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Odagiri F, Tokano T, Miyazaki T, Hirabayashi K, Ishi K, Abe H, Ishiwata S, Kakihara M, Maki M, Matsumoto H, Shimai R, Aikawa T, Takano S, Kimura Y, Kuroda S, Isogai H, Ozaki D, Shiozawa T, Yasuda Y, Takasu K, Iijima K, Takamura K, Matsubara T, Tabuchi H, Hayashi H, Yokoyama K, Sekita G, Sumiyoshi M, Nakazato Y, Minamino T. Clinical impact of cryoballoon posterior wall isolation using the cross-over technique in persistent atrial fibrillation. Pacing Clin Electrophysiol 2024. [PMID: 39132971 DOI: 10.1111/pace.15058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/22/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND AND AIMS Successful left atrial posterior wall isolation (LAPWI) using only the cryoballoon (CB) is technically challenging for the treatment of atrial fibrillation (AF). This study aimed to evaluate the efficacy of the cross-over technique, wherein an overlapped ablation is performed by placing the CB from both directions in contact with the LAPW. METHODS This was a single-center, retrospective, observational study of 194 consecutive patients with persistent atrial fibrillation (PerAF) who underwent a first-time procedure of pulmonary vein isolation (PVI) + PWI (108 patients) or PVI-only (86 patients) using the CB. The cross-over technique was applied in all LAPWI. RESULTS For ablation of the LA roof and bottom, respectively, a mean of 8.6 ± 1.0 (right to left [R→L] 4.3 ± 1.1 and left to right [L→R] 4.3 ± 1.1) and 9.1 ± 1.2 (R→L 4.6 ± 1.6 and L→R 4.5 ± 1.2) CB applications were delivered. LAPW was successfully isolated solely using the CB in 99.1% of patients. Although the PVI + PWI group had significantly longer procedure time, no severe adverse events were observed in either group. During a median follow-up of 19 months, freedom from recurrence of all atrial tachyarrhythmias was achieved in 93.5% of the PVI + PWI group and 72.9% of the PVI-only group (p = .011). CONCLUSIONS LAPWI performed solely with the CB using the cross-over technique is feasibly, safe, and was independently associated with a significantly higher freedom from recurrence of atrial tachyarrhythmias compared with PVI alone in patients with PerAF.
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Affiliation(s)
- Fuminori Odagiri
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Takashi Tokano
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Tetsuro Miyazaki
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Koji Hirabayashi
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kai Ishi
- Department of Cardiology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto-ku, Tokyo, Japan
| | - Hiroshi Abe
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Sayaki Ishiwata
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Midori Kakihara
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Masaaki Maki
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Hiroki Matsumoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ryosuke Shimai
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Tadao Aikawa
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Shintaro Takano
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni city, Shizuoka, Japan
| | - Yuki Kimura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Shunsuke Kuroda
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Hiroyuki Isogai
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Dai Ozaki
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Tomoyuki Shiozawa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni city, Shizuoka, Japan
| | - Yuki Yasuda
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kiyoshi Takasu
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Kenichi Iijima
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Tomomi Matsubara
- Department of Cardiology, Juntendo Tokyo Koto Geriatric Medical Center, Juntendo University School of Medicine, Koto-ku, Tokyo, Japan
| | - Haruna Tabuchi
- Department of Cardiology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Hidemori Hayashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Ken Yokoyama
- Department of Cardiology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Gaku Sekita
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Masataka Sumiyoshi
- Department of Cardiology, Juntendo University Nerima Hospital, Nerima-ku, Tokyo, Japan
| | - Yuji Nakazato
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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Kueffer T, Stettler R, Maurhofer J, Madaffari A, Stefanova A, Iqbal SUR, Thalmann G, Kozhuharov NA, Galuszka O, Servatius H, Haeberlin A, Noti F, Tanner H, Roten L, Reichlin T. Pulsed-field vs cryoballoon vs radiofrequency ablation: Outcomes after pulmonary vein isolation in patients with persistent atrial fibrillation. Heart Rhythm 2024; 21:1227-1235. [PMID: 38614191 DOI: 10.1016/j.hrthm.2024.04.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Pulsed-field ablation (PFA) has shown promising data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI), with similar long-term outcomes compared to radiofrequency ablation (RFA) and cryoballoon ablation (CBA) in patients with paroxysmal atrial fibrillation (AF). OBJECTIVE The purpose of this study was to compare the procedural and long-term outcomes in patients with persistent AF undergoing PVI using PFA, CBA, or RFA. METHODS Consecutive patients with persistent AF undergoing first PVI with PFA, CBA, or RFA were included. Patients underwent 7-day Holter electrocardiography at 3, 6, and 12 months postablation. The primary outcome was recurrence of any atrial arrhythmia after a 90-day blanking period. Safety outcomes included the composite of in-hospital major adverse events. RESULTS A total of 533 patients with persistent AF underwent PVI using PFA (n = 214, 39%), CBA (n = 190, 36%), or RFA (n = 129, 24%). Procedures with PFA guided by fluoroscopy were shorter than those with CBA (median 60 minutes; interquartile range [IQR] 53-80 minutes vs 84 minutes; IQR 68-101 minutes; P ≤ .001), and procedures with PFA in combination with 3-dimensional electroanatomic mapping were shorter than those with RFA (median 101 minutes; IQR 85-126 minutes vs 171 minutes; IQR 141-204 minutes; P < .001). Acute safety events occurred in 2.3%, 2.6%, and 0.8% in the PFA, CBA, and RFA groups, respectively (P = .545). The 1-year confounder-adjusted estimate for freedom from atrial arrhythmias was 62.1% for CBA, 55.3% for PFA, and 48.3% for RFA (CBA vs PFA: P = .79; CBA vs RFA: P = .009; PFA vs RFA: P = .010). CONCLUSION In patients with persistent AF undergoing first PVI, 1-year confounder-adjusted outcomes are better with PFA and CBA than with RFA.
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Affiliation(s)
- Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; SITEM Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Robin Stettler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita Stefanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Salik Ur Rehman Iqbal
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola A Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; SITEM Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Reichlin T, Kueffer T, Knecht S, Madaffari A, Badertscher P, Maurhofer J, Krisai P, Jufer C, Asatryan B, Heg D, Servatius H, Tanner H, Kühne M, Roten L, Sticherling C. PolarX vs Arctic Front for Cryoballoon Ablation of Paroxysmal AF: The Randomized COMPARE CRYO Study. JACC Clin Electrophysiol 2024; 10:1367-1376. [PMID: 38752963 DOI: 10.1016/j.jacep.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/04/2024] [Accepted: 03/22/2024] [Indexed: 07/26/2024]
Abstract
BACKGROUND Pulmonary vein isolation is an effective treatment for atrial fibrillation (AF). Cryoballoon ablation using the Arctic Front cryoballoon (Medtronic) was found to be superior to antiarrhythmic drug treatment. Recently, a novel cryoballoon system was introduced (PolarX, Boston Scientific). OBJECTIVES The purpose of this study was to compare the efficacy and safety of the 2 cryoballoons in a randomized controlled trial. METHODS Patients with symptomatic paroxysmal AF were enrolled in 2 centers and randomized 1:1 to pulmonary vein isolation using the PolarX or the Arctic Front cryoballoon. All patients received an implantable cardiac monitor. The primary endpoint was first recurrence of atrial tachyarrhythmia (AF, atrial flutter, or atrial tachycardia [AT]) between days 91 and 365. Procedural safety was assessed by a composite of tamponade, phrenic nerve palsy lasting >24 hours, vascular complications, stroke/transient ischemic attack, atrioesophageal fistula or death up to 30 days. RESULTS A total of 201 patients were enrolled. At 1 year, recurrence of atrial tachyarrhythmia had occurred in 41 of 99 patients (41.6%) assigned to the PolarX group and in 48 of 102 patients (47.1%) assigned to the Arctic Front group (HR: 0.85 [95% CI: 0.56-1.30]; P = 0.03 for noninferiority; P = 0.46 for superiority). The safety endpoint occurred in 5 patients (5%) in the PolarX group (n = 5 phrenic nerve palsies lasting >24 hours), whereas no safety endpoints occurred in the Arctic Front group (P = 0.03). CONCLUSIONS In this randomized controlled trial using implantable cardiac monitors for continuous rhythm monitoring, the novel PolarX cryoballoon was noninferior compared with the Arctic Front cryoballoon regarding efficacy. However, the PolarX balloon resulted in significantly more phrenic nerve palsies. (Comparison of PolarX and the Arctic Front Cryoballoons for PVI in Patients With Symptomatic Paroxysmal AF [COMPARE-CRYO]; NCT04704986).
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Affiliation(s)
- Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Jufer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
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Maurhofer J, Kueffer T, Knecht S, Thalmann G, Badertscher P, Kozhuharov N, Krisai P, Jufer C, Iqbal SUR, Heg D, Servatius H, Tanner H, Kühne M, Roten L, Sticherling C, Reichlin T. Comparison of Cryoballoon vs. Pulsed Field Ablation in Patients with Symptomatic Paroxysmal Atrial Fibrillation (SINGLE SHOT CHAMPION): Study protocol for a randomized controlled trial. Heart Rhythm O2 2024; 5:460-467. [PMID: 39119022 PMCID: PMC11305878 DOI: 10.1016/j.hroo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Background Single-shot devices are increasingly used for pulmonary vein isolation (PVI) in atrial fibrillation (AF). The Arctic Front cryoballoon is the most frequently used single-shot technology. A recently developed novel pulsed field ablation (PFA) device (FARAPULSE) has been introduced with the aim to improve procedural safety and efficacy. Objective This study will compare the novel FARAPULSE PFA device and the Arctic Front cryoballoon for first PVI in patients with symptomatic paroxysmal AF. Methods SINGLE SHOT CHAMPION is a multicenter, randomized controlled trial with blinded endpoint adjudication by an independent clinical events committee. Overall, 210 patients with paroxysmal AF undergoing their PVI are randomized 1:1 between PFA and cryoballoon ablation. Continuous rhythm monitoring with an implantable cardiac monitor is performed in all patients. Results The primary endpoint is time to first recurrence of any atrial tachyarrhythmia (AF and/or organized atrial tachyarrhythmia) lasting ≥120 seconds and identified by the implantable cardiac monitor within 91 and 365 days postablation. The composite procedural safety endpoint includes cardiac tamponade requiring drainage, persistent phrenic nerve palsy, vascular complications requiring intervention, stroke/transient ischemic attack, atrioesophageal fistula, and death occurring during or up to 30 days after the procedure. Key secondary endpoints include (1) increase in high-sensitivity troponin on day 1 postablation, (2) analysis of postablation 3-dimensional electroanatomic mapping (first 25 patients per study group), (3) AF burden, and (4) quality-of-life changes. Conclusion SINGLE SHOT CHAMPION will evaluate the efficacy and safety of PVI using the novel FARAPULSE PFA for patients with symptomatic paroxysmal AF.
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Affiliation(s)
- Jens Maurhofer
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Jufer
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Salik ur Rehman Iqbal
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Dik Heg
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital – University Hospital Bern, University of Bern, Bern, Switzerland
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Bai R, Liao Y, Wang X, Rosenthal K, Vessey J, Mazor M, Su W. In vivo safety and pulmonary vein isolation performance of a new cryoballoon for the treatment of atrial fibrillation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01836-5. [PMID: 38831168 DOI: 10.1007/s10840-024-01836-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 05/23/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Cryoablation to achieve pulmonary vein (PV) isolation has become one of the standard approaches for atrial fibrillation (AF) ablation. The Arctic Front series cryoballoon and Achieve circular mapping catheter (Medtronic) inherently possess design defects that have been associated with unfavorite clinical outcomes. Lately, a new cryoablation system (Nordica Cryoablation System, Synaptic Medical) was developed with improved design of the cryoballoon and circular mapping catheter to address the inadequacies of current cryoablation technology. An animal study was conducted to test the efficacy and safety in performing PVI with the Nordica Cryoablation System. METHODS Pulmonary vein isolation with the Nordica Cryoablation System was performed on 12 PVs of six healthy canines. Acute PVI and peri-procedural complications were recorded. All animals underwent a repeat EP study at least 4 weeks after index procedures followed by pathological and histological assessments of the heart and collateral/downstream organs after planned euthanasia. RESULTS Acute PV isolation was achieved in all targeted PVs with 50% of PVs being isolated with a single cryoablation application. There were no major peri-procedural complications or device malfunction events. All PVs remained isolated after 29-30 days follow-up. Histological examination showed transmural cryo-lesions at treated sites with minimal inflammation, neovascularization, and neointima formation but no significant injury to adjacent tissue or embolization in downstream organs. CONCLUSION Acute and durable PVI can be achieved by using the novel Nordica Cryoablation System. Ablation with this new cryoablation system is associated with transmural lesions at targeted myocardium but creates no injury to the collateral tissues or downstream organs.
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Affiliation(s)
- Rong Bai
- Division of Cardiology, Banner-University Medicine Heart Institute, Banner University Medical Center-Phoenix, College of Medicine, University of Arizona, 755. E McDowell Road, Floor 4, Phoenix, 85006, AZ, USA.
| | - Yu Liao
- Department of Internal Medicine, Division of Cardiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Xunzhang Wang
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA, USA
| | | | | | | | - Wilber Su
- Division of Cardiology, Banner-University Medicine Heart Institute, Banner University Medical Center-Phoenix, College of Medicine, University of Arizona, 755. E McDowell Road, Floor 4, Phoenix, 85006, AZ, USA.
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Masuda M, Matsuda Y, Uematsu H, Nishijima M, Okamoto S, Ishihara T, Nanto K, Tsujimura T, Hata Y, Mano T. Impact of wall thickness on the tissue cooling effect of cryoballoon ablation. Europace 2024; 26:euae135. [PMID: 38767127 PMCID: PMC11137751 DOI: 10.1093/europace/euae135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/14/2024] [Indexed: 05/22/2024] Open
Abstract
AIMS Understanding of the tissue cooling properties of cryoballoon ablation during pulmonary vein (PV) isolation is lacking. The purpose of this study was to delineate the depth of the tissue cooling effect during cryoballoon freezing at the pulmonary venous ostium. METHODS AND RESULTS A left atrial-PV model was constructed using a three-dimensional printer with data from a patient to which porcine thigh muscle of various thicknesses could be affixed. The model was placed in a 37°C water tank with a PV water flow at a rate that mimicked biological blood flow. Cryofreezing at the PV ostium was performed five times each for sliced porcine thigh muscle of 2, 4, and 6 mm thickness, and sliced muscle cooling on the side opposite the balloon was monitored. The cooling effect was assessed using the average temperature of 12 evenly distributed thermocouples covering the roof region of the left superior PV. Tissue cooling effects were in the order of the 2, 4, and 6 mm thicknesses, with an average temperature of -41.4 ± 4.2°C for 2 mm, -33.0 ± 4.0°C for 4 mm, and 8.0 ± 8.7°C for 6 mm at 180 s (P for trend <0.0001). In addition, tissue temperature drops were steeper in thin muscle (maximum temperature drop per 5 s: 5.2 ± 0.9°C, 3.9 ± 0.7°C, and 1.3 ± 0.7°C, P for trend <0.0001). CONCLUSION The cooling effect of cryoballoon freezing is weaker in the deeper layers. Cryoballoon ablation should be performed with consideration to myocardial thickness.
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Affiliation(s)
- Masaharu Masuda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Yasuhiro Matsuda
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Hiroyuki Uematsu
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Mizuki Nishijima
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Shin Okamoto
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Kiyonori Nanto
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo 660-8511, Japan
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Scazzuso F, Ptaszyński P, Kaczmarek K, Chun KRJ, Khelae SK, Földesi C, Obidigbo V, van Bragt KA, On YK, Al-Kandari F, Okumura K. Regional variations in patient selection and procedural characteristics for cryoballoon ablation of atrial fibrillation in the cryo global registry. J Interv Card Electrophysiol 2024; 67:493-501. [PMID: 37505337 PMCID: PMC11016010 DOI: 10.1007/s10840-023-01582-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 05/25/2023] [Indexed: 07/29/2023]
Abstract
BACKGROUND Cryoballoon ablation is a well-established anatomical approach for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Although widely adopted, regional variations in standards of care have not been well characterized. METHODS Patients with AF were enrolled in the Cryo Global Registry (NCT02752737) from May 2016 to Sept 2021 at 128 sites in 37 countries and treated with cryoballoon ablation according to local clinical practice. Baseline patient and procedural characteristics were summarized for 8 regions (Central Asia & Russia, East Asia, Europe, Middle East, North America, South Africa, South America, and Southeast Asia). Serious procedure-related adverse events (SAEs) were evaluated in a subset of patients with ≥ 7 days of follow-up. RESULTS A total of 3,680 patients undergoing initial PVI for AF were included. Cryoballoon ablation was commonly performed in patients with paroxysmal AF. Mean age ranged from 47 ± 12 years in the Middle East to 64 ± 11 years in East Asia. Mean procedure time was ≤ 95 min in all regions. Average freeze duration ranged from 153 ± 41 s in Southeast Asia to 230 ± 29 s in Central Asia & Russia. Acute procedural success was ≥ 94.7% in all geographies. In 3,126 subjects with ≥ 7 days of follow-up, 122 procedure-related SAEs were reported in 111 patients (3.6%) and remained low in all regions. One procedure-related death was reported during data collection. CONCLUSIONS Despite regional variations in patient selection and procedural characteristics, PVI using cryoballoon ablation was performed with high acute success and short procedural times around the world. CLINICAL TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02752737.
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Affiliation(s)
| | | | | | | | | | - Csaba Földesi
- Gottsegen György Országos Kardiovaszkuláris Intézet, Budapest, Hungary
| | | | | | - Young Keun On
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | - Ken Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Chollet L, Iqbal SUR, Wittmer S, Thalmann G, Madaffari A, Kozhuharov N, Galuszka O, Küffer T, Gräni C, Brugger N, Servatius H, Noti F, Haeberlin A, Roten L, Tanner H, Reichlin T. Impact of atrial fibrillation phenotype and left atrial volume on outcome after pulmonary vein isolation. Europace 2024; 26:euae071. [PMID: 38597211 PMCID: PMC11004789 DOI: 10.1093/europace/euae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/12/2024] [Indexed: 04/11/2024] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is increasingly performed in patients with atrial fibrillation (AF). Both AF phenotype and left atrial (LA) volume have been shown to influence ablation outcome. The inter-relationship of the two is incompletely understood. We aimed to investigate the impact of AF phenotype vs. LA volume on outcome after PVI. METHODS AND RESULTS In a retrospective analysis of a prospective registry of patients undergoing a first PVI, the association of AF phenotype and LA volume index (LAVI) was assessed as well as their impact on AF recurrence during follow-up. Overall, 476 patients were enrolled (median age 63 years, 29% females, 65.8% paroxysmal AF). Obesity, hypertension, chronic kidney disease, and heart failure were all significantly more frequent in persistent AF. After 1 year, single-procedure, freedom from arrhythmia recurrence was 61.5%. Patients with paroxysmal AF had better outcomes compared with patients with persistent AF (65.6 vs. 52.7%, P = 0.003), as had patients with no/mild vs. moderate/severe LA dilation (LAVI <42 mL/m2 67.1% vs. LAVI ≥42 mL/m2 53%, P < 0.001). The combination of both parameters refined prediction of 1-year recurrence (P < 0.001). After adjustment for additional clinical risk factors in multivariable Cox proportional hazard analysis, both AF phenotype and LAVI ≥42 mL/m2 contributed significantly towards the prediction of 1-year recurrence. CONCLUSION Atrial fibrillation phenotype and LA volume are independent predictors of outcome after PVI. Persistent AF with no/mild LA dilation has a similar risk of recurrence as paroxysmal AF with a moderate/severe LA dilation and should be given similar priority for ablation.
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Affiliation(s)
- Laurève Chollet
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Salik ur Rehman Iqbal
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Severin Wittmer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Thomas Küffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Nicolas Brugger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, 3010 Bern, Switzerland
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Maurhofer J, Kueffer T, Madaffari A, Stettler R, Stefanova A, Seiler J, Thalmann G, Kozhuharov N, Galuszka O, Servatius H, Haeberlin A, Noti F, Tanner H, Roten L, Reichlin T. Pulsed-field vs. cryoballoon vs. radiofrequency ablation: a propensity score matched comparison of one-year outcomes after pulmonary vein isolation in patients with paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:389-397. [PMID: 37776355 PMCID: PMC10902096 DOI: 10.1007/s10840-023-01651-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Pulsed-field ablation (PFA) has shown favourable data in terms of safety and procedural efficiency for pulmonary vein isolation (PVI). We sought to compare procedural and 1-year follow-up data of patients with paroxysmal atrial fibrillation (AF) undergoing PVI using PFA, cryoballoon ablation (CBA) and radiofrequency ablation (RFA). METHODS Consecutive patients with paroxysmal AF undergoing a first PVI with PFA at our institution were included. For comparison, patients with paroxysmal AF undergoing a first PVI with CBA and RFA were selected using a 1:2:2 propensity score matching. The PFA group followed the standard 32-applications lesion-set protocol, the CBA group a time-to-effect plus 2-min strategy, and the RFA group the CLOSE protocol. Patients were followed with 7d-Holter ECGs 3, 6, and 12 months after ablation. The primary endpoint was recurrence of atrial tachyarrhythmia (ATa) following a blanking period of 3 months. RESULTS A total of 200 patients were included (PFA n = 40; CBA n = 80; RFA n = 80). Median procedure times were shortest with CBA (75 min) followed by PFA (94 min) and RFA (182 min; p < 0.001). Fluoroscopy dose was lowest with RFA (1.6Gycm2) followed by PFA (5.0Gycm2) and CBA (5.7Gycm2; p < 0.001). After a 1-year follow-up, freedom from ATa recurrence was 85.0% with PFA, 66.2% with CBA and 73.8% with RFA (p = 0.12 PFA vs. CBA; p = 0.27 PFA vs. RFA). CONCLUSION In a propensity score matched analysis of patients with paroxysmal AF, freedom from any ATa 1 year after PVI using PFA was favourable and at least as good as for PVI with CBA or RFA.
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Affiliation(s)
- Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Robin Stettler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anita Stefanova
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Oskar Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Sitem Center for Translational Medicine and Biomedical Entrepreneurship, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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10
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Honarbakhsh S, Martin CA, Mesquita J, Herlekar R, Till R, Srinivasan NT, Duncan E, Leong F, Dulai R, Veasey R, Panikker S, Paisey J, Ramgopal B, Das M, Ahmed W, Sahu J, Earley MJ, Finlay MC, Schilling RJ, Hunter RJ. Atrial fibrillation cryoablation is an effective day case treatment: the UK PolarX vs. Arctic Front Advance experience. Europace 2023; 25:euad286. [PMID: 37738643 PMCID: PMC10629714 DOI: 10.1093/europace/euad286] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/28/2023] [Indexed: 09/24/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation for atrial fibrillation (AF). There are limited data on the PolarX Cryoballoon. The study aimed to establish the safety, efficacy, and feasibility of same day discharge for Cryoballoon PVI. METHODS AND RESULTS Multi-centre study across 12 centres. Procedural metrics, safety profile, and procedural efficacy of the PolarX Cryoballoon with the Arctic Front Advance (AFA) Cryoballoon were compared in a cohort large enough to provide definitive comparative data. A total of 1688 patients underwent PVI with cryoablation (50% PolarX and 50% AFA). Successful PVI was achieved with 1677 (99.3%) patients with 97.2% (n = 1641) performed as day case procedures with a complication rate of <1%. Safety, procedural metrics, and efficacy of the PolarX Cryoballoon were comparable with the AFA cohort. The PolarX Cryoballoon demonstrated a nadir temperature of -54.6 ± 7.6°C, temperature at 30 s of -38.6 ± 7.2°C, time to -40°C of 34.1 ± 13.7 s, and time to isolation of 49.8 ± 33.2 s. Independent predictors for achieving PVI included time to reach -40°C [odds ratio (OR) 1.34; P < 0.001] and nadir temperature (OR 1.24; P < 0.001) with an optimal cut-off of ≤34 s [area under the curve (AUC) 0.73; P < 0.001] and nadir temperature of ≤-54.0°C (AUC 0.71; P < 0.001), respectively. CONCLUSIONS This large-scale UK multi-centre study has shown that Cryoballoon PVI is a safe, effective day case procedure. PVI using the PolarX Cryoballoon was similarly safe and effective as the AFA Cryoballoon. The cryoablation metrics achieved with the PolarX Cryoballoon were different to that reported with the AFA Cryoballoon. Modified cryoablation targets are required when utilizing the PolarX Cryoballoon.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Claire A Martin
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Joao Mesquita
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
| | - Rahul Herlekar
- Department of Electrophysiology, Royal Papworth Hospital, Cambridge, UK
| | - Richard Till
- Department of Electrophysiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Neil T Srinivasan
- Department of Electrophysiology, Basildon and Thurrock University Hospital NHS Foundation Trust, Essex, UK
| | - Edward Duncan
- Department of Electrophysiology, The University Hospitals Bristol and Weston NHS Foundation trust, Bristol, UK
| | - Fong Leong
- Department of Electrophysiology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Rajdip Dulai
- Department of Electrophysiology, Eastbourne District General Hospital, East Sussex Healthcare NHS trust, Eastbourne, UK
| | - Rick Veasey
- Department of Electrophysiology, Eastbourne District General Hospital, East Sussex Healthcare NHS trust, Eastbourne, UK
| | - Sandeep Panikker
- Department of Electrophysiology, University Hospital Coventry and Warwickshire, Coventry, UK
| | - John Paisey
- Department of Electrophysiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Balasubramanian Ramgopal
- Department of Electrophysiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Moloy Das
- Department of Electrophysiology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Wissam Ahmed
- Department of Electrophysiology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | - Jonathan Sahu
- Department of Electrophysiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Mark J Earley
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
| | - Malcolm C Finlay
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
| | - Richard J Schilling
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew’s Hospital, Barts Health NHS trust, W Smithfield, EC1A 7BE London, UK
- Department of Electrophysiology, OneWellbeck, 1 Wellbeck Street, W1G 0AR London, UK
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11
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Maurhofer J, Kueffer T, Knecht S, Madaffari A, Badertscher P, Seiler J, Krisai P, Jufer C, Asatryan B, Heg D, Servatius H, Tanner H, Kühne M, Roten L, Sticherling C, Reichlin T. Comparison of the PolarX and the Arctic Front cryoballoon for pulmonary vein isolation in patients with symptomatic paroxysmal atrial fibrillation (COMPARE CRYO) - Study protocol for a randomized controlled trial. Contemp Clin Trials 2023; 134:107341. [PMID: 37722483 DOI: 10.1016/j.cct.2023.107341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 08/24/2023] [Accepted: 09/15/2023] [Indexed: 09/20/2023]
Abstract
INTRODUCTION Single-shot devices are increasingly used for pulmonary vein isolation (PVI) in atrial fibrillation (AF). The Arctic Front cryoballoon (Medtronic) is the most frequently used single-shot technology. A recently developed novel cryoballoon has been introduced (PolarX, Boston Scientific) with the aim to address limitations of the Arctic Front system. METHODS COMPARE CRYO is a multicentre, randomized, controlled trial with blinded endpoint adjudication by an independent clinical events committee. A total of 200 patients with paroxysmal AF undergoing their first PVI are randomized 1:1 between PolarX cryoballoon ablation and Arctic Front cryoballoon ablation. Continuous monitoring during follow-up is performed using an implantable cardiac monitor (ICM) in all patients. The primary endpoint is time to first recurrence of any atrial tachyarrhythmia (AF, atrial flutter, and/or atrial tachycardia) ≥ 120 s between days 91 and 365 post ablation as detected on the (ICM). Procedural safety is assessed by a composite of cardiac tamponade, persistent phrenic nerve palsy >24 h, vascular complications requiring intervention, stroke/transient ischemic attack, atrioesophageal fistula or death occurring during or up to 30 days after the procedure. Key secondary endpoints include (1) procedure and fluoroscopy times, (2) AF burden, (3) proportion of patients with recurrence in the blanking period, (4) proportion of patients undergoing repeat ablation, and (5) quality of life changes at 12 months compared to baseline. CONCLUSION COMPARE CRYO will compare the efficacy and safety of the novel PolarX cryoballoon and the standard-of-practice Arctic Front cryoballoon for first PVI performed in patients with symptomatic paroxysmal AF. TRIAL REGISTRATION (ClinicalTrials.gov ID: NCT04704986).
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Affiliation(s)
- Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Krisai
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Corinne Jufer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Babken Asatryan
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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12
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He C, Zhang W, Yin L, Sun M, Zhao Z, Ye G, Liu T, Shi W, Zhang D, Li F, Ding C. Single-shot technique of cryoablation for atrial fibrillation has comparable effective and safety outcomes compared to standard technique: insights from multiple clinical studies. Front Cardiovasc Med 2023; 10:1195492. [PMID: 37745124 PMCID: PMC10512731 DOI: 10.3389/fcvm.2023.1195492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
Background Although there are many freezing protocols available, the optimal freezing dose is still not determined. We aimed to evaluate the effectiveness and safety of different freeze strategies of CBA in the treatment of AF. Methods PubMed, Cochrane Library, Web of Science, and Embase were searched up to 1st December 2022. Studies comparing the outcomes between single-shot technique and standard technique of cryoablation were included. Subgroup analysis identified potential determinants for single-shot technique procedure. Results Our search resulted in 3407 records after deduplication. A total of 17 qualified studies met our inclusion criteria. Compared with standard technique, single-shot technique of cryoablation has a comparable rate of freedom from AF/AT(RR 1.00; P = 0.968), a trend for lower rate of procedure complications (RR 0.80; P = 0.069), a lower rate in transient phrenic paralysis (t-PNP) (RR 0.67; P = 0.038), a similar rate in persistent phrenic paralysis (per-PNP) (RR 1.15; P = 0.645), as well as a comparable procedure parameters. Importantly, potentially significant treatment covariable interactions in procedure complications were found in freeze strategy subgroup, male proportion subgroup and age subgroup, including single-shot freeze (RR 1.02; P = 0.915) and TTI-guided (RR 0.63; P = 0.007) with interaction P = 0.051, high male proportion (RR 0.54; P = 0.005) and a low male proportion (RR 0.94; P = 0.759) with interaction P = 0.074, as well as age ≥ 65 (RR0.91; P = 0.642) and age <65 (RR 0.54; P = 0.006),interaction P = 0.090. Meanwhile, only one significant treatment covariable interactions in procedure complications was found in the hypertension subgroup, including HT > 60% (RR 0.89; P = 0.549) and HT ≤ 60% (RR 0. 46; P < 0.01) with interaction P = 0.043. Conclusions Our study suggested that single-shot technique of cryoablation has comparable effective and safety outcomes for AF ablation compared to standard technique.
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Affiliation(s)
- Changjian He
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Wenchang Zhang
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Lei Yin
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mingzhuang Sun
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Zihan Zhao
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Guojie Ye
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Tengfei Liu
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Wence Shi
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Da Zhang
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
| | - Feng Li
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Chunhua Ding
- Cardiac Department, Aerospace Center Hospital (Peking University Aerospace School of Clinical Medicine), Beijing, China
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13
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Wei Y, Lin C, Xie Y, Bao Y, Luo Q, Zhang N, Wu L. Development and validation of a novel nomogram for predicting recurrent atrial fibrillation after cryoballoon ablation. Front Cardiovasc Med 2023; 10:1073108. [PMID: 37636306 PMCID: PMC10453796 DOI: 10.3389/fcvm.2023.1073108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background Few studies have explored the use of machine learning models to predict the recurrence of atrial fibrillation (AF) in patients who have undergone cryoballoon ablation (CBA). We aimed to explore the risk factors for the recurrence of AF after CBA in order to construct a nomogram that could predict this risk. Methods Data of 498 patients who had undergone CBA at Ruijin Hospital, Shanghai Jiaotong University School of Medicine, were retrospectively collected. Factors such as clinical characteristics and biophysical parameters during the CBA procedure were collected for the selection of variables. Scores for all the biophysical factors-such as time to pulmonary vein isolation (TTI) and balloon temperature-were calculated to enable construction of the model, which was then calibrated and compared with the risk scores. Results A 36-month follow-up showed that 177 (35.5%) of the 489 patients experienced AF recurrence. The left atrial volume, TTI, nadir cryoballoon temperature, and number of unsuccessful freezes were related to the recurrence of AF (P < .05). The area under the curve (AUC) of the nomogram's time-dependent receiver operating characteristic curve was 77.6%, 71.6%, and 71.0%, respectively, for the 1-, 2-, and 3-year prediction of recurrence in the training cohort and 77.4%, 74.7%, and 68.7%, respectively, for the same characteristics in the validation cohort. Calibration and data on the nomogram's clinical effectiveness showed it to be accurate for the prediction of recurrence in both the training and validation cohorts as compared with established risk scores. Conclusion Biophysical parameters such as TTI and cryoballoon temperature have a great impact on AF recurrence. The predictive accuracy for recurrence of our nomogram was superior to that of conventional risk scores.
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Affiliation(s)
| | | | | | | | | | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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14
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Aryana A, Thiemann AM, Pujara DK, Cossette LL, Allen SL, Vierra EC, Bowers MR, Gandhavadi M, Heath R, Trivedi AD, O'Neill PG, Ellis ER, d'Avila A. Outcomes of adjunct posterior wall isolation in atrial fibrillation patients with cardiac implantable electronic devices. Pacing Clin Electrophysiol 2023. [PMID: 37377391 DOI: 10.1111/pace.14767] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 05/29/2023] [Accepted: 06/11/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND Although pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF), several studies have illustrated clinical benefits associated with PVI with posterior wall isolation (PWI). METHODS This retrospective study investigated the outcomes of PVI alone versus PVI+PWI performed using the cryoballoon in patients with cardiac implantable electronic devices (CIEDs) and paroxysmal AF (PAF) or persistent AF (PersAF). RESULTS Acute PVI was achieved in all patients using cryoballoon ablation. Compared to PVI alone, PVI+PWI was associated with longer cryoablation, fluoroscopy, and total procedure times. Adjunct radiofrequency was required to complete PWI in 29/77 patients (37.7%). Adverse events were similar with PVI alone versus PVI+PWI. But at 24 ± 7 months of follow-up, not only cryoballoon PVI+PWI was associated with improved freedom from recurrent AF (74.3% vs. 46.0%, P = .007) and all atrial tachyarrhythmias (71.4% vs. 38.1%, P = .001) in patients with PersAF, cryoballoon PVI+PWI also yielded greater freedom from AF (88.1% vs. 63.7%, P = .003) and all atrial tachyarrhythmias (83.3% vs. 60.8%, P = .008) in those with PAF. Additionally, PVI+PWI was associated with higher reductions in atrial tachyarrhythmia burden (97.9% vs. 91.6%, P < .001), need for cardioversion (5.2% vs. 23.6%, P < .001) and repeat catheter ablation (10.4% vs. 26.1%, P = .005), and a longer time-to-arrhythmia recurrence (16 ± 6 months vs. 8 ± 5 months, P < .001) in both PersAF and PAF patients. CONCLUSION In CIED patients with PersAF or PAF, cryoballoon PVI+PWI is associated with a greater freedom from recurrent AF and atrial tachyarrhythmias, as compared to PVI alone during long-term follow-up.
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Affiliation(s)
- Arash Aryana
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Anna M Thiemann
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Deep K Pujara
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Laura L Cossette
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Shelley L Allen
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Eleanor C Vierra
- Sutter Heart and Vascular Institute, Sacramento, California, USA
| | - Mark R Bowers
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | | | - Russell Heath
- University of Colorado Health, Fort Collins, Aurora, Colorado, USA
| | - Amar D Trivedi
- University of Colorado Health, Fort Collins, Aurora, Colorado, USA
| | - Padraig Gearoid O'Neill
- Department of Cardiology and Cardiovascular Surgery, Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Ethan R Ellis
- University of Colorado Health, Fort Collins, Aurora, Colorado, USA
| | - André d'Avila
- The Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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15
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Aryana A, Thiemann AM, Pujara DK, Cossette LL, Allen SL, Bowers MR, Gandhavadi M, Heath R, Trivedi AD, O'Neill PG, Ellis ER, d'Avila A. Pulmonary Vein Isolation With and Without Posterior Wall Isolation in Paroxysmal Atrial Fibrillation: IMPPROVE-PAF Trial. JACC Clin Electrophysiol 2023; 9:628-637. [PMID: 37225309 DOI: 10.1016/j.jacep.2023.01.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Prior studies have demonstrated clinical benefits associated with cryoballoon pulmonary vein isolation (PVI) and concomitant posterior wall isolation (PWI) in patients with persistent atrial fibrillation (AF). However, the role for this approach in patients with paroxysmal atrial fibrillation (PAF) remains unclear. OBJECTIVES This study investigated the acute and long-term outcomes of PVI vs PVI+PWI using cryoballoon in patients with symptomatic PAF. METHODS This retrospective study (NCT05296824) examined the outcomes of cryoballoon PVI (n = 1,342) vs cryoballoon PVI+PWI (n = 442) in patients with symptomatic PAF during long-term follow-up. Using the nearest-neighbor method, a 1:1 matched sample of patients receiving PVI alone and PVI+PWI was created. RESULTS The matched cohort consisted of 320 patients (PVI: n = 160; PVI+PWI: n = 160). PVI+PWI was associated with longer cryoablation (23 ± 10 minutes vs 42 ± 11 minutes; P < 0.001) and procedure times (103 ± 24 minutes vs 127 ± 14 minutes; P < 0.001). In 39 (24.4%) of 160 patients, adjunct radiofrequency ablation was required for PVI+PWI. Adverse event rates were similar (PVI 3.8% vs PVI+PWI 1.9%; P = 0.31). Though there were no differences at 12 months, freedom from all atrial arrhythmias (67.5% vs 45.0%; P < 0.001) and AF (75.6% vs 55.0%; P < 0.001) were significantly greater with PVI+PWI vs PVI alone at 39 ± 9 months of follow-up. PVI+PWI was also associated with reduced long-term need for cardioversion (16.9% vs 27.5%; P = 0.02) and repeat catheter ablation (11.9% vs 26.3%; P = 0.001), and emerged as the only significant predictor of freedom from recurrent AF (HR: 2.79; 95% CI: 1.64-4.74; P < 0.001). CONCLUSIONS Compared with cryoballoon PVI, cryoballoon PVI+PWI appears to be associated with greater freedom from recurrent atrial arrhythmias and AF in patients with PAF during long-term follow-up >3 years.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.
| | - Anna M Thiemann
- California Northstate University College of Medicine, Elk Grove, California, USA
| | - Deep K Pujara
- University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Laura L Cossette
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Shelley L Allen
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | | | - Russell Heath
- University of Colorado Health, Fort Collins, Colorado, USA
| | - Amar D Trivedi
- University of Colorado Health, Fort Collins, Colorado, USA
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Ethan R Ellis
- University of Colorado Health, Fort Collins, Colorado, USA
| | - André d'Avila
- Harvard Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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16
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Shi LB, Wollner K, Chu SY, Wang YC, Solheim E, Schuster P, Chen J. Thawing plateau time indicating the duration of phase transition from ice to water is the strongest predictor for long-term durable pulmonary vein isolation after cryoballoon ablation for atrial fibrillation-Data from the index and repeat procedures. Front Cardiovasc Med 2023; 10:1058485. [PMID: 36950289 PMCID: PMC10025357 DOI: 10.3389/fcvm.2023.1058485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 02/15/2023] [Indexed: 03/08/2023] Open
Abstract
Introduction This study aimed to clarify the relationship between the durability of pulmonary vein (PV) isolation and the time of phase transition from ice to water indicated by thawing plateau time in a cryoballoon ablation for atrial fibrillation (AF). Methods and results In this retrospective study, 241 PVs from 71 patients who underwent a repeat AF ablation 526 (IQR: 412, 675) days after a cryoballoon ablation were analyzed. Reconnection was observed in 101 (41.9%) PVs of 53 patients (74.6%). Thawing plateau time (TimeTP) was defined as the time from 0°C to 10°C inside the balloon in the thawing period. Durable PV isolation was associated with significantly longer TimeTP compared with PV reconnection (26.0 vs. 11.0 s, P < 0.001). The proportion of durable PV isolations increased with TimeTP in a dose-proportional manner. The cut point for PV reconnection was TimeTP <15 s with a positive predictive value of 82.1% (sensitivity = 63.4%, specificity = 90.0%) while for durable PV isolation the cut point was TimeTP >25 s with a positive predictive value of 84.6% (sensitivity = 55.0%, specificity = 86.1%). In the analysis of multivariable logistic regression, location of PV reconnection (P < 0.01), TimeTP (P < 0.05) and thawing plateau integral (P < 0.01) were shown as independent predictors for durable PV isolation. Conclusion TimeTP is an independent predictor for the durability of PV isolation, and it presents in a dose-proportional manner. TimeTP <15 s predicts long-term reconnection while TimeTP >25 s predicts durable PV isolation.
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Affiliation(s)
- Li-Bin Shi
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Kristian Wollner
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Song-Yun Chu
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Yu-Chuan Wang
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Cardiology, Shi Ji Tan Hospital, Beijing, China
| | - Eivind Solheim
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Peter Schuster
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Jian Chen
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Correspondence: Jian Chen
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17
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Tsiachris D, Doundoulakis I, Antoniou CK, Pagkalidou E, Zafeiropoulos S, Kordalis A, Gatzoulis KA, Chierchia GB, de Asmundis C, Tsioufis K, Stefanadis C. Effectiveness and safety of a time to isolation strategy of cryoballoon ablation of atrial fibrillation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2022; 33:2640-2648. [PMID: 36177697 DOI: 10.1111/jce.15697] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/10/2022] [Accepted: 09/05/2022] [Indexed: 12/15/2022]
Abstract
AIM We conducted a systematic review and meta-analysis of randomized and observational studies with a control group to evaluate the effectiveness and safety of a time to isolation (TTI)-based strategy of cryoballoon ablation (CBA) in the treatment of atrial fibrillation (AF). METHODS Three electronic databases (MEDLINE, Cochrane Central Register of Controlled Trials, and Embase) without language restrictions were searched. The intervention assessed was a TTI-based strategy of CBA in the treatment of AF. TTI was defined as the time from the start of freezing to the last recorded pulmonary veins' potential. The comparison of interest was intended conventional protocol of CBA. The primary endpoint was freedom from atrial arrhythmia. RESULTS Nine studies were deemed eligible (N = 2289 patients). Eight studies reported freedom from atrial arrhythmia and pooled results showed a marginally similar success rate between the two protocols (odds ratio [OR]: 1.24; 95% confidence interval [CI]: 0.98-1.56). A prespecified subgroup analysis verified that a high dose TTI strategy (with >120 s duration of cryotherapy post-TTI) compared to the conventional protocol could significantly increase the patients without atrial arrhythmia during follow-up (OR: 1.39; 95% CI: 1.05-1.83). TTI strategy could also significantly decrease total procedure time (SMD: -26.24 min; 95% CI: -36.90 to -15.57) and phrenic nerve palsy incidence (OR: 0.49; 95% CI: 0.29-0.84). CONCLUSION Moderate confidence evidence suggests that an individualized CBA dosing strategy based on TTI and extended (>2 min post-TTI) duration of CBA is accompanied by fewer recurrences post-AF ablation.
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Affiliation(s)
| | - Ioannis Doundoulakis
- Athens Heart Center, Athens Medical Center, Athens, Greece.,First Department of Cardiology, "Hippokration" Hospital, National and Kapodistrian University, Athens, Greece
| | | | - Eirini Pagkalidou
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stefanos Zafeiropoulos
- Elmezzi Graduate School of Molecular Medicine, Northwell Health, Manhasset, New York, USA.,Feinstein Institutes for Medical Research at Northwell Health, Manhasset, New York, USA
| | - Athanasios Kordalis
- Athens Heart Center, Athens Medical Center, Athens, Greece.,First Department of Cardiology, "Hippokration" Hospital, National and Kapodistrian University, Athens, Greece
| | - Konstantinos A Gatzoulis
- First Department of Cardiology, "Hippokration" Hospital, National and Kapodistrian University, Athens, Greece
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Konstantinos Tsioufis
- First Department of Cardiology, "Hippokration" Hospital, National and Kapodistrian University, Athens, Greece
| | - Christodoulos Stefanadis
- Athens Heart Center, Athens Medical Center, Athens, Greece.,Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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18
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Ekrami NK, Magni FT, Dayalani V, van Gelder IC, Groenveld HF, Tieleman RG, Wiesfeld AC, Tan ES, Rienstra M, Blaauw Y, Mulder BA. Assessment of sex-related differences and outcome in patients who underwent cryoballoon pulmonary vein isolation for atrial fibrillation: an observational cohort study. BMJ Open 2022; 12:e063359. [PMID: 36368743 PMCID: PMC9660622 DOI: 10.1136/bmjopen-2022-063359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Pulmonary vein isolation (PVI) is widely accepted as an effective and safe treatment for symptomatic atrial fibrillation (AF). However, data on sex-related differences and associations with clinical outcome and safety of PVI with cryoballoon ablation are limited. We sought to compare sexrelated efficacy and safety of cryoballoon ablation and identify sex-related associations with clinical outcomes. METHODS AND RESULTS We included 650 consecutive patients with AF undergoing PVI with cryoballoon ablation at our institution between 2013 and 2017. The efficacy outcome was the first documented recurrence (>30 s) of AF, atrial flutter or atrial tachycardia (AF/AT) or repeat ablation during follow-up, after a 90-day blanking period. The safety outcome was the incidence of periprocedural complications. Mean age of the population was 58±10, and 210 (32.3%) patients were women. Women were older, had a higher body mass index, had more renal dysfunction and less coronary artery disease as compared with men. The rate of AF/AT recurrence was similar between women and men at 12-month follow-up (27.6% vs 24.8%, p=0.445). The incidence of periprocedural complications was higher in women (12.9% vs 4.6%; p<0.001), specifically groin haematomas and phrenic nerve palsy. On multivariate analysis, left atrial volume index (adjusted OR 1.05, 95% CI 1.00 to 1.10; p=0.032) was associated with the incidence of procedural complications in women. For men, no relation with complications could be found. CONCLUSION The efficacy of cryoballoon ablation was similar between women and men; however, women had a higher risk of procedural complications.
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Affiliation(s)
- Neda Khalilian Ekrami
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Federico T Magni
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Vijay Dayalani
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Hessel F Groenveld
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Robert G Tieleman
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Ans Cp Wiesfeld
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Eng S Tan
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
| | - Bart A Mulder
- Department of Cardiology, Univeristy Medical Center Groningen, Groningen, The Netherlands
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19
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Spera F, Narducci ML, Bencardino G, Perna F, Bisignani A, Pinnacchio G, Tondo C, Maggio R, Stabile G, Iacopino S, Tundo F, Ferraro A, De Simone A, Malacrida M, Pintus F, Crea F, Pelargonio G. Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation. Front Cardiovasc Med 2022; 9:985182. [DOI: 10.3389/fcvm.2022.985182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair, respectively (p = 0.0068). The mean posterior wall (PW) area was 22.9 ± 2 cm2 and, following PV isolation, 44.8 ± 6% of the PW area was ablated. After CB ablation, complete isolation of each PV was documented by the POLARMap™ catheter in all patients. By contrast, confirmatory UHDM and the Lumipoint™ tool unveiled PV signals in 1 out of 114 of the PVs (0.9%). Over 30-day follow-up, no major procedure-related adverse events were reported. After a mean follow-up of 333 days, 89.7% of patients were free from arrhythmia recurrence.ConclusionThe lesion extension achieved by the new CB ablation system involved the PV antrum, with less than 50% of the PW remaining untouched. The new system, with short tip and circular mapping catheter, failed to achieve PV isolation in only 0.9% of all PVs treated.Clinical trial registration[http://clinicaltrials.gov/], identifier [NCT03793998].
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20
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Agudo CA, Urda VC, Ramos JT, Sánchez DJ, Urrea DV, Jaén EGI, Trung CP, Palomero VM, Santos SM, Lozano IF. The Right Atrial Area as a New Factor to Predict Successful Pulmonary Vein Isolation: an Emergent Predictor Variable. JOURNAL OF CARDIAC ARRHYTHMIAS 2022. [DOI: 10.24207/jca.v35i1.3466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Up to now, few factors have been identified to predict successful pulmonary vein isolation, none of which with high predictive values. The objective of our study was to compare different predictive factors of atrial fibrillation recurrence after pulmonary vein isolation,including new parameters of the right atrium (area and index volume). We retrospectively analysed data from 66 patients and included echocardiogram parameters performed within 18 months prior to the ablation procedure. We excluded patients with left ventricular dysfunction (defined as a left ventricular ejection fraction < 50%); previous diagnostic of cardiomyopathy; severe valvular heart disease; severe pulmonary hypertension; or those with poor image quality in the echocardiogram. We considered atrial fibrillation recurrence to be the presence of atrial fibrillation of 30 seconds or longer demonstrated by a standard electrocardiogram or in a 24-hour Holter electrocardiogram within a year after the ablation procedure. We found that the right atrium area (odds ratio = 1.52; 95% confidence interval 0.95–2.43, P = 0.08) and a previous pulmonary vein isolation procedure (odds ratio = 0.21; 95% confidence interval 0.04–1.01, P = 0.05) were nearly statistically significant predictors of successful atrial fibrillation ablation at one year. Although our study was limited because of a low number of patients and because it is a retrospective analysis, we found that a higher right atrial area may be related to the late recurrence of atrial fibrillation. This tendency may be useful in predicting patient outcomes.
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21
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Radiofrequency Current Versus Balloon-Based Ablation for Atrial Fibrillation. Am J Cardiol 2022; 178:52-59. [PMID: 35817597 DOI: 10.1016/j.amjcard.2022.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 11/23/2022]
Abstract
The basis for selection of contemporary ablation technologies for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF) remains unclear. We compared procedural data and efficacy in a propensity score-matched cohort treated with 4 ablation technologies in a center mainly using cryoballoon (CB). A total of 819 consecutive patients with AF underwent PVI, using radiofrequency current (RFC) (65 patients), CB (693 patients), hot balloon (HB) (74 patients), and laser balloon (LB) (52 patients). A total of patients (82% paroxysmal AF) were selected from each group according to the propensity score. Procedural data and freedom from atrial tachyarrhythmia recurrence after the index procedure were compared. All pulmonary veins were isolated in all groups. Procedure time was shorter in CB and HB groups (RFC: 148 ± 53 vs CB: 85 ± 37 vs HB: 102 ± 31 vs LB: 140 ± 28 minutes, p <0.001). RFC touch-up was most commonly required for PVI in the HB group among balloon groups (40%) (p <0.001). Total complication rate was 4% to 18% without any statistical differences between groups (p = 0.123). Phrenic nerve injury occurred most often in the CB group (16%) (p <0.001). During a mean follow-up of 21 ± 6 months, there were no significant differences among groups for freedom from atrial tachyarrhythmia recurrence after the index procedure (RFC: 68% vs CB: 78% vs HB: 76% vs LB: 76%, p = 0.440). In conclusion, all the ablation technologies facilitate safe and efficient PVI, with slight differences in the procedural data and complications.
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22
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Wei Y, Chen L, Cao J, Liu S, Ling T, Huang X, Zhou G, Lin C, Xie Y, Bao Y, Luo Q, Ye J, Zhang N, Jin Q, Wu L. Long-term outcomes of a time to isolation - based strategy for cryoballoon ablation compared to radiofrequency ablation in patients with symptomatic paroxysmal atrial fibrillation. Pacing Clin Electrophysiol 2022; 45:1015-1023. [PMID: 35767472 DOI: 10.1111/pace.14556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 05/03/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) is one of the most commonly used technologies designed for pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (PAF), although the dosing of CBA remains controversial. We evaluated the long-term efficacy and safety of a novel individualized strategy of CBA compared to radiofrequency ablation (RFA) for patients with PAF. METHODS In this observational study, symptomatic patients with drug-refractory paroxysmal AF were prospectively consented and enrolled in four centers, being assigned either to the CBA or RFA arm for ablation. In the CBA group, we used a time to isolation (TTI) - based dosing protocol. The primary endpoint was the recurrence of atrial arrhythmia >30 s following a 90-day blanking period. The secondary endpoint was procedure-related complications and procedure parameters. RESULTS A total of 500 patients were recruited in either the CBA group (n = 247) or the RFA group (n = 253) between January 2017 and July 2018. After a median follow-up of 778 days, the atrial tachyarrhythmia-free survival was 71.7% in the CBA group and 67.0% in the RFA group. CBA and RFA displayed similar major or minor complication occurrence, while the former had a significantly shorter procedure duration (82.5 min vs. 141.1 min, p < .001) and left atrial dwell time (60.1 min vs. 109.9 min, p < .001) but longer fluoroscopy exposure (13.8 min vs. 8.1 min, p < .001). CONCLUSION Compared to RFA, our TTI-based CBA dosing protocol showed comparable efficacy and safety, with a significantly reduced procedure duration in patients with PAF.
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Affiliation(s)
- Yue Wei
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Lin Chen
- Department of Cardiology, Fujian Provincial Hospital, Fuzhou, People's Republic of China
| | - Jiang Cao
- Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
| | - Shaowen Liu
- Department of Cardiology, Shanghai General Hospital, Shanghai, People's Republic of China
| | - Tianyou Ling
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Xinmiao Huang
- Department of Cardiology, Changhai Hospital, Shanghai, People's Republic of China
| | - Genqing Zhou
- Department of Cardiology, Shanghai General Hospital, Shanghai, People's Republic of China
| | - Changjian Lin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yun Xie
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Yangyang Bao
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qingzhi Luo
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Jiawen Ye
- Department of Cardiology, Shanghai No. 9 People's Hospital, Shanghai, People's Republic of China
| | - Ning Zhang
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Qi Jin
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Liqun Wu
- Department of Cardiovascular Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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23
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Honarbakhsh S, Earley MJ, Martin CA, Creta A, Sohaib A, Ang R, Butcher C, Waddingham PH, Dhinoja M, Lim W, Srinivasan NT, Providencia R, Kanthasamy V, Sporton S, Chow A, Lambiase PD, Schilling RJ, Finlay MC, Hunter RJ. PolarX Cryoballoon metrics predicting successful pulmonary vein isolation: targets for ablation of atrial fibrillation. Europace 2022; 24:1420-1429. [PMID: 35737685 DOI: 10.1093/europace/euac100] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
AIM Evaluate the novel PolarX Cryoballoon in atrial fibrillation (AF) catheter ablation through a propensity-matched comparison with the Arctic Front Advance (AFA). The aim was also to identify cryoablation metrics that are predictive of successful pulmonary vein isolation (PVI) with the PolarX Cryoballoon. METHODS AND RESULTS This prospective multi-centre study included patients that underwent cryoablation for AF. All patients underwent PVI with reconnection assessed after a 30-min waiting period and adenosine. Safety, efficacy, and cryoablation metrics were compared between PolarX and a propensity-matched AFA cohort. Seventy patients were included with 278 veins treated. In total, 359 cryoablations were performed (1.3 ± 0.6 per vein) to achieve initial PVI with 205 (73.7%) veins isolating with a single cryoablation. Independent predictors for achieving initial PVI included temperature at 30 s [odds ratio (OR) 1.26; P = 0.003] and time to reach -40°C (OR 1.88; P < 0.001) with an optimal cut-off of ≤-38.5°C at 30 s [area under the curve (AUC) 0.79; P < 0.001] and ≤-40°C at ≤32.5 s (AUC 0.77; P < 0.001), respectively. Of the 278 veins, 46 (16.5%) veins showed acute reconnection. Temperature at 30 s (≤-39.5°C, OR 1.24; P = 0.002), nadir temperature (≤-53.5°C, OR 1.35; P = 0.003), and time to isolation (≤38.0 s, OR 1.18; P = 0.009) were independent predictors of sustained PVI. Combining two of these three targets was associated with reconnection in only 2-5% of PVs. Efficacy and safety of the PolarX Cryoballoon were comparable to AFA Cryoballoon, however, cryoablation metrics were significantly different. CONCLUSIONS The PolarX Cryoballoon has a different cryoablation profile to AFA Cryoballoon. Prospective testing of these proposed targets in large outcomes studies is required.
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Affiliation(s)
- Shohreh Honarbakhsh
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mark J Earley
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | | | - Antonio Creta
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Afzal Sohaib
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard Ang
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Charles Butcher
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Peter H Waddingham
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Mehul Dhinoja
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Wei Lim
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - Neil T Srinivasan
- Circulatory Health Research Group, Medical Technology Research Centre, School of Medicine, Anglia Ruskin University, CM1 1SQ Chelmsford, UK
| | - Rui Providencia
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Vijayabharathy Kanthasamy
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Simon Sporton
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Anthony Chow
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Pier D Lambiase
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Richard J Schilling
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Malcolm C Finlay
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
| | - Ross J Hunter
- The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, W. Smithfield, EC1A 7BE London, UK
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Saouma S, Kowalski M. Frozen, Gone in 60 Seconds! J Cardiovasc Electrophysiol 2022; 33:1380-1382. [PMID: 35488748 DOI: 10.1111/jce.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
Abstract
The field of electrophysiology has seen the development of a novel ultralow temperature cryoablation (ULTC) system. The data presented in this manuscript shows that the ULTC system is feasible, safe, and effective in acute PVI under sedation and by using angiography only This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Samer Saouma
- Staten Island University Hospital and Northwell Health System, Staten Island, New York, USA
| | - Marcin Kowalski
- Staten Island University Hospital and Northwell Health System, Staten Island, New York, USA
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Alyesh D, Frederick J, Choe W, Sundaram S. Step by step: How to perform a fluoroless cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:2351-2355. [PMID: 35437834 DOI: 10.1111/jce.15502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/02/2022] [Accepted: 04/11/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Pulmonary vein isolation is the cornerstone of ablation of atrial fibrillation. With widespread use of 3D Electroanatomic Mapping Systems and advances in intracardiac echo imaging, fluoroless ablation has been possible. METHODS Fluoroless ablation with cryoballoon (CB), however, has not been widely performed because of the need to prove occlusion of the vein with contrast dye and fluoroscopy. RESULTS AND CONCLUSION In this step-by-step guide, the authors will show how a CB ablation can be performed without the use of fluoroscopy.
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Affiliation(s)
- Daniel Alyesh
- South Denver Cardiology Associates, Littleton, Colorado, USA
| | | | - William Choe
- South Denver Cardiology Associates, Littleton, Colorado, USA
| | - Sri Sundaram
- South Denver Cardiology Associates, Littleton, Colorado, USA
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Innovations in atrial fibrillation ablation. J Interv Card Electrophysiol 2022; 66:737-756. [PMID: 35411440 DOI: 10.1007/s10840-022-01215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Catheter-based ablation to perform pulmonary vein isolation (PVI) has established itself as a mainstay in the rhythm control strategy of atrial fibrillation. This review article aims to provide an overview of recent advances in atrial fibrillation ablation technology. METHODS We reviewed the available literature and clinical trials of innovations in atrial fibrillation ablation technologies including ablation catheter designs, alternative energy sources, esophageal protection methods, electroanatomical mapping, and novel ablation targets. RESULTS Innovative radiofrequency (RF) catheter designs maximize energy delivery while avoiding overheating associated with conventional catheters. Single-shot balloon catheters in the form of cryoballoons, radiofrequency, and laser balloons have proven effective at producing pulmonary vein isolation and improving procedural efficiency and reproducibility. Pulsed field ablation (PFA) is a highly anticipated novel nonthermal energy source under development, which demonstrates selective ablation of the myocardium, producing durable lesions while also minimizing collateral damage. Innovative devices for esophageal protection including esophageal deviation and cooling devices have been developed to reduce esophageal complications. Improved electroanatomical mapping systems are being developed to help identify additional non-pulmonary triggers, which may benefit from ablation, especially with persistent atrial fibrillation. Lastly, the vein of Marshall alcohol ablation has been recently studied as an adjunct therapy for improving outcomes with catheter ablation for persistent atrial fibrillation. CONCLUSIONS Numerous advances have been made in the field of atrial fibrillation ablation in the past decade. While further long-term data is still needed for these novel technologies, they show potential to improve procedural efficacy and safety.
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Neven K, Füting A, Reinsch N. The clock is ticking for cryoablation as treatment option for atrial fibrillation. J Cardiovasc Electrophysiol 2022; 33:1104-1105. [PMID: 35304792 DOI: 10.1111/jce.15456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Kars Neven
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Anna Füting
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
| | - Nico Reinsch
- Department of Electrophysiology, Alfried Krupp Hospital, Essen, Germany
- Department of Medicine, Witten/Herdecke University, Witten, Germany
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Rexha E, Heeger CH, Maack S, Rottner L, Wohlmuth P, Lemes C, Maurer T, Reißmann B, Rillig A, Mathew S, Sohns C, Ouyang F, Kuck KH, Metzner A. Impact of a time-to-effect guided ablation protocol in cryoballoon ablation on durability of pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:1096-1103. [PMID: 35304790 DOI: 10.1111/jce.15453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/09/2022] [Accepted: 01/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cryoballoon (CB) based pulmonary vein isolation (PVI) has proven to be as effective as radiofrequency (RF) based ablation. Different ablation protocols took the individual time-to-isolation (TTI) into account aiming at shorter but equally or even more effective freeze-cycles. The current study sought to assess the impact of the TTI on PVI durability in patients undergoing a repeat procedure for recurrence of atrial tachyarrhythmia (ATA). METHODS AND RESULTS In 205 patients with ATA recurrence after previous CB-based PVI a total of 806 PVs were identified. One hundred-twenty-six out of 806 PVs (16%) were previously treated with a TTI guided ablation (protocol #1; TTI+120 sec.), in 92/806 (11%) PVs TTI was only monitored (m) but fixed freeze-cycles were applied (protocol #2; mTTI) and in 588/806 (73%) a fixed freeze-cycle was applied without TTI-monitoring. There was no difference in the PV-reconduction rate between the groups (p=0.23). The right inferior pulmonary vein (RIPV) showed overall significantly higher reconduction rates compared to the other PVs (RIPV - left inferior PV (LIPV) p<0.003, -left superior PV (LSPV) p<0.001, - right superior PV RSPV p<0.013). Twenty-one patients (10%) were demonstrated to have only electrical reconduction of the RIPV, while all other PVs were still electrically isolated. CONCLUSIONS TTI based CB ablation did not show significant differences regarding PV-reconduction rates compared to the other protocols. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Enida Rexha
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Sabrina Maack
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Peter Wohlmuth
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | | | - Shibu Mathew
- Department of Cardiology, University Clinic Gießen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität, Bochum, Bad Oeynhausen, Germany
| | | | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
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Aryana A, Lafortune P, Di Biase L, Natale A. Cryoballoon Ablation of the Pulmonary Veins, the Posterior Wall, the Left Atrial Appendage, and the Mitral Isthmus Guided by Intracardiac Echocardiography-integrated and Three-dimensional Mapping. J Innov Card Rhythm Manag 2022; 13:4863-4868. [PMID: 35127241 PMCID: PMC8812479 DOI: 10.19102/icrm.2022.130105] [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: 04/04/2021] [Accepted: 06/09/2021] [Indexed: 11/06/2022] Open
Abstract
Here, we describe the first reported case of pulmonary vein, posterior wall, and left atrial appendage (LAA) isolation with concomitant ablation of a mitral isthmus flutter using the cryoballoon, guided by intracardiac echocardiography (ICE)-integrated 3-dimensional mapping in a patient with long-standing persistent atrial fibrillation and intolerance to long-term oral anticoagulation, followed by ICE-guided LAA closure using an endocardial occlusion device. This report illustrates the safety and feasibility of this combined approach. Additionally, it advocates for empiric LAA isolation prior to LAA occlusion, as LAA ablation/isolation can prove challenging in those with existing endocardial LAA occlusion devices should they require subsequent ablations to target arrhythmias or triggers arising from this structure.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
| | - Paula Lafortune
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
| | - Luigi Di Biase
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX, USA
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Kimura M, Kobori A, Nitta J, Hirao K, Shizuta S, Kurita T, Okishige K, Kumagai K, Koyama J, Hiroshima K, Inaba O, Goya M, Yamauchi Y, Kueffer FJ, Becker D, Okumura K. Cryoballoon ablation for paroxysmal atrial fibrillation in Japan: 2-year safety and efficacy results from the Cryo AF Global Registry. J Interv Card Electrophysiol 2022; 64:695-703. [PMID: 35119586 PMCID: PMC9470593 DOI: 10.1007/s10840-022-01132-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/17/2022] [Indexed: 11/24/2022]
Abstract
Purpose Catheter ablation is a recommended rhythm control therapy after failed or intolerant antiarrhythmic drug (AAD) treatment for patients with atrial fibrillation (AF). This study evaluates clinical performance and safety of pulmonary vein isolation (PVI) using the cryoballoon (Arctic Front Advance) in Japan. Methods Cryo AF Global Registry is a prospective, multi-center registry. Patients with paroxysmal AF (PAF) were treated at 10 Japanese hospitals. Efficacy was evaluated by freedom from a ≥ 30-s recurrence of AF/atrial flutter (AFL)/atrial tachycardia (AT), AF-related symptoms, and quality of life using the EQ-5D-3L questionnaire. The safety endpoint was serious device- and procedure-related adverse events. Results The study included 352 patients with PAF (65 ± 10 years of age, 36% female, 36% without prior failure of AAD). Mean duration since first diagnosis of AF was 3.0 ± 5.5 years. Serious device- and procedure-related adverse event rate was 2.6% (95% CI: 1.2–4.8%). Freedom from AF/AFL/AT was 88.5% (95% CI: 84.7–91.4%) at 12 months and 86.7% (95% CI: 81.1–90.8%) at 24 months. The number of patients with ≥ 1 AF symptom was significantly decreased from 88% at enrollment to 22% (p < 0.01) at 12-month follow-up. General quality of life using EQ-5D did not improve significantly after 12 months in the summary score. However, in the visual analog scale score, there was improvement (5.8 ± 18.4; p < 0.01). Conclusions This study demonstrates that cryoablation used for PVI is a safe and effective treatment in real-world use for patients with PAF in Japan. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01132-0.
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Affiliation(s)
| | | | | | - Kenzo Hirao
- Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | | | | | | | | | - Masahiko Goya
- Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan
| | | | | | | | - Ken Okumura
- Saiseikai Kumamoto Hospital, Kumamoto, Japan
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Martin A, Fowler M, Breskovic T, Ouss A, Dekker L, Yap SC, Bhagwandien R, Albrecht EM, Cielen N, Richards E, Tran BC, Lever N, Anic A. Novel cryoballoon to isolate pulmonary veins in patients with paroxysmal atrial fibrillation: long-term outcomes in a multicentre clinical study. J Interv Card Electrophysiol 2022; 65:609-616. [PMID: 35412168 PMCID: PMC9726810 DOI: 10.1007/s10840-022-01200-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/23/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND Recently, a novel cryoballoon ablation catheter has demonstrated acute safety and efficacy in de novo pulmonary vein isolation (PVI) procedures in patients with paroxysmal atrial fibrillation (PAF). However, there are limited studies demonstrating the long-term efficacy. The aim of this study was to evaluate the long-term safety and efficacy of this novel cryoballoon in treating PAF. METHODS This was a non-randomized, prospective, multicentre study enrolling 58 consecutive patients. Cryoablation was delivered for 180 s if time to isolation was ≤ 60 s. Otherwise a 240-s cryoablation was performed. One centre performed pre- and post-ablation high-density mapping (n = 9) to characterize lesion formation. After a 3-month blanking period, recurrence was defined as having any documented, symptomatic episode(s) of AF or atrial tachycardia. All patients were followed for 1 year. RESULTS Acute PVI was achieved in 230 of 231 pulmonary veins (99.6%) with 5.3 ± 1.6 cryoablations per patient (1.3 ± 0.7 cryoablations per vein). Forty-three (77%) patients remained arrhythmia-free at 1-year follow-up. Four patients (6.9%) experienced phrenic nerve injury (3 resolved during the index procedure; 1 resolved at 6 months). One serious adverse device event was reported: femoral arterial embolism event occurring 2 weeks post-index procedure. For patients who underwent high-density mapping, cryoablation was antral with 50% of the posterior wall ablated. CONCLUSIONS Initial multicentre clinical experience with a novel cryoballoon has demonstrated safety and efficacy of PVI in patients with PAF. Ablation with this cryoballoon provides a wide, antral lesion set with significant debulking of the posterior wall of the left atrium.
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Affiliation(s)
- Andrew Martin
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Marina Fowler
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Toni Breskovic
- grid.412721.30000 0004 0366 9017University Hospital Center Split, Split, Croatia
| | - Alexandre Ouss
- grid.413532.20000 0004 0398 8384Catharina Hospital, Eindhoven, Netherlands
| | - Lukas Dekker
- grid.413532.20000 0004 0398 8384Catharina Hospital, Eindhoven, Netherlands
| | - Sing-Chien Yap
- grid.5645.2000000040459992XErasmus MC, Rotterdam, Netherlands
| | | | - Elizabeth M. Albrecht
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Nele Cielen
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Elizabeth Richards
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Binh C. Tran
- grid.418905.10000 0004 0437 5539Boston Scientific Corp., Electrophysiology, St. Paul, MN USA
| | - Nigel Lever
- grid.414055.10000 0000 9027 2851Green Lane Cardiovascular Services, Auckland Mail Centre, Auckland City Hospital, Private Bag 92 189, Auckland, 1142 New Zealand
| | - Ante Anic
- grid.412721.30000 0004 0366 9017University Hospital Center Split, Split, Croatia
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Key characteristics for effective acute pulmonary vein isolation when using a novel cryoballoon technology: insights from the CHARISMA registry. J Interv Card Electrophysiol 2021; 64:641-648. [PMID: 34853986 DOI: 10.1007/s10840-021-01063-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE A new cryoballoon (CB) technology (POLARx™; Boston Scientific) for pulmonary vein (PV) isolation in patients with atrial fibrillation (AF) has recently been introduced. The aim of this study was to evaluate procedural and biophysical parameters resulting in acute PV isolation when using this new CB. METHODS We assessed the first 69 consecutive patients indicated for AF ablation who underwent PV isolation by means of a novel CB system. Procedural metrics were prospectively recorded. RESULTS A total of 274 PVs were targeted in 69 patients. PV isolation was achieved in all patients by means of cryoablation alone. The median time to isolation (TTI) was 44 [31-68] s (median temperature at TTI = - 49 [- 53 to - 41] °C). The median duration of CB ablation was 180 [180 to 240] s. The median nadir temperature was - 56.0 [- 61 to - 52] °C, and the median thaw time to 0 °C was 18 [15-21] s. The median grade of PV occlusion was 4 [3 to 4]. On the basis of ROC analysis, we defined the following cut-off values for acute PV isolation: - 56 °C for nadir temperature (sensitivity = 73.3%, specificity = 64.6%, AUC = 0.716; positive predictive value = 88.1%), 30 s for TTT (60.2%, 53.3%, 0.578; 79.7%), thaw time > 17 s (65.3%, 70.0%, 0.709; 86.9%), and grade of PV occlusion = 4 (79.4%, 66.7%, 0.738; 88.5%). No major procedure-related adverse events were observed at 30-day post-procedure. CONCLUSIONS The new POLARx™ CB appears to be effective and safe. A nadir temperature of - 56 °C, a thaw time to 0 °C ≥ 17 s, and complete PV occlusion were the best predictors of acute PV isolation. CLINICAL TRIAL REGISTRATION Catheter Ablation of Arrhythmias with a High-Density Mapping System in Real-World Practice (CHARISMA). URL: http://clinicaltrials.gov/Identifier : NCT03793998. Registration date: January 4, 2019.
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Mulder BA, Al-Jazairi MIH, Magni FT, Groenveld HF, Tieleman RG, Wiesfeld ACP, Tan YES, Van Gelder IC, Rienstra M, Blaauw Y. Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures. Open Heart 2021; 8:e001718. [PMID: 34949648 PMCID: PMC8705215 DOI: 10.1136/openhrt-2021-001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/29/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures. METHODS AND RESULTS We included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74. CONCLUSIONS Using a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.
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Affiliation(s)
- Bart A Mulder
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Meelad I H Al-Jazairi
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Federico T Magni
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Hessel F Groenveld
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Robert G Tieleman
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Ans C P Wiesfeld
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yong E S Tan
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Isabelle C Van Gelder
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
- Thorax Center, Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands
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van Deutekom C, Mulder BA, Groenveld HF, Tieleman RG, Wiesfeld ACP, Tan ES, van Gelder IC, Rienstra M, Blaauw Y. Heart rate increase and inappropriate sinus tachycardia after cryoballoon pulmonary vein isolation for atrial fibrillation. Neth Heart J 2021; 30:282-288. [PMID: 34762282 PMCID: PMC9043054 DOI: 10.1007/s12471-021-01645-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cryoballoon pulmonary vein isolation (PVI) is a common therapy for atrial fibrillation (AF). While moderately increased sinus rhythm heart rate (HR) after PVI has been observed, inappropriate sinus tachycardia (IST) is a rare phenomenon. We aimed to investigate the prevalence and natural history of an abnormal sinus HR response after cryoballoon PVI. METHODS We included 169/646 (26.2%) patients with AF undergoing PVI with available Holter recordings before and 3, 6 and 12 months after the procedure. Patients with AF on Holter monitoring were excluded. Mean HR increase ≥ 20 bpm or an IST-like pattern (mean HR > 90 bpm or > 80 bpm when beta-blocking agents were used) following PVI was categorised as abnormal sinus HR response. RESULTS Following PVI, mean HR ± standard deviation increased in the entire group from 63.5 ± 8.4 to 69.1 ± 9.9 bpm at 3 months (p < 0.001), and to 71.9 ± 9.4 bpm at 6 months (p < 0.001). At 12 months, mean HR was 71.2 ± 10.1 bpm (p < 0.001). Only 7/169 patients (4.1%) met criteria for abnormal sinus HR response: mean HR was 61.9 ± 10.6 bpm (pre-ablation), 84.6 ± 9.8 bpm (3 months), 80.1 ± 6.5 bpm (6 months) and 76.3 ± 10.1 bpm (12 months). Even at 12 months, mean HR was significantly different from that pre-ablation in this group (p = 0.033). However, in patients meeting IST-like pattern criteria, mean HR at 12 months was no longer significantly different from that pre-ablation. CONCLUSION Few patients had an abnormal sinus HR response after PVI. Peak HR was observed 3 months after PVI, but HR was still significantly increased 12 months post-ablation compared with pre-ablation. An IST-like pattern was rarely observed. In these patients, HR decreased to pre-ablation values within a year.
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Affiliation(s)
- C van Deutekom
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - B A Mulder
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - H F Groenveld
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - R G Tieleman
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - A C P Wiesfeld
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - E S Tan
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - I C van Gelder
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - M Rienstra
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Y Blaauw
- Department of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
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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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Liu G, Wang Y, Xu X, Tian J, Lv T. Comparison for the efficacy and safety of time-to-isolation protocol and conventional protocol of cryoballoon in the treatment of atrial fibrillation: a meta-analysis and systematic review. J Interv Card Electrophysiol 2021; 62:259-268. [PMID: 33033904 DOI: 10.1007/s10840-020-00890-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cryoballoon (CB) has been widely utilized in the treatment of drug-refractory atrial fibrillation (AF), but the balance point between efficacy and safety has been unclear. The protocol based on the time-to-isolation (TTI) was expected to provide patients with individualized ablation strategies. METHODS All studies up to June 2020 comparing the CB of TTI-based protocol (TTIP) and conventional protocol (ConP) in PubMed, Embase, and Cochrane Library databases were searched. The pooled OR or SMD with 95% CIs for each outcome were calculated with inverse-variance random effect model. The Egger method was used to evaluate the publication bias and the subgroup analysis was conducted according to the type of atrial fibrillation. RESULTS Six studies enrolling a total of 1770 patients with drug-refractory AF were included. The pool real-time recording of pulmonary veins potential was 71% (95% CI: 61 ~ 81%, I2 = 97.9%) and a similar incidence of freedom from ATs after 1 year (OR: 1.12; 95% CI: 0.86 ~ 1.46, I2 = 0.0%, P = 0.481) was observed between two protocols. No difference was observed in complications (OR: 0.67; 95% CI: 0.43 ~ 1.04, I2 = 0.0%, P = 0.717) and phrenic nerve palsy (OR: 0.70; 95% CI: 0.37 ~ 1.35, I2 = 0.0%, P = 0.807). TTIP could significantly decrease the CB freezes per patient (SMD: - 2.44; 95% CI: - 4.46 to approximately - 0.41; I2 = 99.5%, P = 0.00) and shorten the cryotherapy application time (SMD: - 3.04; 95% CI: - 4.18 to approximately - 1.89; I2 = 97.4%, P = 0.00), procedure time (SMD: - 1.51; 95% CI: - 2.08 to approximately - 0.94; I2 = 95.4%, P = 0.00), and fluorescence time (SMD: - 0.70; 95% CI: - 1.25 to approximately - 0.15; I2 = 95.7%, P = 0.00). CONCLUSION TTIP is safe and effective and it opens a new chapter in the field of individualized protocol of CB for patients with AF.
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Affiliation(s)
- Guolin Liu
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - YuanLi Wang
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Xin Xu
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Jie Tian
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Tiewei Lv
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Makino Y, Mizutani Y, Yamashita D, Yonekawa J, Satake A, Kurobe M, Hiramatsu T, Ichimiya H, Uchida Y, Watanabe J, Kanashiro M, Ichimiya S, Yanagisawa S, Inden Y, Murohara T. Cryoballoon ablation for atrial fibrillation without the use of a contrast medium: a combination of the intracardiac echocardiography and pressure wave monitoring guided approach. Heart Vessels 2021; 37:765-774. [PMID: 34636968 DOI: 10.1007/s00380-021-01963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/08/2021] [Indexed: 12/01/2022]
Abstract
In cryoballoon ablation (CBA), a contrast medium is commonly used to confirm balloon occlusion of the pulmonary veins (PVs). However, a contrast medium cannot always be used in patients with renal dysfunction and allergy. The present study aimed to assess the efficacy and safety of CBA without the use of a contrast medium. We retrospectively examined consecutive patients with paroxysmal atrial fibrillation (PAF) who underwent first-time CBA. We compared the procedural results and outcomes in patients for whom a contrast medium was used (contrast group) and those from whom a contrast medium was not used (non-contrast group). In the non-contrast group, we used saline injection on the intracardiac echocardiography and pressure wave monitoring for PV occlusion. Fifty patients (200 PVs) and 22 patients (88 PVs) underwent CBA with and without a contrast medium, respectively. The success rate of PV isolation with CBA alone was 93% and 90% in the non-contrast and contrast groups, respectively (p = 0.40). The fluoroscopy time and nadir temperature were significantly lower in the non-contrast group as compared to that in the contrast group. The recurrence rate 1 year after ablation did not differ between the two groups (18% vs. 18%, p > 0.99). Furthermore, the number of reconnected PVs in patients with recurrence was significantly lower in the non-contrast group than in the contrast group (6% vs. 36%, p = 0.017). In conclusion, CBA using the intracardiac echocardiography and pressure monitoring approach without the use of a contrast medium was safe and efficient.
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Affiliation(s)
- Yuichiro Makino
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan.
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Daiki Yamashita
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Jun Yonekawa
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Akinori Satake
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Masanari Kurobe
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Takatsugu Hiramatsu
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Hitoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Yasuhiro Uchida
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Junji Watanabe
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Satoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, 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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Reddy VY, Al-Ahmad A, Aidietis A, Daly M, Melton I, Hu Y, Sulkin M, Rackauskas G, Ebner A, Hooks DA, Sofi A, Neužil P, Crozier IG. A Novel Visually Guided Radiofrequency Balloon Ablation Catheter for Pulmonary Vein Isolation: One-Year Outcomes of the Multicenter AF-FICIENT I Trial. Circ Arrhythm Electrophysiol 2021; 14:e009308. [PMID: 34583521 DOI: 10.1161/circep.120.009308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Vivek Y Reddy
- Department of Cardiology, Homolka Hospital, Prague, Czechia (V.Y.R., P.N.).,Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., A.S.)
| | - Amin Al-Ahmad
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin (A.A.-A.)
| | - Audrius Aidietis
- Centre for Cardiology and Angiology, Vilnius University, Lithuania (A.A., G.R.)
| | - Matthew Daly
- Department of Cardiology, Christchurch Hospital, New Zealand (M.D., I.M., I.G.C.)
| | - Iain Melton
- Department of Cardiology, Christchurch Hospital, New Zealand (M.D., I.M., I.G.C.)
| | - Yan Hu
- Boston Scientific Corp., Electrophysiology, St. Paul, MN (Y.H., M.S.)
| | - Matthew Sulkin
- Boston Scientific Corp., Electrophysiology, St. Paul, MN (Y.H., M.S.)
| | | | - Adrian Ebner
- Cardiovascular Department, Sanatorio Italiano, Asunción, Paraguay (A.E.)
| | - Darren A Hooks
- Department of Cardiology, Wellington Hospital, New Zealand (D.A.H.)
| | - Aamir Sofi
- Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, NY (V.Y.R., A.S.)
| | - Petr Neužil
- Department of Cardiology, Homolka Hospital, Prague, Czechia (V.Y.R., P.N.)
| | - Ian G Crozier
- Department of Cardiology, Christchurch Hospital, New Zealand (M.D., I.M., I.G.C.)
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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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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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Benali K, Da Costa A, Macle L, Hammache N, Galand V, Romeyer C, Guichard JB, Leclercq C, Pavin D, Martins R. Distance between the descending aorta and the left inferior pulmonary vein as a determinant of biophysical parameters during paroxysmal atrial fibrillation cryoablation. J Cardiovasc Electrophysiol 2021; 32:2943-2952. [PMID: 34455655 DOI: 10.1111/jce.15234] [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: 05/25/2021] [Revised: 08/09/2021] [Accepted: 08/24/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The distance from the descending aorta (DA) to the posterior wall of the left atrium (LA) is variable. We aimed to determine whether the proximity between the DA and the left inferior pulmonary vein (LIPV) ostium has an impact on biophysical parameters and cryoballoon (CB) ablation efficacy during LIPV freezing. METHODS Patients referred for CB-ablation of atrial fibrillation (AF) in two high-volume centers were included. Cryoablation data were collected prospectively for each patient. The anatomical relationships between the LIPV and the DA (distance LIPV ostium-DA, presence of an aortic imprint on the posterior aspect of the LIPV) were then retrospectively analysed on the LA computed tomography scans realized before AF ablation. RESULTS A total of 350 patients were included (70% men, 59.7 ± 11.5 years). The decrease in the Ostium-DA distance was significantly correlated to the increase in the time-to-isolation (TTI) (r = -.31; p = .036), with less negative temperature (r = -.11; p = .045). Similarly, the presence of an aortic imprint on the LIPV was associated with a longer TTI (p < .001). The analysis of redo procedures data shows a trend toward the presence of shorter ostium-DA distances (15.3 ± 3.29 vs. 18.1 ± 4.99, p = .15) and more frequent aortic imprints (63.6% vs. 47.5%, p = .34) in patients with LIPV reconnection as opposed to patients without reconnection in the LIPV. CONCLUSION Our findings indicated that the DA seems to have a "radiator" effect influencing LIPV cryoablation parameters during CB-ablation. Additional studies will be needed to elucidate whether this biophysical influence has a clinical impact in LIPVs reconnections.
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Affiliation(s)
- Karim Benali
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France.,University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France
| | - Antoine Da Costa
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Montreal, Canada
| | - Nefissa Hammache
- University of Nancy, CHU Nancy, INSERM-IADI, U947, Vandœuvre lès-Nancy, France.,Department of Cardiology, Nancy University Hospital, Vandœuvre lès-Nancy, France
| | - Vincent Galand
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Cécile Romeyer
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | - Jean Baptiste Guichard
- Department of Cardiology, Saint-Etienne University Hospital, Saint-Priest-En-Jarez, France
| | | | - Dominique Pavin
- Department of Cardiology, Rennes University Hospital, Rennes, France
| | - Raphaël Martins
- Department of Cardiology, Rennes University Hospital, Rennes, France.,University of Rennes, CHU Rennes, INSERM-LTSI, U1099, Rennes, France
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Ferrero-De-Loma-Osorio Á, Cózar R, García-Alberola A, Valles E, Barrera A, Toquero J, Ormaetxe JM, Sánchez JM, Ruiz-Granell R, Amador PB, Rubio JM, Martí-Amor J, Pascual P, Molina I, Martínez-Alday JD. Primary results of the Spanish Cryoballoon Ablation Registry: acute and long-term outcomes of the RECABA study. Sci Rep 2021; 11:17268. [PMID: 34446764 PMCID: PMC8390492 DOI: 10.1038/s41598-021-96655-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Cryoablation is safe and effective for the treatment of atrial fibrillation (AF) in controlled clinical trials, but contemporary real-world usage and outcomes are limited. The Report of the Spanish Cryoballoon Ablation Registry (RECABA) was designed to evaluate acute and 12-month outcomes of cryoballoon ablation for the treatment of AF in Spain. Patients from 27 Spanish centers were prospectively enrolled. Patients were treated with cryoballoon ablation and managed according to standard of care protocols at each center. The primary endpoint was ≥ 30 s freedom from AF at 12-month after a 3-month blanking period. Secondary endpoints included a description of patient characteristics, cryoablation procedural strategy and safety, and predictors of efficacy. In total, 1742 patients (71.4% PAF, 68.8% male, mean age 58.02 ± 10.40 years, 76.1% overweight or obese, CHA2DS2-VASc index 1.40 ± 1.28) were enrolled. Patients received 7.2 ± 2.67 cryo-applications. PV potentials could be detected in 61% of the PVs during ablation, with a mean time to block of 52.9 ± 37.02 s. Acute PVI was observed in 97% of PVs with 75.8% isolated with the first cryo-application. Mean procedural time was 113 ± 41 min. Acute complications occurred in 4.4% of the cases. With follow-up in 1628 patients, AF-free survival was 78.5% (PAF: 80.6% vs PersAF 73.3%; p < 0.001). Left atrium enlargement, female sex, non-PAF, and early recurrence were independent predictors of AF recurrence (p < 0.05). RECABA provides detailed insight into current dosing practices and demonstrates cryoablation is safe and effective in real-world use.ClinicalTrials.gov number: NCT02785991.
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Affiliation(s)
- Ángel Ferrero-De-Loma-Osorio
- Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario, INCLIVA Foundation, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain.
| | - Rocío Cózar
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Arcadio García-Alberola
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Ermengol Valles
- Arrhythmia Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Alberto Barrera
- Arrhythmia Unit, Cardiology Department Hospital Virgen de la Victoria Málaga, Málaga, Spain
| | - Jorge Toquero
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Juan Martínez Sánchez
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Ricardo Ruiz-Granell
- Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario, INCLIVA Foundation, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Pablo Bastos Amador
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jose Manuel Rubio
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Julio Martí-Amor
- Arrhythmia Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain
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Bordignon S, Chen S, Bologna F, Thohoku S, Urbanek L, Willems F, Zanchi S, Bianchini L, Trolese L, Konstantinou A, Fuernkranz A, Schmidt B, Chun JKR. Optimizing cryoballoon pulmonary vein isolation: lessons from >1000 procedures- the Frankfurt approach. Europace 2021; 23:868-877. [PMID: 33458770 DOI: 10.1093/europace/euaa406] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted ablation strategy for rhythm control in atrial fibrillation (AF). We describe efficacy and safety in a high volume centre with a long experience in the use of the second-generation CB (CB2). METHODS AND RESULTS Consecutive paroxysmal AF (PAF) or persistent AF (persAF) patients undergoing CB2-PVI were enrolled. Procedural data, efficacy, and safety issues were systematically collected. The 28 mm CB2 was used in combination with an inner lumen spiral catheter, a luminal oesophageal temperature (LET) probe was used with a cut-off of 15°C, the phrenic nerve (PN) monitored during septal PVs ablation. Freeze duration was mainly set at 240 s with a bonus application in case of delayed time-to-isolation (TTI > 75 s). A total of 1017 CB2 procedures were analysed (58% male, 66 ± 12 years old, 70% with PAF). 3964 PVs were identified, 99.8% PVs isolated using solely the 28 mm CB. Mean procedure time was 69 ± 25 min, TTI during the first application was recorded in 77% of PVs after a mean of 48 ± 31 s. We recorded 0.2% cardiac tamponade, 4.8% PN injury (1.6% of PN palsy), and 19% of LET < 15°C. Among 725 patients with follow-up data, 84% with PAF and 75% with persAF were in stable SR at 1 year. Shorter freezing duration and longer TTI were procedural predictors for recurrence. CONCLUSION Cryoballoon procedures are fast and associated with a benign safety profile. Shorter TTI and longer freeze durations are associated with sinus rhythm during follow-up.
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Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Shota Thohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Franziska Willems
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | | | | | - Luca Trolese
- Herzzentrum Uniklinik Freiburg, Freiburg, Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
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Aryana A. Rationale and Outcomes of Cryoballoon Ablation of the Left Atrial Posterior Wall in Conjunction with Pulmonary Vein Isolation. J Innov Card Rhythm Manag 2021; 12:4633-4646. [PMID: 34476116 PMCID: PMC8384303 DOI: 10.19102/icrm.2021.120801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
There is strong evidence in support of pulmonary vein isolation (PVI) with concomitant left atrial (LA) posterior wall (PW) isolation (PWI) for the treatment of patients with persistent atrial fibrillation (persAF). While this may be achieved using surgical and catheter-based strategies, there is growing interest in performing this approach using the cryoballoon. There are several potential advantages to this strategy. First, lesions created using the current-generation cryoballoons are typically large and durable. Second, cryoballoon ablation offers a simple technique to directly ablate and debulk the LAPW. Moreover, some consider cryoenergy a safer modality specifically with regard to collateral structures (ie, the esophagus). Based on the available data, cryoballoon PVI + PWI is associated with greater intraprocedural AF terminations and reductions in long-term AF recurrence (typically by ~20%), as compared to PVI alone in patients with persAF, but with similar rates of adverse events. As such, PVI + PWI has emerged as a significant predictor of freedom from recurrent AF (odds ratio: 3.67, 95% confidence interval: 1.44-9.34; p = 0.006) as well as all atrial arrhythmias (hazard ratio: 2.04, 95% confidence interval: 1.15-3.61; p = 0.015). Adjunct radiofrequency ablation to complete PWI is required in at least one-third of the patients, and this need is highly predicted by the LA size (significantly increased with an LA diameter > 48 mm). LAPW reconnection also seems to be associated with LA dimension, particularly an LA diameter greater than 48 mm (negative predictive value: 89.7%). Nevertheless, based on the analysis of patients who underwent repeat electrophysiology study for arrhythmia recurrences, cryoballoon PVI + PWI yields acceptable long-term durability (> 80%).
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Affiliation(s)
- Arash Aryana
- Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
- Cardiac Catheterization Laboratory, Mercy General Hospital, Sacramento, CA, USA
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The impact of electrical connections between left ipsilateral pulmonary veins on the time-to-isolation values in cryoballoon ablation. J Interv Card Electrophysiol 2021; 64:581-586. [PMID: 34292463 DOI: 10.1007/s10840-021-01034-7] [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: 05/06/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The time-to-isolation (TTI) may be a physiological predictor of durable isolations, and TTI-guided dosing strategies are widely performed in cryoballoon ablation. We sought to investigate the impact of the order of targeting the pulmonary veins (PVs) on the TTI values of left ipsilateral PVs. METHODS This study included 144 atrial fibrillation patients who underwent PV isolations using 28-mm fourth-generation cryoballoons. In 101 patients, the left superior PV (LSPV) was targeted and followed by the left inferior PV (LIPV) (group 1), and the LIPV was targeted and followed by the LSPV in the remaining 43 (group 2). RESULTS The total LSPV and LIPV freeze durations were 193 ± 60 and 171 ± 40 s, respectively. Real-time PV isolation monitoring was capable in 137 (95.1%) LSPVs and 119 (82.6%) LIPVs and in 112 (77.8%) patients (78 in group 1 and 34 in group 2) in both LSPVs and LIPVs. Among them, the LSPV TTI was significantly longer in group 1 than that in group 2 (54.8 ± 32.1 vs. 34.1 ± 17.3 s, p < 0.0001), while the LIPV TTI was significantly shorter in group 1 than that in group 2 (23.7 ± 11.8 vs. 39.2 ± 19.4 s, p < 0.0001). The ΔTTI ((TTI in LSPV)-(TTI in LIPV)) was significantly greater in group 1 than that in group 2 (31.1 ± 31.4 vs. - 5.0 ± 25.9 s, p < 0.0001). In 5 patients (3 in group 1 and 2 in group 2), initially targeted left PVs were not isolated despite complete vein occlusions, while they were by subsequent applications at the other ipsilateral PVs. CONCLUSIONS In CB ablation, the order of targeting PVs highly influenced the TTI of the left PVs owing to the presence of electrical connections between left ipsilateral PVs.
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Farkowski MM, Karlinski M, Barra S, Providencia R, Golicki D, Pytkowski M, Anic A, Chun JKR, de Asmundis C, Lane DA, Boveda S. Effectiveness and safety of a single freeze strategy of cryoballoon ablation of atrial fibrillation: an EHRA systematic review and meta-analysis. Europace 2021; 24:58-69. [PMID: 34297839 DOI: 10.1093/europace/euab133] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/01/2021] [Indexed: 12/25/2022] Open
Abstract
To conduct a systematic review and meta-analysis to compare the effectiveness and safety of cryoballoon ablation of atrial fibrillation (AF) performed using a single freeze strategy in comparison to an empiric double ('bonus') freeze strategy. We systematically searched MEDLINE, EMBASE, and CENTRAL databases from inception to 12 July 2020, for prospective and retrospective studies of patients undergoing cryoballoon for paroxysmal or persistent AF comparing a single vs. bonus freeze strategy. The main outcome was atrial arrhythmia-free survival and eligible studies required at least 12 months of follow-up; the primary safety outcome was a composite of all complications. Study quality was assessed using the Cochrane risk of bias tool and the Newcastle-Ottawa Scale. Thirteen studies (3 randomized controlled trials and 10 observational studies) comprising 3163 patients were eligible for inclusion (64% males, 71.5% paroxysmal AF, mean CHA2DS2-VASc score 1.3 ± 0.9). There was no significant difference in pooled effectiveness between single freeze strategy compared to double freeze strategy [relative risk (RR) 1.03; 95% confidence interval (CI): 0.98-1.07; I2 = 0%]. Single freeze procedures were associated with a significantly lower adverse event rate (RR 0.72; 95% CI: 0.53-0.98; I2 = 0%) and shorter average procedure time (90 ± 27 min vs. 121 ± 36 min, P < 0.001). A trend for lower risk of persistent phrenic nerve palsy was observed (RR 0.61; 95% CI: 0.37-1.01; I2 = 0%). The quality of included studies was moderate/good, with no evidence of significant publication bias. Single freeze strategy for cryoballoon of AF is as effective as an empiric double ('bonus') freeze strategy while appearing safer and probably quicker (PROSPERO registration number CRD42020158696).
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Affiliation(s)
- Michal Miroslaw Farkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Michal Karlinski
- 2nd Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - Sergio Barra
- Cardiology Department, Hospital da Luz Arrabida, V. N. Gaia, Portugal
- Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Rui Providencia
- St Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, London, UK
- Institute of Health Informatics, University College of London, London, UK
| | - Dominik Golicki
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Pytkowski
- 2nd Department of Heart Arrhythmia, National Institute of Cardiology, Alpejska 42, 04-628 Warsaw, Poland
| | - Ante Anic
- Department for Cardiovascular Diseases, University Hospital Split, Split, Croatia
| | - Julian Kyoung Ryul Chun
- CCB Frankfurt/Med. Klinik III, Markuskrankenhaus, Frankfurt am Main, Germany
- Med. Klinik II, Universtätsklinikum Schleswig Holstein, Campus Lübeck, Germany
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Deirdre Anne Lane
- Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, UK
- Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
- Heart Rhythm Management Department, Clinique Pasteur, Toulouse, France
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Moore JP, Gallotti R, Su J, Nguyen HL, Bedayat A, Prosper A, Buch E. Pulmonary vein and left atrial posterior wall isolation for the treatment of atrial fibrillation: Comparable outcomes for adults with congenital heart disease. J Cardiovasc Electrophysiol 2021; 32:1868-1876. [PMID: 33821546 DOI: 10.1111/jce.15027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/18/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Optimal treatment strategies for ACHD with AF are unknown. This study sought to assess outcomes of pulmonary vein isolation (PVI) ± left atrial (LA), posterior wall isolation (PWI) for adults with congenital heart disease (ACHD), and atrial fibrillation (AF). METHODS A retrospective review of all cryoballoon (CB) PVI ± PWI procedures at a single center over a 3-year period were performed. Clinical characteristics and outcomes for patients with and without ACHD were compared. The primary outcome was the occurrence of atrial tachyarrhythmia at 12-months postablation after a 90-day blanking period. RESULTS Three-hundred and sixteen patients (mean: 63 ± 12 years, [63% male]) underwent CB PVI ± PWI during the study, including 31 (10%) ACHD (simple 35%, moderate 39% complex 26%; nonparoxysmal AF in 52%). ACHD was younger (51 vs. 64 years; p < .001) with a lower CHADS2 DS2 -VASc score (1.2 vs. 2.1; p = .001) but had a greater LA diameter (4.9 vs. 4.0 cm; p < .001) and a number of prior cardioversions (0.9 vs. 0.4; p < .001) versus controls. 12-month freedom from recurrent AF was similar for ACHD and controls (76% vs. 80%; p = .6) and remained nonsignificant in multivariate analysis (hazard ratio: 1.8, 95% confidence interval: 0.7-5.1; p = .22). At 12-months postablation, 75% of ACHD versus 93% of control patients were off antiarrhythmic drug therapy (p = .07). CONCLUSION This study demonstrates younger age and lower conventional stroke risk, yet clinically advanced AF for ACHD relative to controls. CB PVI ± PWI was an effective strategy for the treatment of AF among all forms of ACHD with similar 12-month outcomes as compared to controls.
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Affiliation(s)
- Jeremy P Moore
- Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, Los Angeles, California, USA.,UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - Roberto Gallotti
- Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine, Los Angeles, California, USA.,UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - Jonathan Su
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, California, USA
| | - Heajung L Nguyen
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California, USA
| | - Arash Bedayat
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Ashley Prosper
- Department of Radiological Sciences, Thoracic and Diagnostic Cardiovascular Imaging, David Geffen School of Medicine, UCLA, Los Angeles, California, USA
| | - Eric Buch
- UCLA Cardiac Arrhythmia Center, David Geffen School of Medicine, Los Angeles, California, USA
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Anic A, Lever N, Martin A, Breskovic T, Sulkin MS, Duffy E, Saliba WI, Niebauer MJ, Wazni OM, Varma N. Acute safety, efficacy, and advantages of a novel cryoballoon ablation system for pulmonary vein isolation in patients with paroxysmal atrial fibrillation: initial clinical experience. Europace 2021; 23:1237-1243. [PMID: 33729470 PMCID: PMC8350865 DOI: 10.1093/europace/euab018] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Cryoballoon pulmonary vein isolation (PVI) is a safe and effective treatment for atrial fibrillation (AF). Current limitations include incomplete vein occlusion due to balloon rigidity and inconsistent electrogram recording, which impairs identification of isolation. We aimed to evaluate the acute safety and performance of a novel cryoballoon system. METHODS AND RESULTS The system includes a steerable sheath, mapping catheter, and a balloon that maintains uniform inflation pressure and size following initiation of ablation. Protocol-directed cryoablation was delivered for 180 s for isolation documented in ≤60 s, otherwise freeze duration was 240 s. Primary endpoints were acute safety and vein isolation. Pulmonary vein isolation was confirmed at ≥30 min post-isolation. Data were compared across vein locations. Thirty patients with paroxysmal AF were enrolled at two centres and underwent PVI. Pulmonary vein isolation was achieved with cryoablation only in 100% of veins (120/120). Nadir temperature was -53.1 ± 5.3°C. The number of applications to achieve PVI was 1.4 ± 0.4 per vein. Of the 120 veins, 89 were isolated with a single cryothermal application (10/30 patients required only 4 total cryoablations). There were no procedural- or device-related serious adverse events at 30 days post-procedure. A subset (24/30) of patients was followed for 1-year and 71% (17/24) remained free of atrial arrhythmias. Six patients with arrhythmia recurrence were remapped and three had durable PVI for all four veins. CONCLUSION In this first human experience, the novel cryoballoon platform was safe, efficacious, and demonstrated a high proportion of successful single ablation isolation.
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Affiliation(s)
- Ante Anic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | - Nigel Lever
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Martin
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Toni Breskovic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | | | - Elizabeth Duffy
- Electrophysiology, Boston Scientific Corp., St. Paul, MN, USA
| | - Walid I Saliba
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Mark J Niebauer
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Oussama M Wazni
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Niraj Varma
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
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Methods to Optimize Cryoballoon Ablation for Atrial Fibrillation to Minimize Risk of Adverse Outcomes and Arrhythmia Recurrences. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Alyesh D, Venkataraman G, Stucky A, Joyner J, Choe W, Sundaram S. Acute Safety and Efficacy of Fluoroless Cryoballoon Ablation for Atrial Fibrillation. J Innov Card Rhythm Manag 2021; 12:4413-4420. [PMID: 33654573 PMCID: PMC7906563 DOI: 10.19102/icrm.2021.120205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/12/2020] [Indexed: 01/04/2023] Open
Abstract
Pulmonary vein isolation (PVI) is widely used for the ablation of atrial fibrillation, with prior reports suggesting good efficacy. Due to the widespread use of three-dimensional electroanatomic mapping systems and advances in intracardiac echocardiography, fluoroless ablation has been made possible. Fluoroless ablation with a cryoballoon (CB), however, has not been widely performed because of the need to prove occlusion of the vein with contrast dye and fluoroscopy. The objective of this study is to show that CB ablation can be performed safely and effectively without fluoroscopy. A dual-center, case–control study was performed of patients undergoing CB PVI with a fluoroless approach and a control group with traditional fluoroscopic techniques. The absence of color-flow Doppler signals around the periphery of the CB on intracardiac echocardiography and an increase in mean pressure by 5 mmHg, loss of the A-wave, and an increase in the V-wave as measured with continuous-wave pressure monitoring were adopted as indicators of vein occlusion in the absence of fluoroscopy. Temperature at 30 seconds, minimum temperature, time to isolation, procedure length, and complications were evaluated. During the study period of November 15, 2018 to November 15, 2019, a total of 100 patients underwent CB PVI at the participating centers. A total of 50 patients were enrolled in the fluoroless arm [35 men (70%), mean age: 64.9 ± 12 years, mean left atrium size: 44.2 ± 16 mL/m2, left ventricular ejection fraction: 61% ± 5%], while 50 patients were enrolled in the control arm with similar characteristics. Four hundred forty-one 441 PVs were evaluated in the study cohort compared to 339 PVs in the control arm. When comparing fluoroless and traditional techniques, the mean temperature at 30 seconds was −31.7°C ± 6°C versus −32.8°C ± 5°C (p = 0.037), the minimum temperature was −47.4°C ± 6°C versus −47.7°C ± 9°C (p = 0.677), the time to isolation was 56.8 ± 28 seconds versus 74.8 ± 45 seconds (p = 0.212), and the procedure time was 102.2 ± 27.3 seconds versus 104.5 ± 16.9 seconds (p = 0.6436). Ultimately, this proof-of-concept study revealed that fluoroless ablation can be performed with success and efficiency outcomes similar to those of a traditional ablation approach. This suggests that the ablation of atrial fibrillation with CB can be performed safely and effectively without the use of fluoroscopy by experienced operators.
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Affiliation(s)
- Daniel Alyesh
- Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, CO, USA
| | | | | | | | - William Choe
- Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, CO, USA
| | - Sri Sundaram
- Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, CO, USA
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