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Liu C, Li C, Zhao T, Yu M, Huang X, Cao J, Huang S, Guo Z. Safety and efficacy of the second-generation cryoballoon for left atrial appendage electrical isolation in canines. Europace 2024; 26:euae100. [PMID: 38637325 PMCID: PMC11065359 DOI: 10.1093/europace/euae100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024] Open
Abstract
AIMS Left atrial appendage electrical isolation (LAAEI) has demonstrated a significant enhancement in the success rate of atrial fibrillation (AF) ablation. Nevertheless, concerns persist about the safety of LAAEI, particularly regarding alterations in left atrial appendage (LAA) flow velocity and the potential risks of thrombus. This study aimed to assess the efficacy and safety of LAAEI, investigating changes in LAA flow velocity in canines. METHODS AND RESULTS The study comprised a total of 10 canines. The LAAEI procedure used by a 23 mm cryoballoon of the second generation was conducted at least 180 s. Intracardiac ultrasonography (ICE) was employed to quantify the velocity flow of the LAA both prior to and following LAAEI. Following a 3-month period, subsequent evaluations were performed to assess the LAA velocity flow and the potential reconnection. Histopathological examination was conducted. Left atrial appendage electrical isolation was effectively accomplished in all canines, resulting in a 100% acute success rate (10/10). The flow velocity in the LAA showed a notable reduction during LAAEI as compared with the values before the ablation procedure (53.12 ± 5.89 vs. 42.01 ± 9.22 cm/s, P = 0.007). After the follow-up, reconnection was observed in four canines, leading to a success rate of LAAEI of 60% (6/10). The flow velocity in the LAA was consistently lower (53.12 ± 5.89 vs. 44.33 ± 10.49 cm/s, P = 0.006), and no blood clot development was observed. The histopathological study indicated that there was consistent and complete injury to the LAA, affecting all layers of its wall. The injured tissue was subsequently replaced by fibrous tissue. CONCLUSION The feasibility of using cryoballoon ablation for LAAEI was confirmed in canines, leading to a significant reduction of LAA flow velocity after ablation. Some restoration of LAA flow velocity after ablation may be linked to the passive movement of the LAA and potential reconnecting. However, this conclusion is limited to animal study; more clinical data are needed to further illustrate the safety and accessibility of LAAEI in humans.
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Affiliation(s)
- Chao Liu
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Changjin Li
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Teng Zhao
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Manli Yu
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Xinmiao Huang
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Jiang Cao
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Songqun Huang
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
| | - Zhifu Guo
- Department of Cardiology, Changhai Hospital, 168 Changhai Road, Shanghai 200433, China
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Lin C, Bao Y, Xie Y, Wei Y, Luo Q, Ling T, Zhang N, Jin Q, Pan W, Xie Y, Wu L. Initial experience of a novel method for electrical isolation of the superior vena cava using cryoballoon in patients with atrial fibrillation. Clin Cardiol 2022; 46:126-133. [PMID: 36403256 PMCID: PMC9933103 DOI: 10.1002/clc.23947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/17/2022] [Accepted: 10/30/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Damage to the sinus node (SN) has been described as a potential complication of superior vena cava (SVC) isolation. There have been reports of permanent SN injury requiring pacemaker implantation during isolation of the SVC. HYPOTHESIS It is safe and effective to isolate SVC with the second-generation 28-mm cryoballoon by using a novel method. METHODS Forty-three patients (including six redo cases) with SVC-related atrial fibrillation (AF) from a consecutive series of 650 patients who underwent cryoballoon ablation were included. After pulmonary vein isolation was achieved, if the SVC trigger was identified, the SVC was electrically isolated using the cryoballoon. First, the cryoballoon was inflated in the right atrium (RA) and advanced towards the SVC-RA junction. After total occlusion was confirmed by dye injection with total retention of contrast in the SVC, the SVC-RA junction was determined. Next, the cryoballoon was deflated, advanced into SVC, then reinflated, and pulled back gently. The equatorial band of the cryoballoon was then set slightly (4.32 ± 0.71 mm) above the SVC-RA junction for isolation of the SVC. RESULTS Real-time SVC potential was observed in all patients during ablation. The mean time to isolation was 24.5 ± 10.7 s. The SVC was successfully isolated in all patients. The mean number of freeze cycles was 2.5 ± 1.4 per patient, and the mean ablation time was 99.8 ± 22.7 s. A transient phrenic nerve (PN) injury occurred in one patient (2.33%). There were no SN injuries. Freedom from AF rates at 6 and 12 months was 97.7% and 93.0%, respectively. CONCLUSIONS This novel method for SVC isolation using the cryoballoon is safe and feasible when the SVC driver during AF is determined and could avoid SN injury. PN function should still be carefully monitored during an SVC isolation procedure.
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Affiliation(s)
- Changjian Lin
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yangyang Bao
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yun Xie
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yue Wei
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qingzhi Luo
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Tianyou Ling
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ning Zhang
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Qi Jin
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wenqi Pan
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Yucai Xie
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
| | - Liqun Wu
- Department of cardiovascular medicine, Ruijin HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
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Miraglia V, Bisignani A, Pannone L, Iacopino S, Chierchia GB, de Asmundis C. Cryoballoon Ablation Beyond Pulmonary Vein Isolation in the Setting of Persistent Atrial Fibrillation. Expert Rev Med Devices 2022; 19:431-439. [PMID: 35786107 DOI: 10.1080/17434440.2022.2096437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Catheter ablation has been demonstrated to be a safe and an effective treatment for drug resistant atrial fibrillation (AF); electrical isolation of pulmonary veins (PVI) is the main strategy in paroxysmal AF, since pulmonary vein triggers have a pivotal role in its pathogenesis; non-paroxysmal AF is a complex arrhythmia that results from the interplay of a substrate, namely AF-induced electrical and structural atrial remodeling, and a trigger that can be often found outside pulmonary veins, namely non-pulmonary veins triggers. AREAS COVERED The aim of this review is to provide a state-of-the-art overview of non-pulmonary veins triggers with special focus on cryoballoon (CB) catheter ablation. EXPERT OPINION Besides PVI, CB catheter ablation of non-pulmonary veins triggers is a novel and promising strategy for non-paroxysmal AF.
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Affiliation(s)
- Vincenzo Miraglia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Cotignola, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
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Comparison between superior vena cava ablation in addition to pulmonary vein isolation and standard pulmonary vein isolation in patients with paroxysmal atrial fibrillation with the cryoballoon technique. J Interv Card Electrophysiol 2021; 62:579-586. [PMID: 33447964 PMCID: PMC8645537 DOI: 10.1007/s10840-020-00932-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/27/2020] [Indexed: 11/18/2022]
Abstract
Background Paroxysmal atrial fibrillation (PAF) can be triggered by non-pulmonary vein foci, like the superior vena cava (SVC). The latter is correlated with improved result in terms of freedom from atrial tachycardias (ATs), when electrical isolation of this vessel utilizing radiofrequency energy (RF) is achieved. Objectives Evaluate the clinical impact, in patients with PAF, of the SVC isolation (SVCi) in addition to ordinary pulmonary vein isolation (PVI) by means of the second-generation cryoballoon (CB) Methods A total of 100 consecutive patients that underwent CB ablation for PAF were retrospectively selected. Fifty consecutive patients received PVI followed by SVCi by CB application, and the following 50 consecutive patients received standard PVI. All patients were followed 12 months. Results The mean time to SVCi was 36.7 ± 29.0 s and temperature at SVC isolation was − 35 (− 18 to − 40) °C. Real-time recording (RTR) during SVCi was observed in 42 (84.0%) patients. At the end of 12 months of follow-up, freedom from ATs was achieved in 36 (72%) patients in the PVI only group and in 45 (90%) patients of the SVC and PV isolation group (Fisher’s exact test p = 0.039, binary logistic regression: p = 0.027, OR = 0.28, 95%CI = 0.09–0.86). In survival analysis, SVC and PV isolation group was also associated with improved freedom from ATs (log-rank test: p = 0.017, Cox regression: p = 0.026, HR = 0.31, 95%CI = 0.11–0.87). Conclusion Superior vena cava isolation with the CB in addition to PVI might improve freedom from ATs if compared to PVI alone at 1-year follow-up.
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Kiełbasa G, Jastrzębski M. Cryoballoon pulmonary vein isolation as a standard approach for interventional treatment of atrial fibrillation. A review and a practical guide to an effective and safe procedure. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2020; 16:359-375. [PMID: 33598008 PMCID: PMC7863834 DOI: 10.5114/aic.2020.101760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022] Open
Abstract
Since the cryoballoon was introduced into clinical practice, approximately half a million patients have undergone a pulmonary vein isolation (PVI) using this tool throughout the world. This single-shot technique makes the pulmonary vein isolation procedure easier and has the potential to expand access to the interventional treatment of atrial fibrillation (AF), eventually leading to a reduction of the AF-related disease burden. Several studies and metanalyses have assessed the acute and long-term efficacy of cryoballoon-based PVI. The reported success rate of PV isolation during the procedure is about 98%. Despite this, the long-term effectiveness of the procedure (AF free survival) assessed at 1 year after the ablation is in the range of 70-82%. The AF-free survival rate significantly depends on the clinical characteristics of the studied group and the presence of risk factors, especially the type of AF (paroxysmal vs. persistent), LA size and the presence of heart failure. For a safe and effective procedure the electrophysiologist should be aware of all minute details of the procedure including several tricks developed by the most experienced operators and the pre-procedural and post-procedural management recommendations. Detailed knowledge of complications of cryoballoon (CB)-based ablation is mandatory. This review concentrates on the practical aspects and recommendations for a cryoballoon ablation procedure. The review is based on the authors' experience, including 800 procedures performed over 11 years with a low complication rate, and is presented within the context of the literature.
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Affiliation(s)
- Grzegorz Kiełbasa
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
| | - Marek Jastrzębski
- First Department of Cardiology, Interventional Electrocardiology and Hypertension, Jagiellonian University Medical College, Krakow, Poland
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Wei H, Guo X, Sun Q, Yang J, Xie H, Cao Z, Chen Y, Zhang S, Wu S, Ma J. Electrical isolation of the superior vena cava using second‐generation cryoballoon in patients with atrial fibrillation. J Cardiovasc Electrophysiol 2020; 31:1307-1314. [PMID: 32250512 DOI: 10.1111/jce.14477] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 03/06/2020] [Accepted: 04/02/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hui‐Qiang Wei
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical Science Guangzhou China
| | - Xiao‐Gang Guo
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Qi Sun
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jian‐Du Yang
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hai‐Yang Xie
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Zhong‐Jing Cao
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Yan‐Qiao Chen
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shu Zhang
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Shulin Wu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's HospitalGuangdong Academy of Medical Science Guangzhou China
| | - Jian Ma
- Department of Cardiology, Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China
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Safety and feasibility of electrical isolation of the superior vena cava in addition to pulmonary vein ablation for paroxysmal atrial fibrillation using the cryoballoon: lessons from a prospective study. J Interv Card Electrophysiol 2020; 60:255-260. [DOI: 10.1007/s10840-020-00740-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/26/2020] [Indexed: 01/12/2023]
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