CB) is considered to be the crucial factor for a successful PV isolation (PVI). We investigated whether a complete occlusion was indispensable for a successful CB based PVI of every PV. Methods and Results Atrial fibrillation patients (n=123, 97; paroxysmal) undergoing a de novo PVI were enrolled. A total of 477 PVs were analyzed. The occlusion grade (OG) was scored as follows: OG3 (complete occlusion), OG2 (incomplete occlusion with slight leakage), OG1 (poor occlusion with massive leakage). There was no significant difference in the CB temperature (CBT) at all measured time points (from 30 to 120sec after freezing) and nadir CBT between OG2 and OG3 in all PVs except for the right inferior PV (RIPV). The RIPV isolation success rate was significantly lower for the OG2 status than OG3 (97.5 vs. 57.6%; p<0.0001). In contrast, there was not significant difference in the isolation success rate of the other three PVs between OG2 and OG3. In particular, the success rate of the right superior PV (RSPV) isolation was >95% for both OG2 and OG3. Phrenic nerve paralysis (PNP) was provoked during the RSPV isolation in two patients in whom the RSPVs were frozen during OG3. Conclusion An OG3 may not always be required for a successful PVI of all PVs except the RIPV. OG2 could have comparable effects as OG3 in terms of a successful RSPV isolation. Not aiming for OG3 for the RSPV may reduce the risk of PNP.
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Affiliation(s)
- Takuro Nishimura
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | | | - Hideshi Aoyagi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | - Naruhiko Ito
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | - Yusuke Tsuchiya
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | | | - Rena Nakamura
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | - Mitsutoshi Asano
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | | | | | - Hidetoshi Suzuki
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | - Tsukasa Shimura
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | | | | | - Tetsuo Sasano
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo
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Mesquita J, Bisla J, Lee A, Perez M. Video-assisted thoracoscopic surgery to displace the phrenic nerve during endocardial ablation of right atrial tachycardia. HeartRhythm Case Rep 2018; 4:304-306. [PMID: 30023277 PMCID: PMC6050457 DOI: 10.1016/j.hrcr.2018.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- João Mesquita
- Cardiology Department, Hospital de Santa Cruz, Lisbon, Portugal
| | | | - Anson Lee
- Stanford University Medical Center, Palo Alto, California
| | - Marco Perez
- Stanford University Medical Center, Palo Alto, California
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Chen X, Fang P, Liu Z, He J, Tang M, Liu J, Lu B, Zhang S. Pulmonary Vein Anatomy is Associated with Cryo Kinetics during Cryoballoon Ablation for Atrial Fibrillation. Arq Bras Cardiol 2018; 110:440-448. [PMID: 29898044 PMCID: PMC5967138 DOI: 10.5935/abc.20180071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/09/2017] [Indexed: 11/24/2022] Open
Abstract
Background The influence of pulmonary vein (PV) anatomy on cryo kinetics during
cryoballoon (CB) ablation is unclear. Objective To investigate the relationship between PV anatomy and cryo kinetics during
CB ablation for atrial fibrillation (AF). Methods Sixty consecutive patients were enrolled. PV anatomy, including ostial
diameters (long, short and corrected), ratio between short and long
diameters, ostium shape (round, oval, triangular, and narrow), and drainage
pattern (typical, with common trunk, common antrum, ostial branch and
supernumerary PV) were evaluated on multi-detector computed tomography
(MDCT) images pre-procedure. Cryo kinetics parameters [balloon freeze
time from 0 to -30ºC (BFT), balloon nadir temperature (BNT) and
balloon warming time from -30 to +15ºC (BWT)] were recorded
during procedure. All p values are two-sided, with values of p < 0.05
considered to be statistically significant. Results 606 times of freezing cycle were accomplished. Moderate negative correlation
was documented between BNT and corrected PV diameter (r = -0.51, p <
0.001) when using 23-mm CBs, and mild negative correlation (r = - 0.32, p =
0.001) was found when using 28-mm CBs. Multivariate logistic regression
analysis revealed that PV corrected ostial diameter (OR, 1.4; p = 0.004)
predicted a BNT < -51ºC when using 23-mm CBs, while PV ostium oval
shape (OR, 0.3; p = 0.033) and PV locations (left inferior PV: OR, 0.04; p =
0.005; right superior PV: OR, 4.3; p = 0.025) predicted BNT <
-51ºC when using 28-mm CBs. Conclusions MDCT can provide PV anatomy accurate evaluation prior CB ablation. PV anatomy
is associated with cryo kinetics during ablation.
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Affiliation(s)
- Xiongbiao Chen
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Pihua Fang
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Zheng Liu
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Jia He
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Min Tang
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Jun Liu
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Bin Lu
- Department of Radiology - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Disease - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Shu Zhang
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
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Kuniss M, Greiß H, Pajitnev D, Akkaya E, Deubner N, Hain A, Bodammer L, Berkowitsch A, Chierchia GB, Hamm CW, Neumann T. Cryoballoon ablation of persistent atrial fibrillation: feasibility and safety of left atrial roof ablation with generation of conduction block in addition to antral pulmonary vein isolation. Europace 2018; 19:1109-1115. [PMID: 27738068 DOI: 10.1093/europace/euw146] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 04/25/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Although the generation of linear lesions by ablation improves success rates in patients with persistent atrial fibrillation (AF), the procedure has been considered unsuitable for cryoablation balloon catheter technologies. We developed a technique for linear ablations, using second-generation cryoballoon technology. Methods and results This was a single-arm, prospective study in 76 patients with persistent AF treated consecutively at our centre. Cryoablation was performed using a 28 mm second-generation cryoballoon. The first cryoenergy application was performed in close proximity to the position during isolation of the left superior pulmonary vein (PV). Sequential overlapping freezes were applied along the left atrial (LA) roof by slight clockwise rotation of the sheath in combination with slight retraction of the sheath and incremental advancement of the cryoballoon, until reaching the original position for right superior PV isolation. The acute endpoint was the creation of a roofline, defined as complete conduction block across the LA roof >120 ms and ascending activation across the posterior LA wall. Acute success in roofline generation was achieved in 88% of patients, applying on average five (median 4-6) freezes with nadir temperature of -40°C (-36 to -44°C). In five patients, conduction block could not be achieved. No phrenic nerve injuries occurred during roofline generation. Conclusion Generation of linear roofline lesions is possible with the second-generation cryoballoon. The technique can be used in combination with PV isolation to treat persistent AF with good acute success rates, short procedure times, and acceptable safety concerns. If validated by further studies, the method would be an appealing alternative to radiofrequency ablation techniques.
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Affiliation(s)
- Malte Kuniss
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Harald Greiß
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Dmitri Pajitnev
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Ersan Akkaya
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Nikolas Deubner
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Andreas Hain
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Lars Bodammer
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Alexander Berkowitsch
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | | | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Neumann
- Department of Cardiology, Kerckhoff Heart and Thorax Centre, Benekestrasse 2-8, 61231 Bad Nauheim, Germany
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Deubner N, Greiss H, Akkaya E, Zaltsberg S, Hain A, Berkowitsch A, Güttler N, Kuniss M, Neumann T. The slope of the initial temperature drop predicts acute pulmonary vein isolation using the second-generation cryoballoon. Europace 2018; 19:1470-1477. [PMID: 27702863 DOI: 10.1093/europace/euw192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/29/2016] [Indexed: 11/13/2022] Open
Abstract
Aims There is no objective, early indicator of occlusion quality, and efficacy of cryoballoon pulmonary vein isolation. As previous experience suggests that the initial cooling rate correlates with these parameters, we investigated the slope of the initial temperature drop as an objective measure. Methods and results A systematic evaluation of 523 cryoapplications in 105 patients using a serial ROC-AUC analysis was performed. We found the slope of a linear regression of the temperature-time function to be a good predictor (PPV 0.9, specificity 0.72, sensitivity 0.71, and ROC-AUC 0.75) of acute isolation. It also correlated with nadir temperatures (P< 0.001, adjusted R2= 0.43), predicted very low nadir temperatures, and varied according to visual occlusion grades (ANOVA P< 0.001). Conclusions About 25 s after freeze initiation, the temperature-time slope predicts important key characteristics of a cryoablation, such as nadir temperature. The slope is the only reported predictor to actually precede acute isolation and thus to support decisions about pull-down manoeuvres or aborting a cryoablation early on. It is also predictive of very low nadir temperatures and phrenic nerve palsy and thus may add to patient safety.
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Chen S, Schmidt B, Bordignon S, Bologna F, Perrotta L, Nagase T, Chun KRJ. Atrial fibrillation ablation using cryoballoon technology: Recent advances and practical techniques. J Cardiovasc Electrophysiol 2018; 29:932-943. [PMID: 29663562 DOI: 10.1111/jce.13607] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) affects 1-2% of the population, and its prevalence is estimated to double in the next 50 years as the population ages. AF results in impaired patients' life quality, deteriorated cardiac function, and even increased mortality. Antiarrhythmic drugs frequently fail to restore sinus rhythm. Catheter ablation is a valuable treatment approach for AF, even as a first-line therapy strategy in selected patients. Effective electrical pulmonary vein isolation (PVI) is the cornerstone of all AF ablation strategies. Use of radiofrequency (RF) catheter in combination of a three-dimensional electroanatomical mapping system is the most established ablation approach. However, catheter ablation of AF is challenging even sometimes for experienced operators. To facilitate catheter ablation of AF without compromising the durability of the pulmonary vein isolation, "single shot" ablation devices have been developed; of them, cryoballoon ablation, is by far the most widely investigated. In this report, we review the current knowledge of AF and discuss the recent evidence in catheter ablation of AF, particularly cryoballoon ablation. Moreover, we review relevant data from the literature as well as our own experience and summarize the key procedural practical techniques in PVI using cryoballoon technology, aiming to shorten the learning curve of the ablation technique and to contribute further to reduction of the disease burden.
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Affiliation(s)
- Shaojie Chen
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Laura Perrotta
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Takahiko Nagase
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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38
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Jin ES, Wang PJ. Cryoballoon Ablation for Atrial Fibrillation: a Comprehensive Review and Practice Guide. Korean Circ J 2018; 48:114-123. [PMID: 29441744 PMCID: PMC5861002 DOI: 10.4070/kcj.2017.0318] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 11/30/2017] [Indexed: 11/11/2022] Open
Abstract
The cryoballoon was invented to achieve circumferential pulmonary vein isolation more efficiently to compliment the shortcomings of point-by-point ablation by radiofrequency ablation (RFA). Its efficacy and safety were shown to be comparable to those of RFA, and the clinical outcomes have improved with the second-generation cryoballoon. The basic biophysics, implemental techniques, procedural recommendations, clinical outcomes, and complications of the cryoballoon are presented in this practical and systematic review.
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Affiliation(s)
- Eun Sun Jin
- Cardiovascular Center, Kyung Hee University Hospital at Gangdong, Kyung Hee University, Seoul, Korea
| | - Paul J Wang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Ferrero-de-Loma-Osorio Á, García-Fernández A, Castillo-Castillo J, Izquierdo-de-Francisco M, Ibáñez-Críado A, Moreno-Arribas J, Martínez A, Bertomeu-González V, López-Mases P, Ajo-Ferrer M, Núñez C, Bondanza-Saavedra L, Sánchez-Gómez JM, Martínez-Martínez JG, Chorro-Gascó FJ, Ruiz-Granell R. Time-to-Effect–Based Dosing Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005318. [DOI: 10.1161/circep.117.005318] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ángel Ferrero-de-Loma-Osorio
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Amaya García-Fernández
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Jesús Castillo-Castillo
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Maite Izquierdo-de-Francisco
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Alicia Ibáñez-Críado
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Jose Moreno-Arribas
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Angel Martínez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Vicente Bertomeu-González
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Patricia López-Mases
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - María Ajo-Ferrer
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Carlos Núñez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Lourdes Bondanza-Saavedra
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Juan Miguel Sánchez-Gómez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Juan Gabriel Martínez-Martínez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Francisco Javier Chorro-Gascó
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Ricardo Ruiz-Granell
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
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Chierchia GB, Iacopino S, de Asmundis C. Cryoballoon Ablation in Today's Practice: Can the Left Common Ostium Be Ablated and Injury to the Right Phrenic Nerve Avoided? Arrhythm Electrophysiol Rev 2017; 6:156-158. [PMID: 29326828 DOI: 10.15420/aer.2017.6.4eo2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cryoballoon ablation is rapidly gaining popularity among electrophysiologists in the setting of pulmonary vein isolation for the treatment of AF. The first part of the following review focuses on the feasibility and clinical outcome of this technique in patients exhibiting a left common ostium. In the second part, we discuss how to predict and prevent the most common complication related to cryoballoon ablation: right phrenic nerve palsy.
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Affiliation(s)
| | - Saverio Iacopino
- Electrophysiology Unit, Villa Maria Cecilia Hospital,Ravenna, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, University of Brussels,Brussels, Belgium
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Canpolat U, Kocyigit D, Aytemir K. Complications of Atrial Fibrillation Cryoablation. J Atr Fibrillation 2017; 10:1620. [PMID: 29487676 PMCID: PMC5821627 DOI: 10.4022/jafib.1620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022]
Abstract
Catheter ablation either by using radiofrequency or cryo energy in symptomatic patients with atrial fibrillation (AF) has shown to be effective as compared to anti-arrhythmic drugs. However, all the techniques used during AF ablation are not free of complication. There are several well-known peri-procedural complications in which operators should be informed of the possible risks, cautious during the procedure and able to manage them when occurred. Herein, we aimed to review possible complications of AF cryoablation.
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Affiliation(s)
- Ugur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Duygu Kocyigit
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Kudret Aytemir
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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Zhao A, Squara F, Marijon E, Thomas O. Two-year clinical outcome after a single cryoballoon ablation procedure: A comparison of first- and second-generation cryoballoons. Arch Cardiovasc Dis 2017; 110:543-549. [DOI: 10.1016/j.acvd.2017.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 11/25/2022]
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Watanabe K, Nitta J, Sato A, Goya M, Isobe M, Hirao K. Hemoptysis after five months of cryoballoon ablation: What is the relationship? HeartRhythm Case Rep 2017; 3:357-359. [PMID: 28748144 PMCID: PMC5511970 DOI: 10.1016/j.hrcr.2017.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Keita Watanabe
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
- Address reprint requests and correspondence: Dr Keita Watanabe, Japanese Red Cross Saitama Hospital, 1-5 Shintoshin, Chuo-ku, Saitama 330-8553, Japan.Japanese Red Cross Saitama Hospital1-5 Shintoshin, Chuo-kuSaitama330-8553Japan
| | - Junichi Nitta
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Akira Sato
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Masahiko Goya
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Mitsuaki Isobe
- Department of Cardiology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kenzo Hirao
- Heart Rhythm Center, Tokyo Medical and Dental University, Tokyo, Japan
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Maurer T, Kuck KH. The quest for durable lesions in catheter ablation of atrial fibrillation - technological advances in radiofrequency catheters and balloon devices. Expert Rev Med Devices 2017; 14:621-631. [PMID: 28723304 DOI: 10.1080/17434440.2017.1358086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Atrial fibrillation is the most common cardiac arrhythmia and represents a growing clinical, social and economic challenge. Catheter ablation for symptomatic atrial fibrillation has evolved from an experimental procedure into a widespread therapy and offers a safe and effective treatment option. A prerequisite for durable PVI are transmural and contiguous circumferential lesions around the pulmonary veins. However, electrical reconnection of initially isolated pulmonary veins remains a primary concern and is a dominant factor for arrhythmia recurrence during long-term follow up. Areas covered: This article discusses the physiology of lesion formation using radiofrequency-, cryo- or laser- energy for pulmonary vein isolation and provides a detailed review of recent technological advancements in the field of radiofrequency catheters and balloon devices. Finally, future directions and upcoming developments for the interventional treatment of atrial fibrillation are discussed. Expert commentary: Durable conduction block across deployed myocardial lesions is mandatory not only for PVI but for any other cardiac ablation strategy as well. A major improvement urgently expected is the intraprocedural real-time distinction of durable lesions from interposed gaps with only transiently impaired electrical conduction. Furthermore, a simplification of ablation tools used for PVI is required to reduce the high technical complexity of the procedure.
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Affiliation(s)
- Tilman Maurer
- a Department of Cardiology , Asklepios Klinik St. Georg , Hamburg , Germany
| | - Karl-Heinz Kuck
- a Department of Cardiology , Asklepios Klinik St. Georg , Hamburg , Germany
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Luik A, Kunzmann K, Hörmann P, Schmidt K, Radzewitz A, Bramlage P, Schenk T, Schymik G, Merkel M, Kieser M, Schmitt C. Cryoballoon vs. open irrigated radiofrequency ablation for paroxysmal atrial fibrillation: long-term FreezeAF outcomes. BMC Cardiovasc Disord 2017; 17:135. [PMID: 28545407 PMCID: PMC5445510 DOI: 10.1186/s12872-017-0566-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Effective treatment of paroxysmal atrial fibrillation (AF) is essential for reducing the risk of stroke and heart failure. Cryoballoon (CB) ablation has been developed as an alternative to the use of radiofrequency (RF) energy for electrical isolation of the pulmonary veins. Herein, we provide long-term data regarding the efficacy of CB ablation in comparison to RF. Methods FreezeAF was a randomised non-inferiority study comparing CB ablation with RF ablation for the treatment of patients with drug-refractory paroxysmal AF. Procedural success for the long-term follow-up (30 months) was defined as freedom from AF with an absence of persistent complications. Results Of the 315 patients that were randomised and received catheter ablation, 292 (92.7%) completed the 30-month follow-up (147 in the RF group and 145 in the CB group). The baseline characteristics of the RF and CB groups were similar. Single-procedure success was achieved by 40% of patients in the RF group and 42% of the CB group (p < 0.001 for non-inferiority). When including re-do procedures in the analysis, the multiple procedure success rate was 72% in the RF group and 76% in the CB group. Conclusion The data provide long-term evidence that CB ablation is non-inferior to RF ablation, with high proportions of patients reporting freedom from AF 30 months after the index procedure. Trial registration ClinicalTrials.gov Identifier: NCT00774566; first registered October 16, 2008; first patient included October 20, 2008.
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Affiliation(s)
- Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany.
| | - Kevin Kunzmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Patrick Hörmann
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Kerstin Schmidt
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Andrea Radzewitz
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Mahlow, Germany
| | - Thomas Schenk
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Gerhard Schymik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Matthias Merkel
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Claus Schmitt
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Long-term outcome after second-generation cryoballoon ablation for paroxysmal atrial fibrillation - a 3-years follow-up. J Interv Card Electrophysiol 2017; 49:93-100. [DOI: 10.1007/s10840-017-0237-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 02/22/2017] [Indexed: 01/15/2023]
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Pott A, Messemer M, Petscher K, Iturbe-Orbe M, Bothner C, Rottbauer W, Dahme T. Clinical outcome of 2nd generation cryoballoon pulmonary vein isolation in patients over 75 years of age. J Cardiol 2017; 69:24-29. [DOI: 10.1016/j.jjcc.2016.07.020] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/30/2016] [Accepted: 07/22/2016] [Indexed: 11/25/2022]
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Parikh V, Kowalski M. Comparison of Phrenic Nerve Injury during Atrial Fibrillation Ablation between Different Modalities, Pathophysiology and Management. J Atr Fibrillation 2016; 8:1314. [PMID: 27957229 DOI: 10.4022/jafib.1314] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/19/2015] [Accepted: 11/20/2015] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation ablation has emerged as an effective tool in the management of symptomatic atrial fibrillation. Currently, the electrophysiologists are striving to maximize the success while minimizing complications. Phrenic nerve injury (PNI) is one of the concerning complications, especially in cases of cryoballoon ablation. Due to anatomical proximity to atrial tissue, phrenic nerve is particularly susceptible to injury. With evolving monitoring techniques it is now possible to minimize the likelihood of a permanent PNI. However, the challenge remains to detect PNI at the earliest and to avoid further damage to the nerve. In this review, we discuss pertinent anatomical principles, techniques to avoid PNI and management in cases where PNI is encountered.
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Affiliation(s)
- Valay Parikh
- Division of Electrophysiology, Department of Cardiology, Staten Island University Hospital, Northwell Health System, NY
| | - Marcin Kowalski
- Division of Electrophysiology, Department of Cardiology, Staten Island University Hospital, Northwell Health System, NY
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Scholz E, Lugenbiel P, Schweizer PA, Xynogalos P, Seyler C, Zitron E, Becker R, Katus HA, Thomas D. Efficacy, High Procedural Safety And Rapid Optimization Of Cryoballoon Atrial Fibrillation Ablation In The Hands Of A New Operator. J Atr Fibrillation 2016; 8:1341. [PMID: 27909474 DOI: 10.4022/jafib.1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/20/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cryoballoon (CB) ablation is successful in eliminating atrial fibrillation (AF). PURPOSE The purpose of this study was to assess procedural efficacy and safety of CB ablation performed by a newly trained operator. METHODS Forty patients with documented paroxysmal AF (58 ± 11 years, 26 male) undergoing CB catheter ablation were prospectively enrolled. RESULTS Electrical pulmonary vein (PV) isolation was achieved in all patients (156 PVs). The primary end point (PV isolation using CB only) was reached in 31 patients (92% PV isolation, 144/156 PVs). In the remaining 9 patients (12 PVs), additional single point cryofocal ablations were required to achieve isolation of all veins (LSPV, n = 5; LIPV, n = 3; LCPV, n = 2; RSPV, n = 1; RIPV, n = 1). There was no vascular access complication, pericardial effusion/tamponade, stroke/transient ischemic attack, phrenic nerve palsy, acute PV stenosis, or atrioesophageal fistula. The procedure duration decreased with experience by 30% from 155 min during the first 10 procedures to 108 min (final 10 treatments). Similar effects were observed with fluoroscopy time (-57%; from 28 min to 12 min), dose area product (-66%; from 22 Gy x cm2 to 8 Gy x cm2), CB time in the left atrium (-24%; from 99 min to 75 min), and cryoenergy delivery time (-19%; from 83 min to 67 min), when comparing cases #1-10 to cases #30-40. CONCLUSIONS CB ablation of AF is effective and safe in the hands of a new operator. Procedure and fluoroscopy times decrease with user experience.
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Affiliation(s)
- Eberhard Scholz
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Patrick Lugenbiel
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Panagiotis Xynogalos
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Claudia Seyler
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Edgar Zitron
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Rüdiger Becker
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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