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Chaumont C, Hayoun C, Savoure A, Al Hamoud R, Auquier N, McDonnell E, Eltchaninoff H, Anselme F. Pentaspline Pulsed Field Ablation Catheter Versus Cryoballoon for Atrial Fibrillation Ablation: Results From a Prospective Comparative Study. J Am Heart Assoc 2024; 13:e033146. [PMID: 38471838 PMCID: PMC11010030 DOI: 10.1161/jaha.123.033146] [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: 10/17/2023] [Accepted: 02/05/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Cryoballoon ablation is currently the gold standard technique for single-shot pulmonary vein isolation (PVI). Pulsed field ablation (PFA) has recently emerged as an interesting nonthermal alternative energy for PVI. The purpose of our study was to evaluate the safety and long-term efficacy of PVI using the pentaspline PFA catheter in comparison to cryoballoon ablation. METHODS AND RESULTS Between January 2021 and December 2022, we included all consecutive patients of our center in whom a first PVI-only procedure was performed using PFA or cryoballoon. The choice of the energy was based on patients' preference between general anesthesia (PFA) and local anesthesia (cryoballoon). The primary end point was freedom from documented atrial arrhythmia recurrence after a 3-month blanking period. A total of 301 patients (paroxysmal atrial fibrillation in 220 patients) underwent a first PVI procedure performed using PFA (n=151) or cryoballoon (n=150). Complete short-term PVI was obtained in 144 of 150 patients (96%) in the cryoballoon group and in all patients of the PFA group (P=0.01). Procedure duration was significantly longer in the cryoballoon group. Transient and persistent phrenic nerve injuries were observed in the cryoballoon group only (13/150 and 2/150, respectively). One-year freedom from atrial arrhythmia was significantly higher in the PFA group compared with the cryoballoon group (87.9% versus 77.7%; adjusted hazard ratio, 0.53 [95% CI, 0.30-0.96]; P=0.037). CONCLUSIONS This prospective, comparative, real-life study suggested that PFA could overcome safety limitations of cryoballoon with optimal effectiveness. Randomized controlled studies are required to further investigate the potential superiority of PFA over cryoballoon.
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Affiliation(s)
- Corentin Chaumont
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 Rouen France
| | - Camilia Hayoun
- Department of Cardiology Rouen University Hospital Rouen France
| | - Arnaud Savoure
- Department of Cardiology Rouen University Hospital Rouen France
| | | | | | - Emily McDonnell
- Department of Cardiology Rouen University Hospital Rouen France
| | - Helene Eltchaninoff
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 Rouen France
| | - Frederic Anselme
- Department of Cardiology Rouen University Hospital Rouen France
- UNIROUEN, INSERM U1096 Rouen France
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Ikenouchi T, Miyazaki S, Nitta J, Sekiguchi Y, Kobori A, Nakamura K, Inamura Y, Murakami M, Sagawa Y, Sasaki Y, Inaba O, Yamauchi Y, Naito S, Hirakawa A, Sasano T. Characteristics of two different cryoballoon systems for treatment of paroxysmal atrial fibrillation: study protocol for a multicenter randomized controlled trial (CONTRAST-CRYO Trial). J Interv Card Electrophysiol 2024; 67:5-12. [PMID: 38087145 DOI: 10.1007/s10840-023-01718-2] [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: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Single-shot pulmonary vein isolation (PVI) utilizing cryothermal energy is an effective and safe treatment for atrial fibrillation (AF) patients. A novel cryoballoon system, POLARx™, has been recently introduced. The aim of this study was to compare the efficacy, safety, and biophysical parameters of PVI between the novel cryoballoon system, POLARx™, and the standard cryoballoon system, Arctic Front Advance Pro™ (AFA-Pro), in patients with paroxysmal AF. METHODS The CONTRAST-CRYO trial is a prospective, multicenter, open-label, randomized controlled study performed at seven large cardiac centers. This study was approved by the central ethics committee or the local ethics committee of each participating hospital and has been registered at UMIN Clinical Trials Registry (UMIN000049948). The trial will assign 200 patients with paroxysmal AF undergoing PVI to POLARx™ and AFA-Pro in a 1:1 randomization. The primary endpoint is the one-shot acute success rate of the right inferior pulmonary vein. Second endpoints include freedom from documented atrial fibrillation, atrial flutter, or atrial tachycardia without antiarrhythmic drugs at 12 months after the procedure, freedom from re-do procedures, the incidence of procedure-related adverse events, freezing duration, and the biophysical parameters during applications for each PV, total procedure and fluoroscopy time, and PVI durability during re-do procedures. CONCLUSION The CONTRAST-CRYO trial is a prospective, multicenter, randomized study designed to elucidate the difference in the efficacy, safety, and biophysical parameters between POLARx™ and AFA-Pro in paroxysmal AF patients undergoing PVI. The findings from this trial may provide a valuable indication for selecting the optimal cryoballoon system. CLINICAL TRIAL REGISTRATION UMIN000049948.
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Affiliation(s)
- Takashi Ikenouchi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan
| | - Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Junichi Nitta
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Yukio Sekiguchi
- Department of Cardiology, Sakakibara Heart Institute, Fuchu-shi, Tokyo, Japan
| | - Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe-shi, Hyogo, Japan
| | - Kohki Nakamura
- Devision of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi-shi, Gunma, Japan
| | - Yukihiro Inamura
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama-shi, Japan
| | - Masato Murakami
- Department of Cardiology, Shonankamakura General Hospital, Kamakura-shi, Kanagawa, Japan
| | - Yuichiro Sagawa
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Yokohama-shi, Kanagawa, Japan
| | - Yasuhiro Sasaki
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe-shi, Hyogo, Japan
| | - Osamu Inaba
- Department of Cardiology, Japanese Red Cross Saitama Hospital, Saitama-shi, Japan
| | - Yasuteru Yamauchi
- Department of Cardiology, Japanese Red Cross Yokohama City Bay Hospital, Yokohama-shi, Kanagawa, Japan
| | - Shigeto Naito
- Devision of Cardiology, Gunma Prefectural Cardiovascular Center, Maebashi-shi, Gunma, Japan
| | - Akihiro Hirakawa
- Department of Clinical Biostatistics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Bunkyo-ku, Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Hospital, Yushima 1-5-45, Bunkyo-ku, Tokyo, 113-8510, Japan
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Pang Y, Guo W, Xu Y, Chen C, Chen Q, Cheng K, Ling Y, Liu G, Ge J, Wang M, Zhu W. The Influence of Pulmonary Veins' Anatomic Features and Catheter Coaxiality on Cryoballoon Ablation Results for Paroxysmal Atrial Fibrillation. Am J Cardiol 2023; 209:12-19. [PMID: 37856915 DOI: 10.1016/j.amjcard.2023.09.067] [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: 08/17/2023] [Revised: 09/10/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023]
Abstract
A total of 172 consecutive patients with sympathetic paroxysmal atrial fibrillation who received cryoballoon (CB) ablation from 2020 to 2021 were retrospectively analyzed in this study. Catheter coaxiality and anatomic features of pulmonary veins (PVs) on computed tomography images were explored by several parameters and their influence on the cryoablation results was then analyzed. The rate of incomplete CB occlusion was significantly higher for inferior than superior PVs. A multivariate analysis revealed that a short distance (<6.3 mm) from PV ostium to first branch (D-PVB) and a small angle (<32.5°) of first branch were independent predict factors for an incomplete CB occlusion in right inferior PVs (RIPVs). A combination of D-PVB and angle of first branch could elevate the predictor value for an incomplete balloon occlusion with a sensitivity of 0.85 and specificity of 1.0 for RIPVs. For PVs with a perfect balloon occlusion, the best catheter coaxiality was observed in right superior PV while the worst catheter coaxiality was observed in RIPV. A more aggressive catheter manipulation with a "7" or "reverse-U" shape of long sheath could obtain a better catheter coaxiality compared with conventional manipulation strategy for RIPVs. In Conclusion, a short D-PVB and a small angle of first branch were independent predict factors for an incomplete CB occlusion in RIPVs. A more aggressive catheter manipulation strategy was recommended to achieve a complete balloon occlusion and a better catheter coaxiality for RIPVs.
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Affiliation(s)
- Yang Pang
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Weifeng Guo
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Ye Xu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Chaofeng Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Qingxing Chen
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Kuan Cheng
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Yunlong Ling
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Guijian Liu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Junbo Ge
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China
| | - Mingliang Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.
| | - Wenqing Zhu
- Department of Cardiology, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, P.R. China.
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Yoshizawa R, Sasaki H, Urushikubo T, Sawa Y, Owada S. Occlusion and catheter ablation using a large-size cryoballoon for various pulmonary veins: a case series. Eur Heart J Case Rep 2023; 7:ytad593. [PMID: 38099074 PMCID: PMC10720691 DOI: 10.1093/ehjcr/ytad593] [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: 07/18/2023] [Revised: 11/15/2023] [Accepted: 11/22/2023] [Indexed: 12/17/2023]
Abstract
Background It is established that pulmonary vein isolation using the POLARx™ (Boston Scientific, Marlborough, MA, USA) cryoballoon is a rapid, safe, and effective approach. The new POLARx™ FIT (Boston Scientific), which is expandable from 28 to 31 mm in diameter, is currently available. However, there is limited evidence available regarding the treatment of atrial fibrillation in this setting. In this article, we report a case series of cryoballoon ablation in patients with atrial fibrillation using POLARx™ FIT. Case summary This case series describes a comparison of obstruction in three patients with pulmonary veins of different shapes and diameters undergoing cryoballoon ablation and pulmonary vein isolation with a 31 mm diameter balloon. Discussion Cryoballoon ablation using the 31 mm mode of POLARx™ FIT has the potential to provide safe and stable pulmonary vein isolation with good occlusion for a variety of pulmonary vein geometries. In this case series, the 31 mm mode of the POLARx™ FIT resulted in better pulmonary vein occlusion than the 28 mm mode in patients with large left atria and large pulmonary veins, including the left common pulmonary vein. This approach may be considered a first-line therapy option of cryoballoon ablation in patients with atrial fibrillation.
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Affiliation(s)
- Reisuke Yoshizawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Hiroki Sasaki
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Takashi Urushikubo
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Yohei Sawa
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Shingen Owada
- Division of Cardiology, Department of Internal Medicine, Iwate Medical University School of Medicine, Shiwa, Japan
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Nagy LT, Papp TB, Urbancsek R, Jenei C, Csanadi Z. Right superior pulmonary vein parameter determined by three-dimensional transesophageal echocardiography is an independent predictor of the outcome after cryoballoon isolation of the pulmonary veins. Cardiol J 2023; 30:1010-1017. [PMID: 37853823 PMCID: PMC10713212 DOI: 10.5603/cj.95381] [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: 04/30/2023] [Revised: 08/04/2023] [Accepted: 09/22/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND A direct comparison of three-dimensional transesophageal echocardiography (3DTEE) and cardiac computed tomography imaging has demonstrated good inter-technique agreement for the following pulmonary vein (PV) parameters: the ostium area of the right superior PV (RSPV) and its major (a) and minor axis (b) diameters, the left lateral ridge and the minor axis (b) diameter of the left superior PV. Herein, under investigation, was the predictive value of these parameters for arrhythmia recurrence (AR) after PV isolation with the 28 mm second generation cryoballoon (CBG2). METHODS One hundred eleven patients (67 men, mean age 58.06 ± 10.58 years) undergoing 3DTEE before PV isolation with the CBG2 for paroxysmal atrial fibrillation were followed. "Point by point" redo intervention was offered in case of AR and reconnected PVs were defined. RESULTS During a mean follow-up of 617 ± 258.86 days, 65 (58.9%) patients remained free of AR. Longer RSPV b was found to be the only significant predictor for AR (hazard ratio [HR] 1.059; 95% confidence interval [CI] 1.000-1.121; p = 0.048). RSPV b ≥ 28 mm resulted in a threefold (HR 3.010; 95% CI 1.270-7.134, p = 0.012) increase in the risk of AR. The association of RSPV b with AR was independent of the biophysical parameters of cryoapplications. In 25 "redo" patients, reconnections were found 1.75 times more likely in the RSPV than in the other 3 PVs altogether. CONCLUSIONS Right superior PV b measured with 3DTEE might be a significant predictor of AR after PV isolation with the CBG2. In case of RSPV b exceeding 28 mm, alternative PV isolation techniques or use of a larger balloon might be considered.
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Affiliation(s)
- Laszlo Tibor Nagy
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
| | - Timea Bianka Papp
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Reka Urbancsek
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Jenei
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanadi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Chahine Y, Afroze T, Bifulco SF, Macheret F, Abdulsalam N, Boyle PM, Akoum N. Cryoballoon temperature parameters during cryoballoon ablation predict pulmonary vein reconnection and atrial fibrillation recurrence. J Interv Card Electrophysiol 2023; 66:1367-1373. [PMID: 36418664 PMCID: PMC10205917 DOI: 10.1007/s10840-022-01429-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/15/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) is an established approach for rhythm management of atrial fibrillation (AF). We sought to assess balloon temperature (BT) parameters as predictors of pulmonary vein (PV) reconnection within the index procedure and AF recurrence following CBA. METHODS BT was monitored in 119 AF patients undergoing CBA. PVs were assessed for reconnection during the procedure and patients were followed for arrhythmia recurrence. RESULTS PV reconnection was identified in 39 (8.3%) of 471 PVs. BT was significantly colder in the absence of PV reconnection (30 s: - 33.5 °C [- 36; - 30] vs - 29.5 °C [- 35; - 25.5], p = 0.001; 60 s: - 41 °C [- 44; - 37] vs - 36.5 °C [- 42; - 33.5], p < 0.001; nadir: - 47 °C [- 52; - 43] vs - 41.5 °C [- 47; - 38], p < 0.001). PV reconnection was associated with significantly longer time to reach - 15 °C and - 40 °C (14.5 s [11.5-18.5] vs 12 s [10-15.5], p = 0.023; and 75 s [40-95.5] vs 46 s [37-66.75], p = 0.005) and shorter rewarming time (5.75 s [4.75-8.5] vs 7 s [6-9], p = 0.012). ROC analysis of these procedural parameters had an AUC = 0.71 in predicting PV reconnection. AF recurrence occurred in 51 (42.8%) patients. Kaplan-Meier analysis showed better arrhythmia-free survival for patients in whom BT decreased below - 40 °C in all PVs and patients who had no early PV reconnections, compared to patients in whom BT below - 40 °C was not achieved in at least one PV (log rank = 6.3, p = 0.012) and patients who had PV reconnections (log rank = 4.1, p = 0.043). CONCLUSIONS Slower BT decline, warmer BT nadir, and faster rewarming time predict early PV reconnection. Absence of early PV reconnections and BT dropping below - 40 °C in all PVs during CBA are associated with lower rates of AF recurrence.
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Affiliation(s)
- Yaacoub Chahine
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Tanzina Afroze
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | - Savannah F Bifulco
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
| | - Fima Macheret
- Division of Cardiology, University of Washington, Seattle, WA, USA
| | | | - Patrick M Boyle
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
- Institute for Stem Cell and Regenerative Medicine, University of Washington, Seattle, WA, USA
- Center for Cardiovascular Biology, University of Washington, Seattle, WA, USA
| | - Nazem Akoum
- Division of Cardiology, University of Washington, Seattle, WA, USA.
- Department of Bioengineering, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
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Nagy LT, Jenei C, Papp TB, Urbancsek R, Kolozsvari R, Racz A, Raduly AP, Veisz R, Csanadi Z. Three-dimensional transesophageal echocardiographic evaluation of pulmonary vein anatomy prior to cryoablation: validation with cardiac CT scan. Cardiovasc Ultrasound 2023; 21:6. [PMID: 37076858 PMCID: PMC10114354 DOI: 10.1186/s12947-023-00305-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 04/06/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Anatomical characteristics of the left atrium and the pulmonary veins (PVs) may be relevant to the success rate of cryoballoon (CB)-ablation for atrial fibrillation (AF). Cardiac computed tomography (CCT) is considered as the gold standard for preablation imaging. Recently, three-dimensional transesophageal echocardiography (3DTOE) has been proposed for preprocedural assessment of cardiac structures relevant to CB-ablation. The accuracy of 3DTOE has not been validated by other imaging modalities. OBJECTIVE We prospectively evaluated the feasibility and the accuracy of 3DTOE imaging for the assessment of left atrial and PV structures prior to pulmonary vein isolation (PVI). In addition, CCT was used to validate the measurements obtained with 3DTOE. METHODS PV anatomy of 67 patients (59.7% men, mean age 58.5 ± 10.5 years) was assessed using both 3DTOE and CCT scan prior to PVI with the Arctic Front CB. The following parameters were measured bilaterally: PV ostium area (OA), the major and minor axis diameters of the ostium (a > b) and the width of the carina between the superior and the inferior PVs. In addition, the width of the left lateral ridge (LLR) between the left atrial appendage and the left superior PV. Evaluation of inter-technique agreement was based on linear regression with Pearson correlation coefficient (PCC) and Bland-Altman analysis of biases and limits of agreement. RESULTS Moderate positive correlation (PCC 0.5-0.7) was demonstrated between the two imaging methods for the right superior PV's OA and both axis diameters, the width of the LLR and left superior PV (LSPV) minor axis diameter (b) with limits of agreement ˂50% and no significant biases. Low positive or negligible correlation (PCC < 0.5) was found for both inferior PV parameters. CONCLUSIONS Detailed assessment of the right superior PV parameters, LLR and LSPV b is feasible with 3DTOE prior to AF ablation. This 3DTOE measurements demonstrated a clinically acceptable inter-technique agreement with those obtained with CCT.
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Affiliation(s)
- Laszlo Tibor Nagy
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary.
| | - Csaba Jenei
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Timea Bianka Papp
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Reka Urbancsek
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Rudolf Kolozsvari
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Agnes Racz
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Arnold Peter Raduly
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
| | - Richard Veisz
- Department of Radiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zoltan Csanadi
- Department of Cardiology, Faculty of Medicine, University of Debrecen, 22 Zsigmond Moricz Boulevard, Debrecen, 4032, Hungary
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Terasawa M, Chierchia GB, Housari MA, Bala G, Cosyns B, Droogmans S, Tanaka K, Belsack D, De Mey J, Sieira J, Brugada P, de Asmundis C, Ströker E. Predictors of late pulmonary vein reconnection in patients with arrhythmia recurrence after cryoballoon ablation-per vein analysis including cardiac computed tomography-based anatomic factors. Eur Heart J Cardiovasc Imaging 2022:6958487. [PMID: 36562390 DOI: 10.1093/ehjci/jeac255] [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: 03/29/2022] [Revised: 10/27/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS To identify predictors of individual late pulmonary vein (PV) reconnection after second-generation cryoballoon (CB2) ablation. Anatomic indicators of late pulmonary vein reconnection (LPVR) post-CB2 ablation have not yet been studied on an individual PV level, nor weighed against clinical and procedural factors. METHODS AND RESULTS Clinical, procedural, and PV anatomic data from 125 patients with a repeat procedure for arrhythmia recurrence after index CB2 ablation were analyzed. Preprocedural computed tomography (CT) evaluated 486 PVs for measurement of size; shape (ovality index); carina width; and orientation angle in frontal (superior/inferior) and transversal (anterior/posterior) plane (with horizontal line 0° as reference and upper/lower half circle as positive/negative value, respectively). Durable isolation in all PVs was demonstrated in 50/125 (40%) patients. Late reconnection rates at the different PVs were as follows: 16% left superior (LS), 12% left inferior (LI), 17% right superior (RS), and 31% right inferior (RI) PV. Multivariable analysis performed per vein showed following independent determinants predicting LPVR: ovality index [odds ratio (OR) 1.61, 95% confidence interval (CI) 1.07-2.41, P = 0.022] and carina width (OR 0.75, CI 0.59-0.96, P = 0.024) for LSPV; carina width (OR 0.71, CI 0.53-0.95, P = 0.020) for LIPV; frontal angle (OR 0.91, CI 0.87-0.95, P < 0.001) for RIPV; and transversal angle (OR 1.15, CI 1.03-1.31, P = 0.032) for RSPV. CONCLUSION Cardiac CT-based evaluation of anatomic PV characteristics presented higher predictive value compared to clinical and procedural variables for individual LPVR after CB2 ablation. Pre-procedural identification of unfavourable PV anatomy might be important to tailor the ablation approach.
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Affiliation(s)
- Muryo Terasawa
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium.,Department of Cardiology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku City, Tokyo 160-0023, Japan
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Bernard Cosyns
- Department of Cardiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Steven Droogmans
- Department of Cardiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Kaoru Tanaka
- Department of Radiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Dries Belsack
- Department of Radiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Johan De Mey
- Department of Radiology, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
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9
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Mugnai G, Cecchini F, Stroker E, Paparella G, Iacopino S, Sieira J, De Greef Y, Tomasi L, Bolzan B, Bala G, Overeinder I, Almorad A, Gauthey A, Sorgente A, Ribichini FL, de Asmundis C, Chierchia GB. Pulmonary vein size is associated with reconnection following cryoballoon ablation of atrial fibrillation. J Interv Card Electrophysiol 2022; 65:717-724. [PMID: 35930128 DOI: 10.1007/s10840-022-01330-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/01/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The second-generation cryoballoon (CB) has proven to be a highly effective ablative strategy in patients with symptomatic atrial fibrillation (AF). This study sought to investigate the anatomical characteristics of pulmonary veins (PVs) and the relationship between their size, ovality, and late reconnections in a large cohort of patients undergoing repeat ablation for recurrence of atrial arrhythmias. METHODS AND RESULTS A total of 152 consecutive patients (98 males, 64.5%; mean age 64.9 ± 9.6 years) underwent a repeat ablation for recurrent atrial tachyarrhythmias after a median time of 6.5 months [IQR 11] from the index CB ablation. All repeat ablations were performed using a 3-dimensional electro-anatomical mapping system. Among all 593 PVs, 134 (22.6%) showed a late PV reconnection in 95 patients (0.88 per patient), at the time of repeat ablation procedure. There was a significant difference in ovality between left- and right-sided PVs (p < 0.001). Greater diameters of left superior PV, left inferior PV, and right inferior PV ostia (both maximum and minimum) and higher index ovality were significantly associated with late PV reconnection. CONCLUSIONS The rate of late PV reconnection after CB ablation was low (0.88 PVs/patient). Left-sided PVs were more oval than septal PVs. Larger PV dimensions and higher ovality index were significantly associated with reconnections in all PVs except for RSPV.
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Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium. .,Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy.
| | - Federico Cecchini
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium.,Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - Erwin Stroker
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves De Greef
- Electrophysiology Unit, ZNA Middelheim, Antwerp, Belgium
| | - Luca Tomasi
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Bruna Bolzan
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Gezim Bala
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Anais Gauthey
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Flavio Luciano Ribichini
- Electrophysiology and Cardiac Pacing, Division of Cardiology, Cardio-Thoracic Department, School of Medicine, University Hospital of Verona, Verona, Italy
| | - Carlo de Asmundis
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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10
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Bonczar M, Piątek-Koziej K, Wolska J, Tomala O, Stitou EA, Pękala J, Pękala P, Walocha J, Hołda M, Koziej M. Variations in human pulmonary vein ostia morphology: A systematic review with meta-analysis. Clin Anat 2022; 35:906-926. [PMID: 35460116 DOI: 10.1002/ca.23896] [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: 04/07/2022] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 11/09/2022]
Abstract
This study aimed to establish the most accurate and up-to-date anatomical knowledge of pulmonary veins (PV), ostia variations, diameters and ostial area, to provide physicians, especially heart and thoracic surgeons with exact knowledge concerning this area. The main online medical databases, such as PubMed, Embase, Scopus, Web of Science, and Google Scholar, were searched to gather all studies in which the variations, maximal diameter, and ostial area of the PVs were investigated. During the study, the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Additionally, the critical appraisal tool for anatomical meta-analysis (CATAM) was used to provide the highest quality findings. The most common ostia variation is the classical one, which contains the left superior pulmonary vein (LSPV), left inferior pulmonary vein (LIPV), right superior pulmonary vein (RSPV) and right inferior pulmonary vein (RIPV). The mean diameter and ostial area of each pulmonary vein were established in the general population and in multiple variations considering the method of collecting the data and geographical location. Significant variability in PV ostia is observed. Left-sided PVs have smaller ostia than the corresponding right-sided PVs, and the inferior PVs ostia are smaller than the superior. The LCPV ostium size is the largest among all veins analyzed, while the RMPV ostium is the smallest. The results of this meta-analysis are hoped to help clinicians in planning and performing procedures that involve the pulmonary and cardiac areas, especially catheter ablation for atrial fibrillation.
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Affiliation(s)
- Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | | | - Joanna Wolska
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Olaf Tomala
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - El-Ayachi Stitou
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Przemysław Pękala
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Mateusz Hołda
- HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland.,Division of Cardiovascular Sciences, The University of Manchester, UK
| | - Mateusz Koziej
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland.,HEART - Heart Embryology and Anatomy Research Team, Department of Anatomy, Jagiellonian University Medical College, Cracow, Poland
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11
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Comparison of atrial fibrillation ablation using cryoballoon versus radiofrequency in patients with left common pulmonary veins: mid-term follow-up results. J Interv Card Electrophysiol 2021; 64:597-605. [PMID: 34709505 DOI: 10.1007/s10840-021-01084-x] [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: 04/01/2021] [Accepted: 10/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Cryoballoon (CB) and radiofrequency (RF) ablation techniques have similar outcomes for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). However, there is limited data about the impact of different ablation strategies in patients with left common pulmonary vein (LCPV). Our aim was to compare the safety and efficacy of RF and CB ablation in AF patients with LCPV. METHODS One hundred and twenty-seven (n = 80 CB and n = 47 RF) AF patients with LCPV detected by preprocedural computerized tomography (CT) were included in the study. Ostial dimensions and trunk distance were measured in all patients. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period. RESULTS There was no significant difference in acute procedural success rates for PVI (97.5% in CB and 97.9% in RF, respectively, P = 0.953) and complication rates were similar between the groups (6 (7.5%) in CB and 4 (8.5%) in RF, respectively, P = 1.000). During a median follow-up of 20.7 (4.8-50.2) months for CB and 20.5 (6.2-36.0) months for RF, ATa recurrence was 35.0% and 38.2%, respectively (P = 0.777). Multivariate analysis did not reveal any of the morphologic parameters of LCPV as a significant predictor of ATa recurrence. CONCLUSIONS Our findings demonstrated that both CB and RF ablation techniques have similar efficacy and safety in AF patients with LCPV during the mid-term follow-up.
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12
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Schaerli N, Badertscher P, Spies F, Madaffari A, Osswald S, Sticherling C, Kühne M, Knecht S. A Simplified Method to Detect Phrenic Nerve Injury During Cryoballoon Ablation of Atrial Fibrillation Using Lead aVF of the Surface ECG. Circ Arrhythm Electrophysiol 2021; 14:e009986. [PMID: 34397268 DOI: 10.1161/circep.121.009986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nicolas Schaerli
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Florian Spies
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Antonio Madaffari
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology/Electrophysiology (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland.,Cardiovascular Research Institute Basel (CRIB) (N.S., P.B., F.S., A.M., S.O., C.S., M.K., S.K.), University Hospital Basel, Switzerland
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13
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Kühne M, Knecht S, Spies F, Aeschbacher S, Haaf P, Zellweger M, Schaer B, Osswald S, Sticherling C. Cryoballoon Ablation of Atrial Fibrillation Without Demonstration of Pulmonary Vein Occlusion-The Simplify Cryo Study. Front Cardiovasc Med 2021; 8:664538. [PMID: 34124199 PMCID: PMC8187607 DOI: 10.3389/fcvm.2021.664538] [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: 02/05/2021] [Accepted: 05/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background: The demonstration of pulmonary vein (PV) occlusion is routinely performed and considered a prerequisite for successful cryoballoon (CB) ablation of atrial fibrillation (AF). The purpose of this study was to assess the feasibility and impact on procedural parameters and outcome of a standardized procedural protocol without demonstrating PV occlusion. Methods and Results: Consecutive patients undergoing CB pulmonary vein isolation (PVI) were studied. After cMRI assessment, patients treated by PVI using a novel no-contrast (NC) protocol without routine contrast injections to demonstrate PV occlusion (NC group) were compared to patients undergoing PVI with contrast injections to demonstrate PV occlusion (standard group). One hundred patients with paroxysmal or persistent AF (age 61 ± 10 years, ejection fraction 59 ± 11%, left atrial volume index 37.2 ± 2.0 mL/m2) were studied. The NC protocol was feasible in 72 of 75 patients (96%). Total procedure time and fluoroscopy time were 64.0 ± 14.1 min and 11.0 ± 4.6 min in the NC group and 92.0 ± 25.3 min and 18.0 ± 6.0 min in the standard group, respectively (all p < 0.001). Dose area product was 368 ± 362 cGy*cm2 in the NC group compared to 1928 ± 1541 cGy*cm2 in the standard group (p < 0.001). Forty-five of 75 patients (60%) in the NC group and 16 of 25 patients (64%) in the standard group remained in stable sinus rhythm after a single PVI and a 1-year follow-up (p = 0.815). Conclusions: Performing CB ablation without using contrast injections to demonstrate PV occlusion was feasible, resulted in reduced radiation exposure, and increased the efficiency of the procedure.
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Affiliation(s)
- Michael Kühne
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Florian Spies
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | | | - Philip Haaf
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Michael Zellweger
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Beat Schaer
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital of Basel, Basel, Switzerland
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14
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Bose A, Chevli PA, Berberian G, Januszkiewicz J, Ahmad G, Hashmath Z, Mishra AK, Laidlaw D. Presence of a left common pulmonary vein and pulmonary vein anatomical characteristics as predictors of outcome following cryoballoon ablation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 62:409-417. [PMID: 33206281 DOI: 10.1007/s10840-020-00916-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/10/2020] [Indexed: 01/12/2023]
Abstract
PURPOSE Pulmonary vein (PV) isolation using cryoballoon ablation (CBA) is a common therapy for patients with drug-refractory paroxysmal atrial fibrillation (PAF). However, initial CBA is successful in only 70-80% of patients. The role of an atypical left common PV (LCPV) and PV anatomical indices on CBA outcomes remains unclear. METHODS We followed 80 patients (age 60.7 ± 9.7, 31 % women) with PAF undergoing CBA for 1-year post-procedure for the development of recurrent atrial arrhythmias (AA). Recurrence was assessed by documented AA on EKG or any form of long-term cardiac rhythm monitoring. The presence of an LCPV and individual PV diameters were evaluated using cardiac CT. Based on the maximum and minimum PV ostial diameters, the eccentricity index (EI), ovality index (OI), and PV ostial area (PVA) were calculated for all the veins. A multivariable Cox-proportional hazard model assessed whether the presence of an LCPV or PV anatomic indices (EI, OI, and PVA) predicted recurrence of AA following CBA. RESULTS After 1-year follow-up, 19 (23.7%) participants developed recurrence of AA. On multivariable regression, the presence of an LCPV did not predict the recurrence of AA (p = 0.38). Among the PV anatomical indices, on univariate analysis, only the area of the left inferior PV showed a trend towards predicting recurrence, though this result was not significant on multivariate analysis (p = 0.09). CONCLUSIONS In patients with PAF, neither the presence of an LCPV nor individual PV anatomical indices predicted recurrence of AA following CBA.
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Affiliation(s)
- Abhishek Bose
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, 01604, USA.
| | - Parag A Chevli
- Section of Hospital Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | | | | | - Ghasan Ahmad
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD, USA
| | - Zeba Hashmath
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Ajay K Mishra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA
| | - Douglas Laidlaw
- Division of Cardiology, Saint Vincent Hospital, Worcester, MA, 01604, USA
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15
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Vaishnav AS, Alderwish E, Coleman KM, Saleh M, Makker P, Bhasin K, Bernstein NE, Skipitaris NT, Mountantonakis SE. Anatomic predictors of recurrence after cryoablation for atrial fibrillation: a computed tomography based composite score. J Interv Card Electrophysiol 2020; 61:293-302. [PMID: 32602004 DOI: 10.1007/s10840-020-00799-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Effective pulmonary vein isolation (PVI) with cryoablation depends on adequate occlusion of pulmonary veins (PV) by the cryoballoon and is therefore likely to be affected by PV and left atrial (LA) anatomical characteristics and variants. Thus, the objective of this study was to investigate the effect of LA and PV anatomy, evaluated by computed tomography (CT), on acute and long-term outcomes of cryoablation for atrial fibrillation (AF). METHODS Fifty-eight patients (64.72 + 9.44 years, 60.3% male) undergoing cryoablation for paroxysmal or early persistent AF were included. Pre-procedural CT images were analyzed to evaluate LA dimensions and PV anatomical characteristics. Predictors of recurrence were identified using regression analysis. RESULTS 60.3% of patients had two PVs on each side with separate ostia, whereas 29.3% and 10.3% had right middle and left common PVs, respectively. The following anatomic characteristics were found to be independent predictors of recurrence: right superior PV ostial max:min diameter ratio > 1.32, left superior PV ostial max:min diameter ratio > 1.2, right superior PV antral circumference > 69.1 mm, right inferior PV antral circumference > 61.38 mm, right superior PV angle > 22.7°. Using these factors, LA diameter and right middle PV, a scoring model was created for prediction of "unfavorable" LA-PV anatomy (AUC = 0.867, p = 0.000009, score range = 0-7). Score of ≥ 4 predicted need for longer cryoenergy ablation (p = 0.039) and more frequent switch to radiofrequency energy (p = 0.066) to achieve PVI, and had a sensitivity of 83.3% and specificity of 82.5% to predict clinical recurrence. CONCLUSION CT-based scoring system is useful to identify "unfavorable" anatomy prior to cryo-PVI, which can result in procedural difficulty and poor outcomes.
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Affiliation(s)
- Aditi S Vaishnav
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Edris Alderwish
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kristie M Coleman
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Moussa Saleh
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Parth Makker
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Kabir Bhasin
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Neil E Bernstein
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Nicholas T Skipitaris
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA
| | - Stavros E Mountantonakis
- Division of Cardiac Electrophysiology, Department of Cardiology, Northwell Health- Lenox Hill Heart and Lung, 100 East 77th Street, 2 Lachman, New York, NY, 10075, USA.
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16
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Huang HD, Pietrasik G, Abid QUA, Sharma PS, Krishnan K, Larsen TR, Trohman RG. Supplemental Radiofrequency Ablation After Acutely Unsuccessful Cryoballoon Pulmonary Vein Isolation is Associated With Increased Risk of Recurrent Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015979. [PMID: 32394797 PMCID: PMC7660892 DOI: 10.1161/jaha.120.015979] [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] [Indexed: 12/03/2022]
Abstract
Background Cryoballoon (CB) ablation is widely performed for pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF). Anatomic variations in patient pulmonary vein (PV) anatomy are believed to impact short‐ and long‐term procedural success of CB PVI. Methods and Results We hypothesized that failure of initial PV isolation with a standard technique (ie, requiring >2 freeze cycles per PV and/or radiofrequency ablation [RFA] to achieve PV isolation) during index CB PVI procedures would be associated with decreased freedom from AF. We examined a cohort of 177 consecutive patients with drug‐refractory AF who underwent CB PVI with a 28‐mm balloon second‐generation CB device. Mean follow‐up time was 19±9 months. Forty‐three patients had AF recurrence after the 90‐day blanking period after ablation. In 40 patients, acute isolation of one or more PVs could not be achieved by CB ablation with the standard technique (single freeze with or without bonus freeze). To obtain complete acute PVI, 15 patients received extra freeze applications, 20 required supplemental RFA, and 5 received both extra freeze applications and supplemental RFA. Multivariate regression analysis revealed supplemental RFA use during index CB PVI procedures was independently associated with a threefold increased risk of AF recurrence (adjusted hazard ratio, 3.01; 1.45–10.87; P=0.003). Conclusions Use of supplemental RFA during CB PVI procedures to assist with isolation of one or more PVs was independently associated with increased risk of AF recurrence. Use of additional freezes to achieve PVI did not increase the risk for recurrent AF.
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Affiliation(s)
- Henry D Huang
- Division of Cardiology Rush University Medical Center Chicago IL
| | | | | | | | - Kousik Krishnan
- Division of Cardiology Rush University Medical Center Chicago IL
| | - Timothy R Larsen
- Division of Cardiology Rush University Medical Center Chicago IL
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17
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Abstract
Cryoballoon ablation for the treatment of atrial fibrillation has established itself as an effective and efficient modality for achieving pulmonary vein isolation. Over the past 13 years more than 100,000 Cryoballoon ablation procedures have been performed with the first to fourth generation cryoballoons. Over that time there have been significant advances in our understanding regarding the optimal procedural techniques. The purpose of this "topic in review" is to focus on the practical aspects of performing a Cryoballoon ablation procedure, within the context of the contemporary literature. Specifically there is a focus on how contemporary studies can inform clinical decision making and ensure operators are able to perform a safe and effective procedure.
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Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada.,Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, Canada.,Center for Cardiovascular Innovation, Vancouver, Canada
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18
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Borio G, Maj R, Alessandro R, Stroker E, Sieira J, Osorio TG, Galli A, Terasawa M, Bala G, Al Housari M, Paparella G, Iacopino S, Overeinder I, Brugada P, de Asmundis C, Chierchia GB. Pulmonary veins anatomical determinants of cooling kinetics during second-generation cryoballoon ablation. J Cardiovasc Electrophysiol 2020; 31:629-637. [PMID: 31943519 DOI: 10.1111/jce.14356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to investigate the role of anatomical characteristics of the pulmonary veins (PVs) determining cooling kinetics during second-generation cryoballoon ablation (CbA). METHODS AND RESULTS we enrolled all consecutive patients who underwent CbA for symptomatic atrial fibrillation in our center from January 2019 to March 2019. All patients had complete computed tomography scans of the heart before the ablation. Anatomical characteristics were tested for prediction of a nadir temperature (NT) ≤ -48°C. Significant differences were noted among PV max diameter (20.8 ± 2.8 vs 18.5 ± 2.5 mm; P < .001); PV minimum diameter (15.2 ± 3.0 vs 13.0 ± 3.1 mm; P < .001); PV area (268.1 ± 71.9 vs 206.2 ± 58.7 mm2 ; P < .001); PV ovality (1.4 ± 0.3 vs 1.5 ± 0.3; P = .005); and PV trunk length (27.4 ± 7.4 vs 21.3 ± 6.5 mm; P < .001). A scoring system was created by assigning one point each ranging from 0 (best anatomical combination) to 5. In the group with a score of 0, 94.0% of the CbA could reach a NT ≤ -48°C whereas with a score of 5, only 29.0% (P < .001). Left superior pulmonary vein with short trunk length and acute angle of PV branch was significantly associated with warmer NT (11.8% satisfactory CbA; P = .003). Regarding right inferior pulmonary vein, trunk length (P = .004), maximum diameter (P = .044), and transverse angle (P = .008) were independently associated with good NT. CONCLUSION Anatomical PV features are associated with cooling kinetics and an anatomical score could predict lower NT during second-generation CbA. Specific characteristics were identified for inferior PV. Although heart imaging is not mandatory prior CbA, it can be a useful tool to predict cooling kinetics.
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Affiliation(s)
- Gianluca Borio
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Riccardo Maj
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Rizzo Alessandro
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Erwin Stroker
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Thiago G Osorio
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Alessio Galli
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Muryo Terasawa
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Gruppo Villa Maria, Villa Maria Cecilia Hospital, Cotignola, Italy
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Gian B Chierchia
- Heart Rhythm Management Centre, Postgraduate Course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium
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19
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Kurokawa S, Nagashima K, Watanabe R, Arai M, Wakamatsu Y, Otsuka N, Yagyu S, Nakai T, Okumura Y. Optimal diameter of the pulmonary vein ostium for second‐generation 28‐mm cryoballoon ablation of atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:201-209. [DOI: 10.1111/pace.13867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 12/10/2019] [Accepted: 12/25/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Masaru Arai
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Seina Yagyu
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
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20
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Yorgun H, Canpolat U, Gümeler E, Okşul M, Şener YZ, Ateş AH, Akkaya F, Karahan S, Hazırolan T, Aytemir K. Immediate and long-term outcomes of cryoballoon catheter ablation in patients with atrial fibrillation and left common pulmonary vein anatomy. J Interv Card Electrophysiol 2019; 59:57-65. [PMID: 31811460 DOI: 10.1007/s10840-019-00676-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The efficacy of cryoballoon (CB) for atrial fibrillation (AF) ablation is still debatable in case of anatomical variations like left common pulmonary vein (LCPV). We aimed to assess the impact of LCPV trunk on the acute and long-term clinical outcomes in patients with CB based AF ablation. METHODS We compared a total of 82 AF patients (62.5% paroxysmal and 37.5% persistent) who underwent pulmonary vein isolation using CB (LCPV+ group) with a propensity score-matched cohort of 76 AF patients (LCPV- group) (61.8% paroxysmal and 38.2% persistent). Preprocedural computed tomography was performed in all patients and ostial dimensions and trunk distance were measured. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period. RESULTS Acute procedural success was similar between the groups (100% and 98.7% for LCPV- and LCPV+, respectively, P = 0.991). Overall, 22/76 (28.9%) patients in LCPV- and 21/82 (25.6%) patients in LCPV+ had ATa recurrence at a mean follow-up of 31 ± 15 months (P = 0.770). A multivariate analysis identified only the left atrial (LA) diameter as a predictor of recurrent ATs (HR, 3.28; 95% CI, 1.67-6.41; P = 0.001). In the LCPV+ group, patients with single application had higher ATa recurrence (8/18 patients) compared with sequential freeze group (13/64 patients) (P = 0.042). CONCLUSIONS Our findings indicated that CB was an effective tool in patients with LCPV and freedom from ATa was similar between LCPV- and LCPV+ groups. Only LA diameter predicted the ATa recurrence during long-term follow-up.
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Affiliation(s)
- Hikmet Yorgun
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey. .,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Uğur Canpolat
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Ekim Gümeler
- Department of Radiology, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
| | - Metin Okşul
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Yusuf Ziya Şener
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Ahmet Hakan Ateş
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Fatih Akkaya
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
| | - Tuncay Hazırolan
- Department of Radiology, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
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21
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Terasawa M, Chierchia G, Takarada K, Rizzo A, Maj R, Borio G, Osório TG, Scala O, Galli A, Al Housari M, Tanaka K, Sieira J, Brugada P, Asmundis C, Ströker E. Anatomic predictors of late right inferior pulmonary vein reconnection in the setting of second‐generation cryoballoon ablation. J Cardiovasc Electrophysiol 2019; 30:2294-2301. [DOI: 10.1111/jce.14186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/19/2019] [Accepted: 09/11/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Muryo Terasawa
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Gian‐Battista Chierchia
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Ken Takarada
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Alessandro Rizzo
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Riccardo Maj
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Gianluca Borio
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Oriana Scala
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Alessio Galli
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Kaoru Tanaka
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Carlo Asmundis
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel Brussels Belgium
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22
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Akkaya E, Berkowitsch A, Greiss H, Hamm CW, Sperzel J, Neumann T, Kuniss M. PLAAF score as a novel predictor of long-term outcome after second-generation cryoballoon pulmonary vein isolation. Europace 2019; 20:f436-f443. [PMID: 29161372 DOI: 10.1093/europace/eux295] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 08/28/2017] [Indexed: 02/03/2023] Open
Abstract
Aims Predictors of atrial arrhythmia recurrence have not been described in a long-term follow-up study of patients undergoing pulmonary vein isolation (PVI) using the cryoballoon technique. We aimed to evaluate the efficacy of a second-generation cryoballoon and identify pre-procedural predictors of 3-year outcome after PVI. Methods and results For this observational cohort study, we enrolled 440 patients ablated at our institution with a second-generation cryoballoon. The endpoint was the first documented recurrence (>30 s) of atrial fibrillation (AF), atrial flutter, or atrial tachycardia after a 3-month blanking period. The impact of several pre-existing variables on clinical outcome was evaluated by univariate and multivariate analyses using the Cox proportional hazards regression model. The PLAAF (persistent AF, left atrial area, abnormal PV anatomy, AF history, female gender) score was defined to predict outcome. After a median follow-up of 36 months (interquartile range 25/75-27/42), the endpoint was achieved in 95 of 440 (21.6%) patients. Cox regression analysis showed that persistent AF, left atrial (LA) area, abnormal PV anatomy, AF history, and female gender independently predicted recurrence. The calculated optimal cut-offs for LA area and AF history were 21 cm2 and 3 years, respectively. Patients with a PLAAF score of 0 showed the best outcome, with an arrhythmia-free survival of 86.7%. Conclusion PVI using the cryoballoon technique shows acceptable long-term results depending on predictors described by the new PLAAF score, which may facilitate patient selection for PVI.
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Affiliation(s)
- Ersan Akkaya
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Alexander Berkowitsch
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Harald Greiss
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Christian W Hamm
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany.,Medical Clinic I, Justus-Liebig University, Giessen, Germany
| | - Johannes Sperzel
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Thomas Neumann
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
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23
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Pulmonary vein reconnection following cryo-ablation: Mind the "Gap" in the carinae and the left atrial appendage ridge. Indian Pacing Electrophysiol J 2019; 19:125-128. [PMID: 31351896 PMCID: PMC6697485 DOI: 10.1016/j.ipej.2019.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/17/2019] [Indexed: 11/20/2022] Open
Abstract
Pulmonary vein (PV) isolation (PVI) remains cornerstone to ablation of atrial fibrillation (AF). For effective and durable PVI and thus fewer AF recurrences, lesion gaps in transmurality and contiguity responsible for PV reconnection (PVR) could only be addressed when one is cognizant of the potential location and sites where these lesion characteristics may be more prevalent and responsible for PVR. In the case of RF ablation, newer technologies incorporating contact force, time and power with automated monitoring of lesion formation, paying attention to difficult areas (carinae, left superior PV-LAA ridge, right inferior PV) and measuring inter-lesion distance may provide the tools to reduce PVR. On the other hand, the improved thermodynamic characteristics of the latest generation of cryoballloons and operator dexterity to achieve better PV occlusion, may be crucial determinants towards the direction of reduced PVR. Whether newer visualization tools, more vigilant testing during the index ablation procedure in these particular regions, prolonging or adding cryothermic applications, waiting longer to test for entrance and exit block, and/or use of provocative drug testing (isoproterenol/adenosine challenge) might help prevent future PVRs awaits further studies.
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24
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Wakamatsu Y, Nagashima K, Nakahara S, Iso K, Watanabe R, Arai M, Otsuka N, Yagyu S, Kurokawa S, Ohkubo K, Nakai T, Okumura Y. Electrophysiologic and anatomic factors predictive of a need for touch‐up radiofrequency application for complete pulmonary vein isolation: Comparison between hot balloon‐ and cryoballoon‐based ablation. J Cardiovasc Electrophysiol 2019; 30:1261-1269. [DOI: 10.1111/jce.13989] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/30/2019] [Accepted: 05/16/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Yuji Wakamatsu
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Koichi Nagashima
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Shiro Nakahara
- Department of CardiologyDokkyo Medical University Saitama Medical Center Koshigaya Japan
| | - Kazuki Iso
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Ryuta Watanabe
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Masaru Arai
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Naoto Otsuka
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Seina Yagyu
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Sayaka Kurokawa
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Kimie Ohkubo
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Toshiko Nakai
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of MedicineNihon University School of Medicine Tokyo Japan
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25
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Long-term outcomes of cryoballoon pulmonary vein isolation for paroxysmal and persistent atrial fibrillation in Chinese patients. J Interv Card Electrophysiol 2019; 57:425-434. [PMID: 31016428 DOI: 10.1007/s10840-019-00542-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE We aimed to study the long-term outcomes of cryoballoon (CB) pulmonary vein isolation (PVI) in treating Chinese patients with atrial fibrillation (AF). METHODS A total of 122 patients (48 women, mean age 57.4 ± 11.3) underwent CB PVI (first generation CB 44.3%, second generation CB 55.7%) for AF (paroxysmal 65.6%, persistent 10.7% and long-standing persistent 23.8%). RESULTS PVI was achieved in 113 (92.6%) patients with CB alone, and it was achieved in all patients with additional touch-up by 8-mm-tip cryocatheter. The mean procedural and fluoroscopic duration were 171.9 ± 41 and 46.6 ± 14.6 min respectively. The recurrence-free survival for paroxysmal and non-paroxysmal AF was 77% and 59% respectively at 1 year and progressively declined over time to reach a plateau of 52% and 30% for paroxysmal and non-paroxysmal AF respectively at 5 years. In patients undergoing PVI with second-generation CB, the recurrence-free survival was 75% for paroxysmal AF and 45% for non-paroxysmal AF at 5 years. With multivariate Cox regression analysis, the types of CB (use of second-generation CB: HR 0.49; 95% CI 0.28-0.85; p = 0.011) and size of left atrium (LA) (larger LA size: HR 1.52; 95% CI 1-2.14; p = 0.017) independently predicted recurrence. Transient phrenic nerve injury (PNI) occurred in four (3.3%) patients and persistent PNI occurred in four (3.3%) patients. Other complications occurred in 10 (8.2%) patients with no procedure-related death. CONCLUSIONS Long-term success of CB PVI for AF declined over time and reached a plateau at 5 years. CB types and LA size are independent predictors for long-term recurrence.
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26
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Mulder BA, Al-Jazairi MIH, Arends BKO, Bax N, Dijkshoorn LA, Sheikh U, Tan ES, Wiesfeld ACP, Tieleman RG, Vliegenthart R, Rienstra M, van Gelder IC, Blaauw Y. Pulmonary vein anatomy addressed by computed tomography and relation to success of second-generation cryoballoon ablation in paroxysmal atrial fibrillation. Clin Cardiol 2019; 42:438-443. [PMID: 30756396 PMCID: PMC6712315 DOI: 10.1002/clc.23163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/10/2019] [Indexed: 02/02/2023] Open
Abstract
Background Cryoballoon isolation is considered a safe and effective treatment for atrial fibrillation (AF). However, recurrence of AF after first cryoballoon ablation occurs in ~30% of patients. Pre‐procedurally identifying patients at risk of AF recurrence could be beneficial. Hypothesis Our aim was to determine how pulmonary vein (PV) anatomy influences the recurrence of AF using the second‐generation cryoballoon in patients with paroxysmal AF. Methods We included 88 consecutive patients with paroxysmal AF undergoing PVI procedure with a second‐generation 28‐mm cryoballoon. All patients were evaluated at 3, 6 and 12 months using a 12‐lead ECG and 24‐hour Holter monitoring. PV anatomy was assessed by creating three‐dimensional models using computed tomography (CT) segmentations of the left atrium. Results Fifty‐one patients (61%) had left PVs with a shared carina, 35 patients (42%) had a shared right carina. Nine patients (11%) were classified having a right middle PV. In total 17 (20.2%) of patients had a left common PV. At 12 months, 14 patients (17%) had experienced AF recurrence. Neither PV ovality, variant anatomy, the presence of shared carina nor a common left PV was a predictor for AF recurrence. Conclusions No specific characteristics of PV dimensions nor morphology were associated with AF recurrence after cryoballoon ablation in patients with paroxysmal AF.
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Affiliation(s)
- Bart A Mulder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Meelad I H Al-Jazairi
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bauke K O Arends
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niels Bax
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Leonard A Dijkshoorn
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Uzaifa Sheikh
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eng S Tan
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ans C P Wiesfeld
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert G Tieleman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Cardiology, Martini Hospital, Groningen, The Netherlands
| | - Rozemarijn Vliegenthart
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Michiel Rienstra
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Isabelle C van Gelder
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yuri Blaauw
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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27
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Analysis of the anatomical features of pulmonary veins on pre-procedural cardiac CT images resulting in incomplete cryoballoon ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2019; 13:118-127. [DOI: 10.1016/j.jcct.2018.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/20/2018] [Accepted: 11/11/2018] [Indexed: 11/18/2022]
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28
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Impact of anatomical features of the left atrial appendage on outcomes after cryoablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2019; 13:105-112. [PMID: 30639114 DOI: 10.1016/j.jcct.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 11/20/2018] [Accepted: 01/03/2019] [Indexed: 11/22/2022]
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29
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Moore BM, Sy RW. Cryoballoon Versus Radiofrequency Ablation for Atrial Fibrillation - Is There a Role for Individualised Patient Selection? Heart Lung Circ 2018; 28:511-518. [PMID: 30528213 DOI: 10.1016/j.hlc.2018.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 11/09/2018] [Accepted: 11/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Benjamin M Moore
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Raymond W Sy
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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Center experience does not influence long-term outcome and peri-procedural complications after cryoballoon ablation of paroxysmal atrial fibrillation: Data on 860 patients from the real-world multicenter observational project. Int J Cardiol 2018; 272:130-136. [PMID: 30045822 DOI: 10.1016/j.ijcard.2018.07.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/13/2018] [Accepted: 07/09/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of this research was to evaluate whether the procedural data, the incidence of complications, and the long-term freedom from atrial fibrillation (AF) recurrences are influenced by center experience in a paroxysmal AF (PAF) population performing a first-time pulmonary vein isolation (PVI) by cryoballoon ablation (CBA). METHODS A total of 860 patients underwent PVI by CBA. Center experience groups were predefined according to the quartiles of the distribution regarding the amount of performed procedures: 3.1%, 10.6%, 22.7% and 63.6% of patients were respectively followed in each group from 1st (less experienced) to 4th (more experienced) quartile of experience. RESULTS In the entire population, median procedure and fluoroscopy time were 105 and 25 min, respectively. The median procedure time significantly decreased from 130 to 90 min (P < 0.001) as the center's experience increased. In 47 (5.5%) patients, a peri-procedural complication occurred. As the experience of centers increased, the acute intraprocedural PVI success rate increased (from 94.3% to 98.9%, P = 0.007), whereas there was a tendency towards a decreased incidence of peri-procedure complications (from 7.4% to 4.6%, P = 0.998). The mean 1-year freedom from AF recurrence probability was 78.3%, and the 18-month mean was 68.9% with no difference among the groups with different levels of experience. CONCLUSION CBA is a safe and effective treatment for patients with PAF. Peri-procedural complications and procedural times were low in all the analyzed sub-groups, showing a decreasing trend in function of center expertise. The long-term freedom from AF recurrence was not influenced by the level of experience. (clinicaltrials.gov: NCT01007474).
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Kocyigit D, Yalcin MU, Gurses KM, Selin Ardali, Turk G, Canpolat U, Evranos B, Yorgun H, Hazirolan T, Aytemir K. Pulmonary vein orientation is independently associated with outcomes following cryoballoon-based atrial fibrillation ablation. J Cardiovasc Comput Tomogr 2018; 12:281-285. [PMID: 29500095 DOI: 10.1016/j.jcct.2018.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 01/13/2018] [Accepted: 01/23/2018] [Indexed: 01/10/2023]
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Chen X, Fang P, Liu Z, He J, Tang M, Liu J, Lu B, Zhang S. Pulmonary Vein Anatomy is Associated with Cryo Kinetics during Cryoballoon Ablation for Atrial Fibrillation. Arq Bras Cardiol 2018; 110:440-448. [PMID: 29898044 PMCID: PMC5967138 DOI: 10.5935/abc.20180071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 11/09/2017] [Indexed: 11/24/2022] Open
Abstract
Background The influence of pulmonary vein (PV) anatomy on cryo kinetics during
cryoballoon (CB) ablation is unclear. Objective To investigate the relationship between PV anatomy and cryo kinetics during
CB ablation for atrial fibrillation (AF). Methods Sixty consecutive patients were enrolled. PV anatomy, including ostial
diameters (long, short and corrected), ratio between short and long
diameters, ostium shape (round, oval, triangular, and narrow), and drainage
pattern (typical, with common trunk, common antrum, ostial branch and
supernumerary PV) were evaluated on multi-detector computed tomography
(MDCT) images pre-procedure. Cryo kinetics parameters [balloon freeze
time from 0 to -30ºC (BFT), balloon nadir temperature (BNT) and
balloon warming time from -30 to +15ºC (BWT)] were recorded
during procedure. All p values are two-sided, with values of p < 0.05
considered to be statistically significant. Results 606 times of freezing cycle were accomplished. Moderate negative correlation
was documented between BNT and corrected PV diameter (r = -0.51, p <
0.001) when using 23-mm CBs, and mild negative correlation (r = - 0.32, p =
0.001) was found when using 28-mm CBs. Multivariate logistic regression
analysis revealed that PV corrected ostial diameter (OR, 1.4; p = 0.004)
predicted a BNT < -51ºC when using 23-mm CBs, while PV ostium oval
shape (OR, 0.3; p = 0.033) and PV locations (left inferior PV: OR, 0.04; p =
0.005; right superior PV: OR, 4.3; p = 0.025) predicted BNT <
-51ºC when using 28-mm CBs. Conclusions MDCT can provide PV anatomy accurate evaluation prior CB ablation. PV anatomy
is associated with cryo kinetics during ablation.
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Affiliation(s)
- Xiongbiao Chen
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Pihua Fang
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Zheng Liu
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Jia He
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Min Tang
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Jun Liu
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Bin Lu
- Department of Radiology - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Disease - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
| | - Shu Zhang
- Department of Cardiac Arrhythmia - State Key Laboratory of Cardiovascular Disease - Fuwai Hospital - National Center for Cardiovascular Diseases - Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing - China
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Impact of an additional right pulmonary vein on second-generation cryoballoon ablation for atrial fibrillation: a propensity matched score study. J Interv Card Electrophysiol 2018; 54:1-8. [PMID: 29679186 DOI: 10.1007/s10840-018-0373-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 04/10/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Cryoballoon (CB) technology in the context of anatomical pulmonary vein (PV) variants might hypothetically hamper successful PV isolation (PVI). Our aim was to assess the impact of a right middle PV (RMPV) in the setting of second-generation cryoballoon (CB advance-CB-A), on procedural parameters and on mid-term follow-up. METHODS Consecutive patients with AF presenting RMPV (RMPV+) at the pre-procedural computed tomography who underwent PVI by CB-A were enrolled. Comparison with propensity score-matched patients without RMPV (RMPV-) was performed. Acute procedural parameters and clinical follow-up were assessed. RESULTS A total of 240 patients (80 RMPV+) were included in the analysis. Twelve of 80 (15%) RMPV+ patients underwent a direct cryo-application in this variant and accomplished the isolation without phrenic nerve palsy, whereas in 25 of 80 (31%) RMPV+ patients, the RMPVs were not targeted directly nor indirectly (by co-occlusion during application at a major PV). At a median follow-up of 17.3 [interquartile range 11.3-26.5] months, there was no significant difference in AF-free survival between RMPV+ and RMPV- patients (78.8 vs 78.1%, P = 1.00), and the recurrence of atrial arrhythmias among patients with versus without an intentional or indirect cryo-application to the RMPV was not different (22 vs 20%, P = 1.00). CONCLUSIONS Mid-term outcome after CB-A ablation did not differ between RMPV+ and RMPV- patients. Within RMPV+ patients, outcome was similar between those with versus without a cryo-application (either direct or indirect) to the additional vein.
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Boveda S. Cryoballoon ablation in atrial fibrillation: Advantages and drawbacks. Rev Port Cardiol 2017; 36 Suppl 1:19-24. [PMID: 29108897 DOI: 10.1016/j.repc.2017.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/18/2017] [Accepted: 09/11/2017] [Indexed: 11/15/2022] Open
Abstract
Pulmonary vein isolation is the cornerstone of atrial fibrillation ablation and is effective for preventing arrhythmias recurrences, especially in patients with paroxysmal atrial fibrillation. During the last years, cryoballoon ablation has emerged as an unquestionable alternative approach to radiofrequency ablation. Many non-randomized and randomized trials have proven undoubtedly that cryoballoon ablation displays similar efficacy and overall safety profile, when compared to radiofrequency ablation for the treatment of patients with drug-refractory paroxysmal atrial fibrillation. These results have been obtained in all types of pulmonary veins anatomical subsets, which confirms that there is no need to select patients according to the latter. The value of cryoablation in the setting of short persistent atrial fibrillation still needs more evidence. Importantly, cryoballoon ablation seems to be less operator-dependent and more reproducible than radiofrequency for the isolation of pulmonary veins.
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Affiliation(s)
- Serge Boveda
- Département de Rythmologie, Clinique Pasteur, Toulouse, France.
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Cryoballoon ablation in atrial fibrillation: Advantages and drawbacks. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zhao A, Squara F, Marijon E, Thomas O. Two-year clinical outcome after a single cryoballoon ablation procedure: A comparison of first- and second-generation cryoballoons. Arch Cardiovasc Dis 2017; 110:543-549. [DOI: 10.1016/j.acvd.2017.01.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 11/25/2022]
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Khoueiry Z, Providencia R, Combes S, Combes N, Pasquie JL, Albenque JP, Boveda S. Cryoablation of paroxysmal atrial fibrillation displayed the same results as radiofrequency despite anatomical variants of pulmonary veins. Europace 2017; 19:1754-1755. [PMID: 27733475 DOI: 10.1093/europace/euw277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ziad Khoueiry
- INSERM U1046, Université Montpellier1, Université Montpellier2, Montpellier, France.,Service de Cardiologie, CHRU Montpellier, 329 Avenue du Major Flandre, Montpellier 34090, France
| | | | | | - Nicolas Combes
- Rhythmologie Department, Clinique Pasteur, Toulouse, France
| | - Jean Luc Pasquie
- INSERM U1046, Université Montpellier1, Université Montpellier2, Montpellier, France.,Service de Cardiologie, CHRU Montpellier, 329 Avenue du Major Flandre, Montpellier 34090, France
| | | | - Serge Boveda
- Rhythmologie Department, Clinique Pasteur, Toulouse, France
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Efficacy and safety of cryoballoon ablation versus radiofrequency catheter ablation in atrial fibrillation: an updated meta-analysis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:240-249. [PMID: 29056997 PMCID: PMC5644043 DOI: 10.5114/aic.2017.70196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Cryoballoon ablation (CBA) and irrigated radiofrequency catheter ablation (RFCA) are the main treatments for drug-refractory symptomatic atrial fibrillation (AF). Aim To compare the efficacy and safety between CBA and RFCA for the treatment of AF. Material and methods We searched the Embase and Medline databases for clinical studies published up to December 2016. Studies that satisfied our predefined inclusion criteria were included. Results After searching through the literature in the two major databases, 20 studies with a total of 9,141 patients were included in our study. The CBA had a significantly shorter procedure time (weighted mean difference (WMD) –30.38 min; 95% CI: –46.43 to –14.33, p = 0.0002) and non-significantly shorter fluoroscopy time (WMD –3.18 min; 95% CI: –6.43 to 0.07, p = 0.06) compared with RFCA. There was no difference in freedom from AF between CBA and RFCA (CBA 78.55% vs. RFCA 83.13%, OR = 1.15, 95% CI: 0.95–1.39, p = 0.14). The CBA was associated with a high risk of procedure-related complications (CBA 9.02% vs. RFCA 6.56%, OR = 1.56, 95% CI: 1.05–2.31, p = 0.03), especially phrenic nerve paralysis (PNP, OR = 10.72, 95% CI: 5.59–20.55, p < 0.00001). The risk of pericardial effusions/cardiac tamponade was low in the CBA group (CBA 1.05% vs. RFCA 1.86%, OR = 0.62, 95% CI: 0.41–0.93, p = 0.02). Conclusions For AF, CBA was as effective as RFCA. However, CBA had a shorter procedure time and a non-significantly shorter fluoroscopy time, a significantly high risk of PNP and a low incidence of pericardial effusions/cardiac tamponade compared with RFCA.
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Shakkottai P, Sy RW, McGuire MA. Cryoablation for Atrial Fibrillation in 2017: What Have We Learned? Heart Lung Circ 2017; 26:950-959. [DOI: 10.1016/j.hlc.2017.05.115] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/02/2017] [Indexed: 01/25/2023]
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Kühne M, Knecht S, Sticherling C. Cryoballoon ablation: The pure and simple truth about the left common ostium? Heart Rhythm 2017; 14:1119-1120. [DOI: 10.1016/j.hrthm.2017.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Indexed: 10/19/2022]
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Shigeta T, Okishige K, Yamauchi Y, Aoyagi H, Nakamura T, Yamashita M, Nishimura T, Ito N, Tsuchiya Y, Asano M, Shimura T, Suzuki H, Kurabayashi M, Keida T, Sasano T, Hirao K. Clinical assessment of cryoballoon ablation in cases with atrial fibrillation and a left common pulmonary vein. J Cardiovasc Electrophysiol 2017; 28:1021-1027. [DOI: 10.1111/jce.13267] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/23/2017] [Accepted: 05/29/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Takatoshi Shigeta
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Kaoru Okishige
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Yasuteru Yamauchi
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Hideshi Aoyagi
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Tomofumi Nakamura
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Mitsumi Yamashita
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Takuro Nishimura
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Naruhiko Ito
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Yusuke Tsuchiya
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Mitsutoshi Asano
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Tsukasa Shimura
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | - Hidetoshi Suzuki
- Heart Center; Yokohama-City Bay Red Cross Hospital; Yokohama City Japan
| | | | | | - Tetsuo Sasano
- Arrhythmia Center; Tokyo Medical and Dental University; Tokyo Japan
| | - Kenzo Hirao
- Arrhythmia Center; Tokyo Medical and Dental University; Tokyo Japan
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Anatomic Parameters Predicting Procedural Difficulty and Balloon Temperature Predicting Successful Applications in Individual Pulmonary Veins During 28-mm Second-Generation Cryoballoon Ablation. JACC Clin Electrophysiol 2017; 3:580-588. [DOI: 10.1016/j.jacep.2017.01.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/05/2017] [Accepted: 01/12/2017] [Indexed: 11/19/2022]
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Yasuoka R, Kurita T, Kotake Y, Hashiguchi N, Motoki K, Kobuke K, Iwanaga Y, Miyazaki S. Particular Morphology of Inferior Pulmonary Veins and Difficulty of Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation. Circ J 2017; 81:668-674. [DOI: 10.1253/circj.cj-16-1161] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Ryobun Yasuoka
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
| | - Takashi Kurita
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
| | - Yasuhito Kotake
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
| | - Naotaka Hashiguchi
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
| | - Koichiro Motoki
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
| | - Kazuhiro Kobuke
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
| | - Yoshitaka Iwanaga
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
| | - Shunichi Miyazaki
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University
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Sticherling C, Kühne M. Pulmonary vein isolation without assessing pulmonary vein potentials: Not there yet. Heart Rhythm 2016; 14:329-330. [PMID: 27940125 DOI: 10.1016/j.hrthm.2016.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Indexed: 11/15/2022]
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Kurzendorfer T, Mewes PW, Maier A, Strobel N, Brost A. Cryo-Balloon Catheter Localization Based on a Support-Vector-Machine Approach. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:1892-1902. [PMID: 26978663 DOI: 10.1109/tmi.2016.2537052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cryo-balloon catheters have attracted an increasing amount of interest in the medical community as they can reduce patient risk during left atrial pulmonary vein ablation procedures. As cryo-balloon catheters are not equipped with electrodes, they cannot be localized automatically by electro-anatomical mapping systems. As a consequence, X-ray fluoroscopy has remained an important means for guidance during the procedure. Most recently, image guidance methods for fluoroscopy-based procedures have been proposed, but they provide only limited support for cryo-balloon catheters and require significant user interaction. To improve this situation, we propose a novel method for automatic cryo-balloon catheter detection in fluoroscopic images by detecting the cryo-balloon catheter's built-in X-ray marker. Our approach is based on a blob detection algorithm to find possible X-ray marker candidates. Several of these candidates are then excluded using prior knowledge. For the remaining candidates, several catheter specific features are introduced. They are processed using a machine learning approach to arrive at the final X-ray marker position. Our method was evaluated on 75 biplane fluoroscopy images from 40 patients, from two sites, acquired with a biplane angiography system. The method yielded a success rate of 99.0% in plane A and 90.6% in plane B, respectively. The detection achieved an accuracy of 1.00 mm±0.82 mm in plane A and 1.13 mm±0.24 mm in plane B. The localization in 3-D was associated with an average error of 0.36 mm±0.86 mm.
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Ang R, Domenichini G, Finlay MC, Schilling RJ, Hunter RJ. The Hot and the Cold: Radiofrequency Versus Cryoballoon Ablation for Atrial Fibrillation. Curr Cardiol Rep 2016; 17:631. [PMID: 26266757 DOI: 10.1007/s11886-015-0631-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Catheter ablation is superior to antiarrhythmic drugs in maintaining sinus rhythm for patients with atrial fibrillation (AF). Pulmonary vein (PV) isolation is the cornerstone of any AF ablation procedure. Conventionally, this is achieved by performing point by point lesions using radiofrequency (RF) energy. However, this is technically challenging, time consuming and is associated with a number of complications. Long-term durability of PV isolation is also a concern. To address these issues, 'one-shot' energy delivery systems and alternative energy sources have been developed. The cryoballoon system has emerged as the most commonly used alternative to point by point RF technology. In this paper, we compare the technology, biophysics and clinical data of cryoballoon to conventional RF ablation for AF. The safety and efficacy of cryoballoon compared to RF ablation is critically reviewed. We conclude by looking at future applications of this technology.
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Affiliation(s)
- Richard Ang
- Department of Arrhythmia Services, The Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust & QMUL, London, EC1A 7BE, UK
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Buist TJ, Gal P, Ottervanger JP, Smit JJJ, Ramdat Misier AR, Delnoy PPHM, Adiyaman A, Jager PL, Elvan A. Association between pulmonary vein orientation and ablation outcome in patients undergoing multi-electrode ablation for atrial fibrillation. J Cardiovasc Comput Tomogr 2016; 10:251-7. [DOI: 10.1016/j.jcct.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 12/07/2015] [Accepted: 01/11/2016] [Indexed: 10/22/2022]
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Khoueiry Z, Albenque JP, Providencia R, Combes S, Combes N, Jourda F, Sousa P, Cardin C, Pasquie JL, Cung T, Massin F, Marijon E, Boveda S. Outcomes after cryoablation vs. radiofrequency in patients with paroxysmal atrial fibrillation: impact of pulmonary veins anatomy. Europace 2016; 18:1343-51. [DOI: 10.1093/europace/euv419] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/10/2015] [Indexed: 11/12/2022] Open
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Tsyganov A, Petru J, Skoda J, Sediva L, Hala P, Weichet J, Janotka M, Chovanec M, Neuzil P, Reddy VY. Anatomical predictors for successful pulmonary vein isolation using balloon-based technologies in atrial fibrillation. J Interv Card Electrophysiol 2015; 44:265-71. [PMID: 26475792 DOI: 10.1007/s10840-015-0068-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 10/07/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE We evaluated the correlation between pulmonary venous (PV) anatomy and acute and long-term success of PV isolation (PVI) with two balloon-based ablation catheter techniques. METHODS One hundred consecutive patients were analyzed in two equal groups treated with either the second-generation cryoballoon (CRYO) catheter or the visually guided laser ablation (VGLA) catheter. All patients underwent multi-detector computed tomography (CT) imaging. The primary and secondary efficacy endpoints were the procedural achievement of proven electrical isolation of all veins and freedom from atrial fibrillation (AF) within a 1-year follow-up period, respectively. RESULTS Variant PV anatomy was observed in 32% of patients in the CRYO group and in 40% of patients in the VGLA group. All PVs were targeted with either the CRYO catheter (n = 199) or the VGLA catheter (n = 206). One hundred ninety-three of 199 PVs (97%) were successfully isolated in the CRYO group and 194 of 206 PVs (94%) in the VGLA group (p = 0.83). Over a 12-month follow-up, AF recurrence was documented in 11/45 (24%) and 7/43 (16%) patients in the CRYO and the VGLA groups, respectively (p = 0.21). In the CRYO group, a larger left inferior PV size was associated with worse long-term outcome (p = 0.001). In the VGLA group, a larger left superior PV size (p = 0.003) and more oval right inferior PV were associated with worse acute success (p = 0.038). There was no absolute cutoff between PV anatomy and clinical success. CONCLUSIONS The variability of PV anatomy did not significantly compromise acute success of PVI or patient outcomes.
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Affiliation(s)
- Alexey Tsyganov
- Na Homolce Hospital, Prague, Czech Republic.
- Petrovsky National Research Centre of Surgery, Moscow, Russia.
| | - Jan Petru
- Na Homolce Hospital, Prague, Czech Republic
| | - Jan Skoda
- Na Homolce Hospital, Prague, Czech Republic
| | | | - Pavel Hala
- Na Homolce Hospital, Prague, Czech Republic
| | | | | | | | | | - Vivek Y Reddy
- The Helmsley Electrophysiology Centre, Mount Sinai School of Medicine, New York, NY, US
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Ang R, Hunter RJ, Baker V, Richmond L, Dhinoja M, Sporton S, Schilling RJ, Pugliese F, Davies C, Earley M. Pulmonary vein measurements on pre-procedural CT/MR imaging can predict difficult pulmonary vein isolation and phrenic nerve injury during cryoballoon ablation for paroxysmal atrial fibrillation. Int J Cardiol 2015; 195:253-8. [DOI: 10.1016/j.ijcard.2015.05.089] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 03/31/2015] [Accepted: 05/14/2015] [Indexed: 12/21/2022]
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