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Calvert P, Ding WY, Mills MT, Snowdon R, Borbas Z, Modi S, Hall M, Morgan M, Clarkson N, Chackochen S, Barton J, Kemp I, Luther V, Gupta D. Durability of thermal pulmonary vein isolation in persistent atrial fibrillation assessed by mandated repeat invasive study. Heart Rhythm 2024; 21:1545-1554. [PMID: 38636929 DOI: 10.1016/j.hrthm.2024.04.061] [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: 02/13/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND No study has assessed the durability of pulmonary vein isolation (PVI) with radiofrequency (RF) and cryoballoon (CB) in patients with persistent atrial fibrillation. These data are especially lacking for those with significantly diseased left atria (LA). OBJECTIVES The goals of this study were to assess PVI durability in patients with significant LA disease and to compare reconnection rates between RF and CB. METHODS Forty-four patients (mean age 63 years; 34 (77%) male; median time since atrial fibrillation diagnosis 22.5 months; median indexed LA volume 36 mL/m2) were randomized 1:1 to RF or CB PVI. A redo procedure using ultra-high-density electroanatomic mapping was mandated at 2 months, where PV reconnections were identified and reisolated. RESULTS Thirty-eight patients underwent both procedures (CB n = 17; RF n = 21). Index RF procedures were longer (median 158 minutes vs 97 minutes; P < .001) but required less fluoroscopy (9.5 minutes vs 23 minutes; P < .001). At the index RF procedure, a median of 47% of LA myocardium had voltage < 0.5 mV, suggesting that half of the mapped LA comprised scar. PV reconnection was observed in 73 of 152 PVs (48.0%) and was more frequent with CB (58.8%) than with RF (39.3%) (P = .022). Reconnection of at least 1 PV was detected in >75% of patients. Significantly more ablation was required during the redo procedure to reisolate PVs in the CB arm (median 10.8 minutes vs 1.2 minutes; P < .001). CONCLUSION PVI durability may be poor in those with significant LA scarring and dilatation, even with modern thermal ablation technologies. RF resulted in significantly better PVI durability than did CB in this complex population.
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Affiliation(s)
- Peter Calvert
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark T Mills
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Richard Snowdon
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Zoltan Borbas
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Simon Modi
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Hall
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Maureen Morgan
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Janet Barton
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ian Kemp
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Vishal Luther
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom.
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Serban T, Mannhart D, Abid QUA, Höchli A, Lazar S, Krisai P, Bettelini AS, Knecht S, Kühne M, Sticherling C, du Fay de Lavallaz J, Badertscher P. Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review. Europace 2023; 25:euad335. [PMID: 37944133 PMCID: PMC10664405 DOI: 10.1093/europace/euad335] [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: 08/24/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF. METHODS AND RESULTS Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies). CONCLUSION We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics.
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Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | | | - Andres Höchli
- Department of Cardiology, Triemli Stadtspital, Zürich, Switzerland
| | - Sorin Lazar
- Department of Cardiology, Cook County Health, Chicago, IL, USA
| | - Philipp Krisai
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Arianna Sofia Bettelini
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
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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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Krause U, Müller MJ, Schneider HE, Paul T. Catheter ablation of atrial fibrillation using 2nd-generation cryoballoon in congenital heart disease patients - significance of RF ablation of additional atrial macro-reentrant tachycardia. J Interv Card Electrophysiol 2022; 65:411-417. [PMID: 35419671 PMCID: PMC9640420 DOI: 10.1007/s10840-022-01213-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/29/2022] [Indexed: 12/03/2022]
Abstract
Background Prevalence of atrial fibrillation (AF) is increasing in adult patients with congenital heart disease (CHD). Experience using the cryoballoon to achieve pulmonary vein isolation (PVI) in adult CHD patients is limited. The aim of the present study was to assess the value of PVI by cryoballoon in adult CHD patients and to evaluate the significance of additional radiofrequency (RF) ablation of atrial tachycardia (AT). Patients and methods Prospective data analysis; all patients with CHD and AF and PVI using the cryoballoon from January 2017 through November 2021 were included. Results Nineteen patients with various types of CHD were included. Median age was 58 (IQR 47–63) years. A total of 12/19 (63%) patients had had RF ablation of right atrial AT before. Median procedure duration was 225 (IQR 196–261) min. Median fluoroscopy time was 12.3 (IQR 5.2–19.5) min and median freeze time was 32 (IQR 28–36.3) min. Procedural success was achieved in all patients. Additional RF catheter ablation of intraatrial reentrant tachycardia within the left atrium was performed in 3/19 (16%) subjects and within the right atrium in 6/19 (32%) patients. Median follow-up was 26 (IQR 9–49) months. Excluding a 90-day blanking period, recurrence of AF was observed in 6/19 subjects (32%). After one redo procedure deploying RF energy only, 84% of all patients remained free from recurrence. Phrenic nerve palsy was observed in 1 subject. Conclusion Results after PVI using the cryoballoon plus additional RF ablation of AT were promising (84% success including one redo procedure). Success of AF ablation was unsatisfactory in all patients who had no additional AT ablation. Ablation of any AT in these patients should therefore be considered in addition to PVI.
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Affiliation(s)
- Ulrich Krause
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany.
| | - Matthias J Müller
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Heike E Schneider
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
| | - Thomas Paul
- Department of Pediatric Cardiology and Intensive Care Medicine, University Medical Center, Georg-August-University Göttingen, Robert-Koch-Str. 40, 37099, Göttingen, Germany
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Gunawardene MA, Schaeffer BN, Jularic M, Eickholt C, Maurer T, Akbulak RÖ, Flindt M, Anwar O, Pape UF, Maasberg S, Gessler N, Hartmann J, Willems S. Pulsed-field ablation combined with ultrahigh-density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations. J Cardiovasc Electrophysiol 2022; 33:345-356. [PMID: 34978360 DOI: 10.1111/jce.15349] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulsed-field ablation (PFA) yields a novel ablation technology for atrial fibrillation (AF). PFA lesions promise to be highly durable, however clinical data on lesion characteristics are still limited. OBJECTIVE This study sought to investigate PFA lesion creation with ultrahigh-density (UHDx) mapping. METHODS Consecutive AF patients underwent PFA-based pulmonary vein isolation (PVI) using a multispline catheter (Farwave, Farapulse Inc.). Additional ablation, including left atrial posterior wall isolation (LAPWI) and mitral isthmus ablation (MI) were performed in a subset of persistent AF patients. The extent of PFA-lesions and decrease of LA-voltage were assessed with pre- and post PFA UHDx-mapping (Orion™ catheter and Rhythmia™ 3D-mapping system, Boston Scientific). RESULTS In 20 patients, acute PVI was achieved in 80/80 PVs, LAPW isolation in 9/9 patients, MI ablation in 2/2 (procedure time: 123 ± 21.6 min, fluoroscopy time: 19.2 ± 5.5 min). UHDx-mapping subsequent to PVI revealed early PV-reconnection in five case (5/80, 6.25%). Gaps were located at the anterior-superior PV ostia and were successfully targeted with additional PFA. Repeat UHDx mapping after PFA revealed a significant decrease of voltage along the PV ostia (1.67 ± 1.36 mV vs. 0.053 ± 0.038 mV, p < .0001) with almost no complex electrogram-fractionation at the lesion border zones. PFA-catheter visualization within the mapping system was feasible in 17/19 (84.9%) patients and adequate in 92.9% of ablation sites. CONCLUSION For the first time illustrated by UHDx mapping, PFA creates wide antral circumferential lesions and homogenous LAPW isolation with depression of tissue voltage to a minimum. Although with a low incidence, early PV reconnection can still occur also in the setting of PFA.
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Affiliation(s)
- Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Benjamin N Schaeffer
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Christian Eickholt
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tilman Maurer
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ruken Ö Akbulak
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Max Flindt
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ulrich F Pape
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Sebastian Maasberg
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.,Asklepios Proresearch, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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Left Atrial Fibrosis after Single Shot Guided Pulmonary Vein Isolation. J Clin Med 2021; 10:jcm10194478. [PMID: 34640495 PMCID: PMC8509823 DOI: 10.3390/jcm10194478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 11/16/2022] Open
Abstract
Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment modality for patients with atrial fibrillation (AF) with encouraging acute and long-term outcome data. However, the size of collaterally created lesion sets adjacent to the pulmonary veins (PVs) remains unclear, especially when CB ablation is performed with individualized time-to-isolation (TTI) protocols. This study seeks to investigate the extension of lesions at the posterior wall and the roof of the left atrium (LA). Thirty patients with paroxysmal or persistent AF underwent ablation with a fourth-generation CB. The individual freeze-cycle duration was set at TTI + 120 s. A total of 120 PVs were identified, and all were successfully isolated. A three-dimensional electroanatomical high-density (HD) mapping of the LA was performed in every patient before and after PVI. The surface areas of the posterior wall and LA roof were measured and compared with lesion extension after PVI. After CB ablation, 65.6 ± 16.9% of the posterior wall and 75.4 ± 18.4% of the LA roof remained unablated. In addition, non-antral lesion formation was observed in every patient in at least one PV. After CB ablation, anterior antral parts of the superior PVs showed the greatest unablated areas compared with the other antral areas. HD re-mapping after CB-based PVI demonstrated that major regions of the posterior wall and roof remained electrically normal and unaffected. Unablated antral areas were localized predominantly in the anterior segments of the superior PVs and may be partly responsible for AF recurrence.
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Gunawardene MA, Eickholt C, Akbulak RÖ, Jularic M, Klatt N, Hartmann J, Schlüter M, Meyer C, Willems S, Schaeffer B. Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current. J Cardiovasc Electrophysiol 2020; 31:1051-1061. [DOI: 10.1111/jce.14413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/29/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie A. Gunawardene
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Christian Eickholt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Ruken Ö. Akbulak
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Mario Jularic
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Niklas Klatt
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
| | - Jens Hartmann
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | | | - Christian Meyer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- DZHK (German Center for Cardiovascular Research), partner site Hamburg/Kiel/LübeckBerlin Germany
| | - Stephan Willems
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
- Department of CardiologyAsklepios Hospital St GeorgHamburg Germany
| | - Benjamin Schaeffer
- Department of Cardiac Electrophysiology, University Heart CenterUniversity Hospital Hamburg EppendorfHamburg Germany
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Radiofrequency versus cryoballoon ablation for atrial fibrillation: an argument for a 'cryo-first' approach. Curr Opin Cardiol 2019; 35:13-19. [PMID: 31688135 DOI: 10.1097/hco.0000000000000700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Radiofrequency and cryoballoon ablation are the two most common modalities for catheter ablation of atrial fibrillation. Radiofrequency, being more prevalent and having existed for a longer period, is often utilized for patients' first ablations, despite the efficiency and efficacy of the cryoballoon tool. Here we examine the advantages of the cryoballoon for its use in first-time ablation of atrial fibrillation. RECENT FINDINGS The FIRE & ICE trial is established as conclusive evidence of the noninferiority of cryoballoon ablation to radiofrequency ablation in terms of efficacy. Since the study, cryoballoon has evolved in both form and technique, suggesting need for repeat consideration of the advantages of cryoablation over radiofrequency ablation. The second-generation cryoballoon has led to greater efficiency in achieving permanent pulmonary vein isolation, reducing complications, and reducing procedure times. SUMMARY There are advantages to the use of cryoballoon which could increase success of first-time ablations, delaying need for repeat procedure and lowering overall burden on patients and the healthcare system. Cryoballoon ablation should be considered for first-time ablation in patients with paroxysmal or persistent atrial fibrillation.
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Martínez-Brotóns A, Bondanza L, Ruiz-Granell R. Intermittent reconnection of a pulmonary vein causing multiple tachyarrhythmias: successful identification with ultra-high-density mapping. Europace 2019; 21:iii5-iii6. [PMID: 31400214 DOI: 10.1093/europace/euz178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Angel Martínez-Brotóns
- Arrhythmia Unit, Department of Cardiology, Hospital Clinico Universitario, Av. Blasco Ibañez, 17, Valencia, Spain
| | - Lourdes Bondanza
- Arrhythmia Unit, Department of Cardiology, Hospital Clinico Universitario, Av. Blasco Ibañez, 17, Valencia, Spain
| | - Ricardo Ruiz-Granell
- Arrhythmia Unit, Department of Cardiology, Hospital Clinico Universitario, Av. Blasco Ibañez, 17, Valencia, Spain
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