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Kujiraoka H, Hojo R, Arai T, Takahashi M, Fukamizu S, Sasano T. Modification of the pulmonary vein antrum is associated with recurrence after durable pulmonary vein isolation for paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2024; 67:1109-1116. [PMID: 37858001 DOI: 10.1007/s10840-023-01668-9] [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: 08/30/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Although previous studies have shown the isolated areas after pulmonary vein isolation (PVI) using cryoballoons (CB) (CB-PVI), no studies have investigated the association between the isolated area and recurrence of atrial fibrillation (AF) and atrial tachycardia (AT). This single-center observational study investigated the association between the ablated area and recurrence rate after durable CB-PVI for paroxysmal AF. METHODS This study included 76 patients with paroxysmal AF who underwent CB-PVI and established durable PVI with a second procedure, regardless of AF/AT recurrence, 6 months after the first procedure. To compare the ablated zones, we quantified the left- and right-sided PV antral isolation areas and non-ablated posterior wall (PW) area. We examined non-ablated areas of the PW and AF/AT recurrence in the chronic phase. RESULTS In total, 16 of the 76 patients had AF/AT recurrence. The mean follow-up duration was 34 months. The non-ablated PW area (14.0 ± 4.6 cm2 vs. 11.5 ± 3.7 cm2; p = 0.0213) and the ratio of the non-ablated PW area to the whole PW area (NAPW) (52.9 ± 9.1% vs. 44.8 ± 9.8%; p = 0.003) were significantly higher in the AF/AT recurrence group than in the AF/AT non-recurrence group. NAPW > 50% was an independent predictor of AF/AT recurrence. CONCLUSION The NAPW after durable CB-PVI is associated with AF/AT recurrence. PW isolation or additional applications on the PV antrum with cryoballoon may be considered in addition to PVI in paroxysmal AF, especially in patients with dilated left atria.
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Affiliation(s)
- Hirofumi Kujiraoka
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan.
| | - Rintaro Hojo
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan
| | - Tomoyuki Arai
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan
| | - Masao Takahashi
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan
| | - Seiji Fukamizu
- Department of Cardiology, Tokyo Metropolitan Hiroo Hospital, 2-34-10, Ebisu, Shibuya-Ku, Tokyo, 150-0013, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
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Galuszka OM, Baldinger SH, Servatius H, Seiler J, Madaffari A, Kozhuharov N, Thalmann G, Kueffer T, Muehl A, Maurhofer J, Haeberlin A, Noti F, Tanner H, Reichlin T, Roten L. Durability of CLOSE-Guided Pulmonary Vein Isolation in Persistent Atrial Fibrillation: A Prospective Remapping Study. JACC Clin Electrophysiol 2024; 10:1090-1100. [PMID: 38639700 DOI: 10.1016/j.jacep.2024.02.026] [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: 10/25/2023] [Revised: 02/20/2024] [Accepted: 02/27/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Recurrence of paroxysmal atrial fibrillation (AF) following pulmonary vein isolation (PVI) is presumably caused by pulmonary vein (PV) reconnections. However, there is little data available on the durability of PVI and incidence of arrhythmia recurrence in patients with persistent AF. OBJECTIVES The purpose of this study was to evaluate the lesion durability by means of an a priori planned remapping procedure in patients with persistent AF undergoing CLOSE-guided PVI. METHODS In a prospective study, we included patients with symptomatic, persistent AF undergoing CLOSE-guided radiofrequency ablation. Irrespective of AF recurrence, a redo procedure was mandated 6 months following the index procedure to evaluate PV reconnections. The outcome of AF ablation was based on clinical recurrence and 7-day Holter electrocardiogram 3 and 6 months after the index procedure and 3, 6, and 12 months after the redo procedure. RESULTS Of 30 patients included, 26 (81% men; median age 68 years) underwent the planned remapping study a median of 6 months after the index procedure, whereas 4 patients without recurrence refused a repeat procedure. In total, 78 of 102 (76%) PVs showed durable isolation and 15 patients (58%) presented complete isolation of all PVs. Beyond the blanking period, 6 of 26 patients (23%) had arrhythmia recurrence before the redo procedure. Recurrence had occurred in 33% of patients with complete isolation of all veins and in 9% of patients with PV reconnections (P = 0.197). After re-PVI in patients with PV reconnections and additional ablation in patients with recurrence but durable PVI, 17 of 26 patients (65%) were free of arrhythmia after 12 months. CONCLUSIONS In patients with persistent AF, CLOSE-guided PVI resulted in durable rate of PVI on a per-vein and per-patient level of 76% and 58%, respectively. Arrhythmia recurrence was numerically higher in patients with durable PVI compared with patients without.
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Affiliation(s)
- Oskar M Galuszka
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Samuel H Baldinger
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Helge Servatius
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Seiler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Madaffari
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nikola Kozhuharov
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Gregor Thalmann
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Kueffer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Aline Muehl
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jens Maurhofer
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Fabian Noti
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hildegard Tanner
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laurent Roten
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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Brahier MS, Piccini JP. Pulmonary Vein Isolation in Persistent Atrial Fibrillation: Not Necessarily Durable, Nor Sufficient. JACC Clin Electrophysiol 2024; 10:1101-1103. [PMID: 38925720 DOI: 10.1016/j.jacep.2024.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Mark S Brahier
- Electrophysiology Section, Duke Heart Center, Duke University Hospital and Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Jonathan P Piccini
- Electrophysiology Section, Duke Heart Center, Duke University Hospital and Duke Clinical Research Institute, Durham, North Carolina, USA.
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De Pooter J, Timmers L, Boveda S, Combes S, Knecht S, Almorad A, De Asmundis C, Duytschaever M. Validation of a machine learning algorithm to identify pulmonary vein isolation during ablation procedures for the treatment of atrial fibrillation: results of the PVISION study. Europace 2024; 26:euae116. [PMID: 38682165 PMCID: PMC11089576 DOI: 10.1093/europace/euae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/25/2024] [Indexed: 05/01/2024] Open
Abstract
AIMS Pulmonary vein isolation (PVI) is the cornerstone of ablation for atrial fibrillation. Confirmation of PVI can be challenging due to the presence of far-field electrograms (EGMs) and sometimes requires additional pacing manoeuvres or mapping. This prospective multicentre study assessed the agreement between a previously trained automated algorithm designed to determine vein isolation status with expert opinion in a real-world clinical setting. METHODS AND RESULTS Consecutive patients scheduled for PVI were recruited at four centres. The ECGenius electrophysiology (EP) recording system (CathVision ApS, Copenhagen, Denmark) was connected in parallel with the existing system in the laboratory. Electrograms from a circular mapping catheter were annotated during sinus rhythm at baseline pre-ablation, time of isolation, and post-ablation. The ground truth for isolation status was based on operator opinion. The algorithm was applied to the collected PV signals off-line and compared with expert opinion. The primary endpoint was a sensitivity and specificity exceeding 80%. Overall, 498 EGMs (248 at baseline and 250 at PVI) with 5473 individual PV beats from 89 patients (32 females, 62 ± 12 years) were analysed. The algorithm performance reached an area under the curve (AUC) of 92% and met the primary study endpoint with a sensitivity and specificity of 86 and 87%, respectively (P = 0.005; P = 0.004). The algorithm had an accuracy rate of 87% in classifying the time of isolation. CONCLUSION This study validated an automated algorithm using machine learning to assess the isolation status of pulmonary veins in patients undergoing PVI with different ablation modalities. The algorithm reached an AUC of 92%, with both sensitivity and specificity exceeding the primary study endpoints.
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Affiliation(s)
- Jan De Pooter
- Heart Center, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
| | - Liesbeth Timmers
- Heart Center, UZ Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium
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Calvert P, Ding WY, Mills MT, Snowdon R, Borbas Z, Modi S, Hall M, Morgan M, Clarkson N, Chackochen S, Barton J, Kemp I, Luther V, Gupta D. Durability of thermal pulmonary vein isolation in persistent atrial fibrillation assessed by mandated repeat invasive study. Heart Rhythm 2024:S1547-5271(24)02388-9. [PMID: 38636929 DOI: 10.1016/j.hrthm.2024.04.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 04/10/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND No study has assessed the durability of pulmonary vein isolation (PVI) with radiofrequency (RF) and cryoballoon (CB) in patients with persistent atrial fibrillation. These data are especially lacking for those with significantly diseased left atria (LA). OBJECTIVES The goals of this study were to assess PVI durability in patients with significant LA disease and to compare reconnection rates between RF and CB. METHODS Forty-four patients (mean age 63 years; 34 (77%) male; median time since atrial fibrillation diagnosis 22.5 months; median indexed LA volume 36 mL/m2) were randomized 1:1 to RF or CB PVI. A redo procedure using ultra-high-density electroanatomic mapping was mandated at 2 months, where PV reconnections were identified and reisolated. RESULTS Thirty-eight patients underwent both procedures (CB n = 17; RF n = 21). Index RF procedures were longer (median 158 minutes vs 97 minutes; P < .001) but required less fluoroscopy (9.5 minutes vs 23 minutes; P < .001). At the index RF procedure, a median of 47% of LA myocardium had voltage < 0.5 mV, suggesting that half of the mapped LA comprised scar. PV reconnection was observed in 73 of 152 PVs (48.0%) and was more frequent with CB (58.8%) than with RF (39.3%) (P = .022). Reconnection of at least 1 PV was detected in >75% of patients. Significantly more ablation was required during the redo procedure to reisolate PVs in the CB arm (median 10.8 minutes vs 1.2 minutes; P < .001). CONCLUSION PVI durability may be poor in those with significant LA scarring and dilatation, even with modern thermal ablation technologies. RF resulted in significantly better PVI durability than did CB in this complex population. TRIAL REGISTRATION clinicaltrials.gov identifier: NCT04111731.
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Affiliation(s)
- Peter Calvert
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark T Mills
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom
| | - Richard Snowdon
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Zoltan Borbas
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Simon Modi
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Mark Hall
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Maureen Morgan
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | | | | | - Janet Barton
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Ian Kemp
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Vishal Luther
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dhiraj Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, United Kingdom.
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Jin Z, Hwang T, Kim D, Lim B, Kwon OS, Kim S, Kim MH, Park JW, Yu HT, Kim TH, Uhm JS, Joung B, Lee MH, Pak HN. Anti- and pro-fibrillatory effects of pulmonary vein isolation gaps in human atrial fibrillation digital twins. NPJ Digit Med 2024; 7:81. [PMID: 38532181 DOI: 10.1038/s41746-024-01075-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Although pulmonary vein isolation (PVI) gaps and extrapulmonary vein triggers contribute to recurrence after atrial fibrillation (AF) ablation, their precise mechanisms remain unproven. Our study assessed the impact of PVI gaps on rhythm outcomes using a human AF digital twin. We included 50 patients (76.0% with persistent AF) who underwent catheter ablation with a realistic AF digital twin by integrating computed tomography and electroanatomical mapping. We evaluated the final rhythm status, including AF and atrial tachycardia (AT), across 600 AF episodes, considering factors including PVI level, PVI gap number, and pacing locations. Our findings revealed that antral PVI had a significantly lower ratio of AF at the final rhythm (28% vs. 56%, p = 0.002) than ostial PVI. Increasing PVI gap numbers correlated with an increased ratio of AF at the final rhythm (p < 0.001). Extra-PV induction yielded a higher ratio of AF at the final rhythm than internal PV induction (77.5% vs. 59.0%, p < 0.001). In conclusion, our human AF digital twin model helped assess AF maintenance mechanisms. Clinical trial registration: https://www.clinicaltrials.gov ; Unique identifier: NCT02138695.
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Affiliation(s)
- Ze Jin
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Taehyun Hwang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byounghyun Lim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Oh-Seok Kwon
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sangbin Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Maccioni S, Sharma R, Lee DD, Haltner A, Khanna R, Vijgen J. Comparative Safety of Pulsed Field Ablation and Cryoballoon Ablation Technologies for Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation: A Critical Literature Review and Indirect Treatment Comparison. Adv Ther 2024; 41:932-944. [PMID: 38185778 PMCID: PMC10879347 DOI: 10.1007/s12325-023-02765-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Cryoballoon ablation (CBA) is a standard catheter ablation technology with demonstrated clinical effectiveness for the treatment of paroxysmal atrial fibrillation (PAF); however, it can be associated with major adverse events, including phrenic nerve paralysis. Pulsed field ablation (PFA) is a novel, minimally thermal technology with comparable effectiveness and low safety risk. This study aimed to compare the safety profiles of PFA and CBA through critical analyses of the literature and indirect treatment comparisons. METHODS Studies were identified by searching the MEDLINE database and the Clinicaltrials.gov registry. Registered clinical trials and/or Food and Drug Administration Investigation Device Exemption (FDA IDE) studies evaluating PFA or CBA in adult patients with drug-refractory PAF between January 2008 and March 2023 were selected. Comparative safety between PFA and CBA was assessed for major and prespecified adverse events. Indirect comparisons were conducted using the proportion of patients experiencing adverse events and confirmed with single-arm meta-analyses and sensitivity analyses. RESULTS Data were extracted from three PFA publications including a total of 497 patients and six CBA studies including a total of 1113 patients. The analysis revealed that PFA was associated with significantly lower risk of major adverse events {risk difference - 4.3% [95% confidence interval (CI) - 5.8, - 2.8]; risk ratio 0.16 [95% CI 0.07, 0.45]} and prespecified adverse events [risk difference - 2.5% (95% CI - 4.4, - 0.5); risk ratio 0.53 (95% CI 0.31, 0.96)]. Meta-analyses confirmed the lower rate of major adverse events for PFA [0.4% (95% CI 0.0, 1.3)] vs. CBA [5.6% (95% CI 2.6, 8.6)] and prespecified adverse events for PFA [2.7% (95% CI 1.2, 4.1)] vs. CBA [5.8% (95% CI 2.7, 9.0)]. Sensitivity analyses exploring heterogeneity across studies confirmed robustness of the main analyses. CONCLUSION The findings of this study show that PFA has a more favorable safety profile than CBA, with significantly lower risks of major and prespecified adverse events. These indirect comparisons help contextualize the safety of PFA compared to CBA for the treatment of drug-refractory PAF in the absence of head-to-head studies.
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Affiliation(s)
- Sonia Maccioni
- Johnson and Johnson Medical Devices, Franchise Health Economics and Market Access, Irvine, CA, 92618, USA.
| | - Reecha Sharma
- Johnson and Johnson Medical Devices, Clinical Research, Irvine, CA, 92618, USA
| | | | | | - Rahul Khanna
- Medical Device Epidemiology and Real-World Data Sciences, Johnson and Johnson, New Brunswick, NJ, USA
| | - Johan Vijgen
- Cardiology Department, Jessa Hospitals, Hasselt, Belgium
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Ruwald MH, Haugdal M, Worck R, Johannessen A, Hansen ML, Sørensen SK, Hansen J. Characterization of durability and reconnection patterns at time of repeat ablation after single-shot pulsed field pulmonary vein isolation. J Interv Card Electrophysiol 2024; 67:379-387. [PMID: 37776356 PMCID: PMC10902076 DOI: 10.1007/s10840-023-01655-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/17/2023] [Indexed: 10/02/2023]
Abstract
BACKGROUND Pulsed field ablation (PFA) is a novel method of cardiac ablation where there is insufficient knowledge on the durability and reconnection patterns after pulmonary vein isolation (PVI). The aim of this study was to characterize the electrophysiological findings at time of repeat procedure in real-world atrial fibrillation (AF) patients. METHODS Patients who underwent a repeat procedure (n=26) for symptomatic recurrent arrhythmias after index first-time treatment with single-shot PFA PVI (n=266) from July 2021 to June 2023 were investigated with 3D high-density mapping and ad-hoc re-ablation by radiofrequency or focal PFA. RESULTS Index indication for PVI was persistent AF in 17 (65%) patients. The mean time to repeat procedure was 292 ± 119 days. Of the 26 patients (104 veins), complete durable PVI was observed in 11/26 (42%) with a durable vein isolation rate of 72/104 (69%). Two patients (8%) had all four veins reconnected. The posterior wall was durably isolated in 4/5 (80%) of the cases. The predominant arrhythmia mechanism was AF in 17/26 (65%) patients and regular atrial tachycardia (AT) in 9/26 (35%). Reconnection was observed 9/26 (35%) in right superior, 11/26 (42%) in right inferior, 7/26 (27%) in left superior, 5/26 (19%) in left inferior, p=0.31 between veins. The gaps were significantly clustered in the right-sided anterior carina compared to other regions (P=0.009). CONCLUSIONS Durable PVI was observed in less than half of the patients at time of repeat procedure. No significant difference in PV reconnection pattern was observed, but the gap location was preferentially located at the anterior aspects of the right-sided PVs. Predominant recurrence was AF. More data is needed to establish lesion formation and durability and AT circuits after PFA.
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Affiliation(s)
- Martin H Ruwald
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark.
| | - Martin Haugdal
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Rene Worck
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Arne Johannessen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Morten Lock Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Samuel K Sørensen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
| | - Jim Hansen
- Division of Electrophysiology, Department of Cardiology, Herlev-Gentofte Hospital, Gentofte Hospitalsvej 1, DK-2900, Hellerup, Denmark
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Szegedi N, Salló Z, Nagy VK, Osztheimer I, Hizoh I, Lakatos B, Boussoussou M, Orbán G, Boga M, Ferencz AB, Komlósi F, Tóth P, Perge P, Kovács A, Merkely B, Gellér L. Long-Term Durability of High- and Very High-Power Short-Duration PVI by Invasive Remapping: The HPSD Remap Study. Circ Arrhythm Electrophysiol 2024; 17:e012402. [PMID: 38284286 PMCID: PMC10876176 DOI: 10.1161/circep.123.012402] [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: 06/07/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND High-power short-duration ablation has shown impressive efficacy and safety for pulmonary vein isolation (PVI); however, initial efficacy results with very high power short-duration ablation were discouraging. This study compared the long-term durability of PVI performed with a 90- versus 50-W power setting. METHODS Patients were randomized 1:1 to undergo PVI with the QDOT catheter using a power setting of 90 or 50 W. Three months after the index procedure, patients underwent a repeat electrophysiology study to identify pulmonary vein reconnections. Patients were followed for 12 months to detect AF recurrences. RESULTS We included 46 patients (mean age, 64 years; women, 48%). Procedure (76 versus 84 minutes; P =0.02), left atrial dwell (63 versus 71 minutes; P =0.01), and radiofrequency (303 versus 1040 seconds; P <0.0001) times were shorter with 90- versus 50-W procedures, while the number of radiofrequency applications was higher with 90 versus 50 W (77 versus 67; P =0.01). There was no difference in first-pass isolation (83% versus 82%; P =1.0) or acute reconnection (4% versus 14%; P =0.3) rates between 90 and 50 W. Forty patients underwent a repeat electrophysiology study. Durable PVI on a per PV basis was present in 72/78 (92%) versus 68/77 (88%) PVs in the 90- and 50-W energy setting groups, respectively; effect size: 72/78-68/77=0.040, lower 95% CI=-0.051 (noninferiority limit=-0.1, ie, noninferiority is met). No complications occurred. There was no difference in 12-month atrial fibrillation-free survival between the 90- and 50-W groups (P =0.2). CONCLUSIONS Similarly high rates of durable PVI and arrhythmia-free survival were achieved with 90 and 50 W. Procedure, left atrial dwell, and radiofrequency times were shorter with 90 W compared with 50 W. The sample size is too small to conclude the safety and long-term efficacy of the high and very high-power short-duration PVI; further studies are needed to address this topic. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT05459831.
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Affiliation(s)
- Nándor Szegedi
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Zoltán Salló
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Vivien Klaudia Nagy
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István Osztheimer
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - István Hizoh
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Lakatos
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Melinda Boussoussou
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Gábor Orbán
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Boga
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Arnold Béla Ferencz
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Ferenc Komlósi
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Patrik Tóth
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Perge
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - László Gellér
- Cardiology Department, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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10
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Çöteli C, Dural M, Yorgun H, Aytemir K. Cryoballoon ablation of non-PV triggers in persistent atrial fibrillation. Pacing Clin Electrophysiol 2024; 47:66-79. [PMID: 37971717 DOI: 10.1111/pace.14878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/21/2023] [Accepted: 11/05/2023] [Indexed: 11/19/2023]
Abstract
Cryoballoon-based catheter ablation has emerged as an efficacious and safe therapeutic intervention for patients with paroxysmal atrial fibrillation (PAF). PAF is primarily associated with the triggers in the pulmonary vein (PV). However, persistent atrial fibrillation (PeAF) is a complex condition that involves changes in the atrial substrate and the presence of non-PV triggers. Therefore, a comprehensive treatment approach is necessary for patients with PeAF. Utilizing a 3D electroanatomical map, the radiofrequency-based ablation technique adeptly identifies and targets the atrial substrate and non-PV triggers. On the other hand, the cryoballoon-based AF ablation was initially designed for PV isolation. However, its single-shot feature makes it a great choice for electrophysiologists looking to address non-PV triggers. It is possible to target the left atrial appendage (LAA), superior vena cava (SVC), left atrial roof, and posterior wall using the apparatus's unique configuration and ablation abilities. This review focuses on the increasing literature regarding cryoballoon-based methods for non-PV trigger ablation. Specifically, it delves into the technical procedures used to isolate the LAA, SVC, and ablate the left atrial roof and posterior wall.
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Affiliation(s)
- Cem Çöteli
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
| | - Muhammet Dural
- Faculty of Medicine, Department of Cardiology, Osmangazi University, Eskişehir, Turkey
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Hikmet Yorgun
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kudret Aytemir
- Faculty of Medicine, Department of Cardiology, Hacettepe University, Ankara, Turkey
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11
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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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12
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Serban T, Mannhart D, Abid QUA, Höchli A, Lazar S, Krisai P, Bettelini AS, Knecht S, Kühne M, Sticherling C, du Fay de Lavallaz J, Badertscher P. Durability of pulmonary vein isolation for atrial fibrillation: a meta-analysis and systematic review. Europace 2023; 25:euad335. [PMID: 37944133 PMCID: PMC10664405 DOI: 10.1093/europace/euad335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/05/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Pulmonary vein isolation (PVI) plays a central role in the interventional treatment of atrial fibrillation (AF). Uncertainties remain about the durability of ablation lesions from different energy sources. We aimed to systematically review the durability of ablation lesions associated with various PVI-techniques using different energy sources for the treatment of AF. METHODS AND RESULTS Structured systematic database search for articles published between January 2010 and January 2023 reporting PVI-lesion durability as evaluated in the overall cohort through repeat invasive remapping during follow-up. Studies evaluating only a proportion of the initial cohort in redo procedures were excluded. A total of 19 studies investigating 1050 patients (mean age 60 years, 31% women, time to remap 2-7 months) were included. In a pooled analysis, 99.7% of the PVs and 99.4% of patients were successfully ablated at baseline and 75.5% of the PVs remained isolated and 51% of the patients had all PVs persistently isolated at follow-up across all energy sources. In a pooled analysis of the percentages of PVs durably isolated during follow-up, the estimates of RFA were the lowest of all energy sources at 71% (95% CI 69-73, 11 studies), but comparable with cryoballoon (79%, 95%CI 74-83, 3 studies). Higher durability percentages were reported in PVs ablated with laser-balloon (84%, 95%CI 78-89, one study) and PFA (87%, 95%CI 84-90, 2 studies). CONCLUSION We observed no significant difference in the durability of the ablation lesions of the four evaluated energies after adjusting for procedural and baseline populational characteristics.
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Affiliation(s)
- Teodor Serban
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Diego Mannhart
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | | | - Andres Höchli
- Department of Cardiology, Triemli Stadtspital, Zürich, Switzerland
| | - Sorin Lazar
- Department of Cardiology, Cook County Health, Chicago, IL, USA
| | - Philipp Krisai
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Arianna Sofia Bettelini
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Michael Kühne
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Christian Sticherling
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Jeanne du Fay de Lavallaz
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
| | - Patrick Badertscher
- Department of Cardiology, University Hospital of Basel, Petersgraben 4, 4031 Basel, Switzerland
- Cardiovascular Research Institute Basel, Spitalstrasse 2, 4056 Basel, Switzerland
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13
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Lin YZ, Peng YM, Lian LH, Zhang JC, Wu MQ, Yang ZP, Chen JQ, Liao XW, Chen L. An evaluation of the clinical efficacy of the application of 28mm cryoballoon for linear ablation of left atrial apex combined with enlarged pulmonary vein vestibule ablation for persistent atrial fibrillation. Hellenic J Cardiol 2023; 72:15-23. [PMID: 37019212 DOI: 10.1016/j.hjc.2023.03.008] [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] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE to retrospectively investigate the efficacy and safety of the application of 28 mm cryoballoon for pulmonary vein electrical isolation (PVI) combined with top left atrial linear ablation and pulmonary vein vestibular expansion ablation for persistent atrial fibrillation. METHODS From July 2016 to December 2020, 413 patients diagnosed with persistent atrial fibrillation were evaluated, including 230 (55.7%) in the PVI group (PVI only) and 183 (44.3%) in the PVIPLUS group (PVI plus ablation of the left atrial apex and pulmonary vein vestibule). The safety and efficacy of the two groups were retrospectively analyzed. RESULTS The AF/AT/AFL-free survival rates at 6, 12, 18, 24 and 30 months after procedure was 86.6%, 72.6%, 70.0%, 61.1% and 56.3% in the PVI group and 94.5%, 87.0%, 84.1%, 75.0% and 67.9% in the PVIPLUS group, respectively. At 30 months after procedure, the AF/AT/AFL-free survival rate was significantly higher in the PVIPLUS group than in the PVI group (P = 0.036; HR:0.63; 95% CI:0.42 to 0.95). CONCLUSION The application of 28-mm cryoballoon for pulmonary vein electrical isolation combined with linear ablation of the left atrial apex and expanded ablation of the pulmonary vein vestibule improves the outcome of persistent atrial fibrillation.
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Affiliation(s)
- Ya-Zhou Lin
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Yi-Ming Peng
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Lian-Hua Lian
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Jian-Cheng Zhang
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Mei-Qiong Wu
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Zhi-Ping Yang
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Jian-Quan Chen
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Xue-Wen Liao
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China
| | - Lin Chen
- Department of Cardiology, Provincial Clinical Medicine College of Fujian Medical University, Fujian Provincial Hospital, No. 134 East Street, Gulou District, Fuzhou, Fujian 350000, PR China.
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14
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Sørensen SK, Johannessen A, Worck R, Hansen ML, Ruwald MH, Hansen J. Differential gap location after radiofrequency versus cryoballoon pulmonary vein isolation: Insights from a randomized trial with protocol-mandated repeat procedure. J Cardiovasc Electrophysiol 2023; 34:519-526. [PMID: 36640430 DOI: 10.1111/jce.15821] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Reconnections to pulmonary vein (PV) triggers of atrial fibrillation (AF) are the primary cause of AF recurrence after PV isolation (PVI) with radiofrequency (RF) or cryoballoon catheter ablation (CRYO), but method-specific contributions to PV reconduction pattern and conductive gap location are incompletely understood. METHODS The objective of this radiofrequency versus cryoballoon catheter ablation for paroxysmal atrial fibrillation substudy was to determine procedure-specific patterns of PV reconduction in a randomized population with protocol-mandated repeat procedures, irrespective of AF recurrence. Each PV was assessed in turn and PV reconnection sites were identified by high-density electroanatomical mapping and locating the earliest activation site. Gap locations were verified by PV re-isolation. RESULTS In 98 patients, 81% versus 76% previously isolated PVs remained isolated after CRYO versus RF (risk ratio [RR]: 1.06; 95% confidence interval [CI]: 0.96-1.18; p = .28). There were no significant differences for any PV: left superior PV: 90% versus 80%; left inferior PV: 80% versus 78%; right superior PV: 81% versus 80%, and right inferior PV: 76% versus 73%. For each reconnected PV, 34% of ipsilateral PVs were also reconnected after CRYO compared with 64% after RF (RR: 0.54; 95% CI: 0.32-0.90; p = .01). After RF, gaps were clustered by the carina and adjacent segments, whereas they were more heterogeneously distributed after CRYO. CONCLUSION Although RF and CRYO produce similar proportions of durably isolated PVs, gap locations appear to develop in procedure-specific patterns. After RF, ipsilateral PV reconduction is more frequent and gap sites cluster by the carina, suggesting that this region should be selectively ablated for more durable PVI.
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Affiliation(s)
- Samuel K Sørensen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Arne Johannessen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - René Worck
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Morten L Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Martin H Ruwald
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Jim Hansen
- Department of Cardiology, Copenhagen University Hospital Gentofte, Hellerup, Denmark
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15
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Benali K, Barré V, Hermida A, Galand V, Milhem A, Philibert S, Boveda S, Bars C, Anselme F, Maille B, André C, Behaghel A, Moubarak G, Clémenty N, Da Costa A, Arnaud M, Venier S, Sebag F, Jésel-Morel L, Sagnard A, Champ-Rigot L, Dang D, Guy-Moyat B, Abbey S, Garcia R, Césari O, Badenco N, Lepillier A, Ninni S, Boulé S, Maury P, Algalarrondo V, Bakouboula B, Mansourati J, Lesaffre F, Lagrange P, Bouzeman A, Muresan L, Bacquelin R, Bortone A, Bun SS, Pavin D, Macle L, Martins RP. Recurrences of Atrial Fibrillation Despite Durable Pulmonary Vein Isolation: The PARTY-PVI Study. Circ Arrhythm Electrophysiol 2023; 16:e011354. [PMID: 36802906 DOI: 10.1161/circep.122.011354] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND Recurrences of atrial fibrillation (AF) after pulmonary vein isolation (PVI) are mainly due to pulmonary vein reconnection. However, a growing number of patients have AF recurrences despite durable PVI. The optimal ablative strategy for these patients is unknown. We analyzed the impact of current ablation strategies in a large multicenter study. METHODS Patients undergoing a redo ablation for AF and presenting durable PVI were included. The freedom from atrial arrhythmia after pulmonary vein-based, linear-based, electrogram-based, and trigger-based ablation strategies were compared. RESULTS Between 2010 and 2020, 367 patients (67% men, 63±10 years, 44% paroxysmal) underwent a redo ablation for AF recurrences despite durable PVI at 39 centers. After durable PVI was confirmed, linear-based ablation was performed in 219 (60%) patients, electrogram-based ablation in 168 (45%) patients, trigger-based ablation in 101 (27%) patients, and pulmonary vein-based ablation in 56 (15%) patients. Seven patients (2%) did not undergo any additional ablation during the redo procedure. After 22±19 months of follow-up, 122 (33%) and 159 (43%) patients had a recurrence of atrial arrhythmia at 12 and 24 months, respectively. No significant difference in arrhythmia-free survival was observed between the different ablation strategies. Left atrial dilatation was the only independent factor associated with arrhythmia-free survival (HR, 1.59 [95% CI, 1.13-2.23]; P=0.006). CONCLUSIONS In patients with recurrent AF despite durable PVI, no ablation strategy used alone or in combination during the redo procedure appears to be superior in improving arrhythmia-free survival. Left atrial size is a significant predictor of ablation outcome in this population.
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Affiliation(s)
- Karim Benali
- CHU Saint Etienne, University of Rennes, INSERM, LTSI -UMR 1099, Rennes (K.B.)
| | - Valentin Barré
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | - Vincent Galand
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | | | | | - Serge Boveda
- Cardiology-Heart Rhythm Management Department, Clinique Pasteur, Toulouse (S.B.)
| | | | | | | | | | | | | | | | | | | | | | - Frédéric Sebag
- Rythmologie, Institut Mutualiste Montsouris, Paris (F.S.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Babé Bakouboula
- Institut Cardiovasculaire de Strasbourg, Clinique RHENA (B.B.)
| | | | | | | | | | | | | | | | | | - Dominique Pavin
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
| | - Laurent Macle
- Department of Medicine, Electrophysiology Service at the Montreal Heart Institute, Canada (L.M.)
| | - Raphaël P Martins
- University of Rennes, CHU Rennes, INSERM, LTSI-UMR 1099, Rennes (V.B., V.G., D.P., R.P.M.)
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16
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Michaelsen J, Parade U, Bauerle H, Winter KD, Rauschenbach U, Mischke K, Schaefer C, Gutleben KJ, Rana OR, Willich T, Schlößer M, Rötzer A, Breithardt OA, Middendorf S, Grove R, Mosa J, Krug J, Imnadze G, Saygili E, Hoffmann R. Twelve-month efficacy of second-generation cryoballoon ablation for atrial fibrillation performed at community hospitals: results of the German register on cryoballoon ablation in local hospitals (regional). J Interv Card Electrophysiol 2023; 66:417-425. [PMID: 35962151 DOI: 10.1007/s10840-022-01331-9] [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: 04/26/2022] [Accepted: 08/01/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND The 12-month follow-up (F/U) efficacy of CBA PVI performed at community hospitals for treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF) is unknown. This study determined the 12-month efficacy of pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) performed at community hospitals with limited annual case numbers. METHODS This registry study included 983 consecutive patients (pts) from 19 hospitals, each with an annual procedural volume of < 100 PVI procedures/year. Pts underwent CBA PVI for paroxysmal AF (n = 520), persistent AF (n = 423), or redo PVI (n = 40). The primary endpoint was frequency of documented recurrent AF, the occurrence of atrial flutter or tachycardia following a 90-day period after the index ablation and up to 12 months. The frequency of repeat ablation was determined. RESULTS Isolation of all PVs was documented in 98% of pts at the end of the procedure. Twelve-month F/U data could be obtained in 916 pts. A 24-h ECG registration was performed in 641 pts (70.0%); in 107 pts (16.7%) of them, recurrent AF was documented. The primary endpoint was met in 193 F/U pts (21.1%). It occurred in 80/486 F/U pts with paroxysmal AF (16.4%), and in 107/390 F/U pts with persistent AF (27.4%). Redo PVI was performed in 71 pts (7.8%), and atrial flutter ablation was performed in 12 pts (1.4%). CONCLUSIONS CBA PVI for paroxysmal or persistent AF can be performed at community hospitals with adequate rates of 12-month symptom freedom and arrhythmia recurrence. The study was registered at the German register of clinical studies (DRKS00016504).
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Affiliation(s)
- Jochen Michaelsen
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Wilhelmstr. 13, 49808, Lingen, Germany
| | - Ulli Parade
- Department of Cardiology, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Hansjörg Bauerle
- Department of Cardiology, Klinikum Friedrichshafen, Friedrichshafen, Germany
| | - Klaus-Dieter Winter
- Department of Cardiology, Hermann-Josef-Krankenhaus Erkelenz, Erkelenz, Germany
| | - Ulrich Rauschenbach
- Department of Cardiology, Ev. Luth. Diakonissenanstalt Flensburg, Flensburg, Germany
| | - Karl Mischke
- Department of Cardiology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Carl Schaefer
- Department of Cardiology, Elbe Kliniken Stade-Buxtehude, Buxtehude, Germany
| | | | - Obaida R Rana
- Department of Cardiology, Helios St. Marienberg-Klinik Helmstedt, Helmstedt, Germany
| | - Tobias Willich
- Kardiologische Gemeinschaftspraxis Brilon, Brilon, Germany
| | - Marc Schlößer
- Department of Cardiology, Dreifaltigkeits-Hospital Lippstadt, Lippstadt, Germany
| | - Alfons Rötzer
- Department of Cardiology, Medius KLINIK Ostfildern, Ostfildern, Germany
| | - Ole A Breithardt
- Department of Cardiology, Agaplesion Diakonie Kliniken Kassel, Kassel, Germany
| | | | - Rainer Grove
- Department of Cardiology, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany
| | - Jörg Mosa
- Department of Cardiology, Krankenhaus Freudenstadt, Freudenstadt, Germany
| | - Joachim Krug
- Department of Cardiology, Klinikum Fulda, Fulda, Germany
| | - Guram Imnadze
- Department of Cardiology, Klinikum Osnabrück, Osnabrück, Germany
| | - Erol Saygili
- Kardio-Diabetes-Zentrum Köln, St. Antonius Krankenhaus, Cologne, Germany
| | - Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Wilhelmstr. 13, 49808, Lingen, Germany.
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17
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Gupta D, Ding WY, Calvert P, Williams E, Das M, Tovmassian L, Tayebjee MH, Haywood G, Martin CA, Rajappan K, Bates MGD, Temple IP, Reichlin T, Chen Z, Balasubramaniam RN, Ronayne C, Clarkson N, Morgan M, Barton J, Kemp I, Mahida S, Sticherling C. Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter. Heart 2023; 109:364-371. [PMID: 36396438 DOI: 10.1136/heartjnl-2022-321729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/17/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE We aimed to compare cryoballoon pulmonary vein isolation (PVI) with standard radiofrequency cavotricuspid isthmus (CTI) ablation as first-line treatment for typical atrial flutter (AFL). METHODS Cryoballoon Pulmonary Vein Isolation as First-Line Treatment for Typical Atrial Flutter was an international, multicentre, open with blinded assessment trial. Patients with CTI-dependent AFL and no documented atrial fibrillation (AF) were randomised to either cryoballoon PVI alone or radiofrequency CTI ablation. Primary efficacy outcome was time to first recurrence of sustained (>30 s) symptomatic atrial arrhythmia (AF/AFL/atrial tachycardia) at 12 months as assessed by continuous monitoring with an implantable loop recorder. Primary safety outcome was a composite of death, stroke, tamponade requiring drainage, atrio-oesophageal fistula, pacemaker implantation, serious vascular complications or persistent phrenic nerve palsy. RESULTS Trial recruitment was halted at 113 of the target 130 patients because of the SARS-CoV-2 pandemic (PVI, n=59; CTI ablation, n=54). Median age was 66 (IQR 61-71) years, with 98 (86.7%) men. At 12 months, the primary outcome occurred in 11 (18.6%) patients in the PVI group and 9 (16.7%) patients in the CTI group. There was no significant difference in the primary efficacy outcome between the groups (HR 1.11, 95% CI 0.46 to 2.67). AFL recurred in six (10.2%) patients in the PVI arm and one (1.9%) patient in the CTI arm (p=0.116). Time to occurrence of AF of ≥2 min was significantly reduced with cryoballoon PVI (HR 0.46, 95% CI 0.25 to 0.85). The composite safety outcome occurred in four patients in the PVI arm and three patients in the CTI arm (p=1.000). CONCLUSION Cryoballoon PVI as first-line treatment for AFL is equally effective compared with standard CTI ablation for preventing recurrence of atrial arrhythmia and better at preventing new-onset AF. TRIAL REGISTRATION NUMBER NCT03401099.
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Affiliation(s)
- Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK .,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Wern Yew Ding
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Peter Calvert
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Emmanuel Williams
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK.,Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool, UK
| | - Moloy Das
- Newcastle Upon Tyne Hospital NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Lilith Tovmassian
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Muzahir H Tayebjee
- Department of Cardiology, Leeds Teaching Hospital NHS Foundation Trust, Leeds, UK
| | - Guy Haywood
- Department of Cardiology, University Hospitals Plymouth NHS Foundation Trust, Plymouth, UK
| | - Claire A Martin
- Department of Cardiology, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Kim Rajappan
- Department of Cardiology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Matthew G D Bates
- Department of Cardiology, South Tees Hospitals NHS Foundation Trust, James Cook University Hospital, Middlesbrough, UK
| | - Ian Peter Temple
- Department of Cardiology, Manchester University NHS Foundation Trust, Wythenshawe Hospital, Manchester, UK
| | - Tobias Reichlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Zhong Chen
- Department of Cardiology, Ashford and St Peter's Hospital NHS Foundation Trust, Surrey, UK
| | - Richard N Balasubramaniam
- Department of Cardiology, Royal Bournemouth and Christchurch Hospital NHS Foundation Trust, Bournemouth, UK
| | - Christina Ronayne
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Nichola Clarkson
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Maureen Morgan
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Janet Barton
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Ian Kemp
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
| | - Saagar Mahida
- Department of Cardiology, Liverpool Heart and Chest Hospital NHS Foundation Trust, Liverpool, UK
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18
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Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures. J Cardiovasc Dev Dis 2023; 10:jcdd10020055. [PMID: 36826551 PMCID: PMC9967334 DOI: 10.3390/jcdd10020055] [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: 12/31/2022] [Revised: 01/23/2023] [Accepted: 01/27/2023] [Indexed: 01/31/2023] Open
Abstract
Nowadays, the cryoballoon (CB) constitutes an established alternative to radio frequency (RF) ablation for pulmonary vein isolation (PVI), which offers the possibility to isolate the PVs with a single application. Since the introduction of the second-generation CB, we prospectively collected our data to optimize the procedure on >1000 consecutive patients who underwent CB PVI performed in our center. It is expected that subsequent guidelines will suggest first-line PVI through CB in patients with paroxysmal AF with a class I indication. Indeed, in the long-term follow-up (36 months) of the EARLY-AF trial, CB had a lower incidence of persistent atrial fibrillation episodes compared to the anti-arrhythmic drugs group. We now review the current best practices in an effort to drive consistent outcomes and minimize complications. PV isolation through CB is the most studied single-shot technique for atrial fibrillation ablation, having shown the potential to alter the natural history of the arrhythmia. Several procedural tips and tricks can improve procedural flow and effectiveness. In the present article we provided not only technical details but measurable biophysical parameters that can reliably guide the operator into achieving the best outcome for his patients.
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19
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Wakabayashi Y, Kobayashi M, Ichikawa T, Koyama T, Abe H. Clinical utility of the "balloon lever technique" in the right inferior pulmonary vein cryoballoon ablation. J Arrhythm 2022; 39:42-51. [PMID: 36733329 PMCID: PMC9885310 DOI: 10.1002/joa3.12801] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/27/2022] [Accepted: 12/04/2022] [Indexed: 12/24/2022] Open
Abstract
Background The acute success rate of pulmonary vein isolation (PVI) with cryoballoon (CB) is reported to be lower in the right inferior pulmonary vein (RIPV). This study aimed to investigate the utility of the "balloon lever technique (BLT)" for RIPV CB ablation. Methods We retrospectively studied consecutive patients who underwent CB-PVI for atrial fibrillation between February 21, 2020 and June 3, 2022. RIPV cryoablation was performed according to a specific protocol. The patients underwent RIPV cryoablation using the conventional method. If the method was found ineffective, BLT cryoablation was performed. The acute success rate of RIPV CB ablation was examined. We also investigated the RIPV isolation rate and procedural parameters during conventional and BLT cryoablation. Results Ninety-three patients were included in the analysis. RIPV isolation was achieved in 89.2% (83/93) of the patients using conventional method and subsequent BLT cryoablation. Meanwhile, 68 patients underwent BLT cryoablation because the conventional method was ineffective. RIPV was isolated with BLT in 85.3% (58/68) of patients. Additionally, BLT was found to be superior to conventional cryoablation in terms of nadir balloon temperature, freezing time, and thawing time to a specific temperature in patients who underwent both conventional and BLT cryoablations. Conclusions BLT is useful in RIPV cryoablation when the conventional method is ineffective. BLT cryoablation may be helpful, mainly because of the BLT-mediated contact of the balloon with the bottom of the RIPV, which leads to optimal RIPV occlusion.
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Affiliation(s)
- Yasushi Wakabayashi
- Department of Cardiovascular MedicineMatsumoto Kyoritsu HospitalMatsumotoNaganoJapan
| | - Masanori Kobayashi
- Department of Cardiovascular MedicineMatsumoto Kyoritsu HospitalMatsumotoNaganoJapan
| | - Tomohide Ichikawa
- Department of Cardiovascular MedicineMatsumoto Kyoritsu HospitalMatsumotoNaganoJapan
| | - Takashi Koyama
- Department of Cardiovascular MedicineMatsumoto Kyoritsu HospitalMatsumotoNaganoJapan
| | - Hidetoshi Abe
- Department of Cardiovascular MedicineMatsumoto Kyoritsu HospitalMatsumotoNaganoJapan
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20
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A novel alternating second-generation cryoballoon or contact-force guided radiofrequency catheter ablation strategy for redo-ablation in patients with recurrent atrial fibrillation: a single-center experience. J Interv Card Electrophysiol 2022; 65:739-750. [PMID: 35945311 DOI: 10.1007/s10840-022-01321-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: 04/22/2022] [Accepted: 07/21/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pulmonary vein (PV) reconnection after radiofrequency (RFC) or cryoballoon (CB) pulmonary vein isolation (PVI) is common. METHOD We report a single-center experience of 156 patients who underwent a redo procedure-ablation strategy for recurrent atrial fibrillation (AF) in a reverse sequence after a failed index RFC or CB PVI. RESULTS A total of 60 patients after index CB PVI underwent RFC-redo ablation (CB-RFC redo), and 96 patients after index RFC PVI underwent CB-redo ablation (RFC-CB redo). During the redo procedure, the proportion of patients with PV reconnection was lower after index CB PVI procedure compared with the proportion of patients after index RFC PVI (88.3% versus 98.9%, p = 0.01). Additionally, a mean number of 1.50 ± 0.8 PVs/patient were reconnected after index CB PVI, compared with 3.36 ± 0.9 PVs/patient after index RFC PVI (p = 0.001). Patients after index RFC PVI frequently presented with ≥ 3 reconnected PVs, compared with index CB PVI (70.8% vs 10%, p < 0.001). At a 2-year follow-up, 43 patients (27.6%) developed recurrence after redo ablation, with a similar AF-free outcome (CB-RFC redo:73.3% vs RFC-CB redo: 71.9%, p = 0.873). In the multivariate analysis, persistent AF (HR = 2.107, 95% CI: 1.085-4.091, p = 0.028) and early AF recurrence after the initial ablation (HR = 2.431, 95% CI: 1.279-4.618, p = 0.007) were independent predictors of AF recurrence. CONCLUSIONS The extent and distribution of PV reconnections were different after index RFC and CB PVI procedures. Alternating CB or RFC ablation technique strategy is effective with a similar long-term outcome, and it may be an appropriate option for repeated AF ablation.
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21
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Michas G, Magriplis E, Micha R, Chourdakis M, Koutelidakis A, Dimitriadis G, Panagiotakos D, Zampelas A. WITHDRAWN: Prevalence and factors associated with smoking in a nationally representative sample of Greek adults: The Hellenic National Nutrition and Health Survey (HNNHS). Hellenic J Cardiol 2022:S1109-9666(22)00068-9. [PMID: 35605945 DOI: 10.1016/j.hjc.2022.05.006] [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: 10/25/2021] [Revised: 05/02/2022] [Accepted: 05/14/2022] [Indexed: 11/18/2022] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, https://doi.org/10.1016/j.hjc.2022.05.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- George Michas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Emmanuella Magriplis
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece
| | - Renata Micha
- Department of Food Science and Nutrition, School of Agricultural Sciences, University of Thessaly, 43 100, Karditsa, Greece
| | - Michail Chourdakis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54 124 Thessaloniki, Greece
| | - Antonis Koutelidakis
- Department of Food Science and Nutrition, University of Aegean, Mytilini, Greece
| | - George Dimitriadis
- 2(nd) 1Department of Internal Medicine, Research Institute and Diabetes Center, National and Kapodistrian University of Athens, Attikon University Hospital, Haidari, Greece
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education Harokopio University, Athens, Eleftheriou Venizelou 70, 176 76 Athens, Greece
| | - Antonis Zampelas
- Department of Food Science and Human Nutrition, Agricultural University of Athens, Iera Odos 75, 118 55 Athens, Greece.
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22
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Saouma S, Kowalski M. Frozen, Gone in 60 Seconds! J Cardiovasc Electrophysiol 2022; 33:1380-1382. [PMID: 35488748 DOI: 10.1111/jce.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 11/26/2022]
Abstract
The field of electrophysiology has seen the development of a novel ultralow temperature cryoablation (ULTC) system. The data presented in this manuscript shows that the ULTC system is feasible, safe, and effective in acute PVI under sedation and by using angiography only This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Samer Saouma
- Staten Island University Hospital and Northwell Health System, Staten Island, New York, USA
| | - Marcin Kowalski
- Staten Island University Hospital and Northwell Health System, Staten Island, New York, USA
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23
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Rexha E, Heeger CH, Maack S, Rottner L, Wohlmuth P, Lemes C, Maurer T, Reißmann B, Rillig A, Mathew S, Sohns C, Ouyang F, Kuck KH, Metzner A. Impact of a time-to-effect guided ablation protocol in cryoballoon ablation on durability of pulmonary vein isolation. J Cardiovasc Electrophysiol 2022; 33:1096-1103. [PMID: 35304790 DOI: 10.1111/jce.15453] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 01/09/2022] [Accepted: 01/30/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Cryoballoon (CB) based pulmonary vein isolation (PVI) has proven to be as effective as radiofrequency (RF) based ablation. Different ablation protocols took the individual time-to-isolation (TTI) into account aiming at shorter but equally or even more effective freeze-cycles. The current study sought to assess the impact of the TTI on PVI durability in patients undergoing a repeat procedure for recurrence of atrial tachyarrhythmia (ATA). METHODS AND RESULTS In 205 patients with ATA recurrence after previous CB-based PVI a total of 806 PVs were identified. One hundred-twenty-six out of 806 PVs (16%) were previously treated with a TTI guided ablation (protocol #1; TTI+120 sec.), in 92/806 (11%) PVs TTI was only monitored (m) but fixed freeze-cycles were applied (protocol #2; mTTI) and in 588/806 (73%) a fixed freeze-cycle was applied without TTI-monitoring. There was no difference in the PV-reconduction rate between the groups (p=0.23). The right inferior pulmonary vein (RIPV) showed overall significantly higher reconduction rates compared to the other PVs (RIPV - left inferior PV (LIPV) p<0.003, -left superior PV (LSPV) p<0.001, - right superior PV RSPV p<0.013). Twenty-one patients (10%) were demonstrated to have only electrical reconduction of the RIPV, while all other PVs were still electrically isolated. CONCLUSIONS TTI based CB ablation did not show significant differences regarding PV-reconduction rates compared to the other protocols. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Enida Rexha
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Sabrina Maack
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Peter Wohlmuth
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | | | - Shibu Mathew
- Department of Cardiology, University Clinic Gießen, Germany
| | - Christian Sohns
- Clinic for Electrophysiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität, Bochum, Bad Oeynhausen, Germany
| | | | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
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24
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Safety and Efficacy of Cryoballoon Ablation of Atrial Fibrillation in relation to the Patients' Age: Results from a Large Real-World Multicenter Observational Project. Cardiol Res Pract 2022; 2021:9996047. [PMID: 34992884 PMCID: PMC8727157 DOI: 10.1155/2021/9996047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background The real-world efficacy and safety of atrial fibrillation (AF) ablation in particularly young and elderly patients are still under debate. The aim of the analysis was to investigate the effect of age on the efficacy and safety of cryoballoon ablation (CBA). Methods 2,534 patients underwent pulmonary vein isolation (PVI) by way of CBA for paroxysmal or persistent drug-resistant and symptomatic AF. The population was divided into age quartiles for evaluation, including (1) <53 years, (2) ≥53 and <61 years, (3) ≥61 and <67 years, and (4) ≥67 years. Furthermore, outcomes were analyzed in patients <41 years, ≥41 and ≤74, and >74 years old. Procedural data and complications were collected, and atrial fibrillation recurrences were evaluated during follow-up. Results Procedural-related complications (4.1%) were similar in the four subgroups according to age. At the 12-month follow-up, freedom from AF recurrence was 79.2%, 77.4%, 76.8%, and 75.2% (p=0.21), respectively (with increasing age). At 24-month follow-up, similar incidences of AF recurrence were observed in the four subgroups. When the sample was arbitrarily divided into the three age groups, a higher rate of recurrence was observed in older patients with regard to long-term follow-up (freedom from AF recurrence was 71.8% and 40.9%, respectively, at 12 and 24-month follow-up). In the univariate and multivariate analysis, age did not result in a significant predictor of AF recurrence during follow-up; however, a trend toward higher AF recurrences rates in patients ≥67 years was observed. Conclusion The data demonstrated a high degree of safety during CBA across all patient ages. Procedural performance and complications were similar between different ages; AF recurrences seem to be more frequent in patients over 74 years.
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25
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Gunawardene MA, Schaeffer BN, Jularic M, Eickholt C, Maurer T, Akbulak RÖ, Flindt M, Anwar O, Pape UF, Maasberg S, Gessler N, Hartmann J, Willems S. Pulsed-field ablation combined with ultrahigh-density mapping in patients undergoing catheter ablation for atrial fibrillation: Practical and electrophysiological considerations. J Cardiovasc Electrophysiol 2022; 33:345-356. [PMID: 34978360 DOI: 10.1111/jce.15349] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/14/2021] [Accepted: 11/08/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pulsed-field ablation (PFA) yields a novel ablation technology for atrial fibrillation (AF). PFA lesions promise to be highly durable, however clinical data on lesion characteristics are still limited. OBJECTIVE This study sought to investigate PFA lesion creation with ultrahigh-density (UHDx) mapping. METHODS Consecutive AF patients underwent PFA-based pulmonary vein isolation (PVI) using a multispline catheter (Farwave, Farapulse Inc.). Additional ablation, including left atrial posterior wall isolation (LAPWI) and mitral isthmus ablation (MI) were performed in a subset of persistent AF patients. The extent of PFA-lesions and decrease of LA-voltage were assessed with pre- and post PFA UHDx-mapping (Orion™ catheter and Rhythmia™ 3D-mapping system, Boston Scientific). RESULTS In 20 patients, acute PVI was achieved in 80/80 PVs, LAPW isolation in 9/9 patients, MI ablation in 2/2 (procedure time: 123 ± 21.6 min, fluoroscopy time: 19.2 ± 5.5 min). UHDx-mapping subsequent to PVI revealed early PV-reconnection in five case (5/80, 6.25%). Gaps were located at the anterior-superior PV ostia and were successfully targeted with additional PFA. Repeat UHDx mapping after PFA revealed a significant decrease of voltage along the PV ostia (1.67 ± 1.36 mV vs. 0.053 ± 0.038 mV, p < .0001) with almost no complex electrogram-fractionation at the lesion border zones. PFA-catheter visualization within the mapping system was feasible in 17/19 (84.9%) patients and adequate in 92.9% of ablation sites. CONCLUSION For the first time illustrated by UHDx mapping, PFA creates wide antral circumferential lesions and homogenous LAPW isolation with depression of tissue voltage to a minimum. Although with a low incidence, early PV reconnection can still occur also in the setting of PFA.
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Affiliation(s)
- Melanie A Gunawardene
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Benjamin N Schaeffer
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Mario Jularic
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Christian Eickholt
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tilman Maurer
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ruken Ö Akbulak
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Max Flindt
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Omar Anwar
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ulrich F Pape
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Sebastian Maasberg
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Department of Internal Medicine, Asklepios Hospital St. Georg, Hamburg, Germany
| | - Nele Gessler
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.,Asklepios Proresearch, Hamburg, Germany
| | - Jens Hartmann
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Stephan Willems
- Department of Cardiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Budapest, Hungary.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
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26
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Heeger CH, Sohns C, Pott A, Metzner A, Inaba O, Straube F, Kuniss M, Aryana A, Miyazaki S, Cay S, Ehrlich JR, El-Battrawy I, Martinek M, Saguner AM, Tscholl V, Yalin K, Lyan E, Su W, Papiashvili G, Botros MSN, Gasperetti A, Proietti R, Wissner E, Scherr D, Kamioka M, Makimoto H, Urushida T, Aksu T, Chun JKR, Aytemir K, Jędrzejczyk-Patej E, Kuck KH, Dahme T, Steven D, Sommer P, Richard Tilz R. Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry. Circ Arrhythm Electrophysiol 2021; 15:e010516. [PMID: 34962134 PMCID: PMC8772436 DOI: 10.1161/circep.121.010516] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. Methods: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. Results: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was −49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. Conclusions: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (C.-H.H., R.R.T.)
| | - Christian Sohns
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., P.S.)
| | - Alexander Pott
- Department of Cardiology, University of Ulm, Germany (A.P., T.D.)
| | - Andreas Metzner
- Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.).,Asklepios Klinik Harburg, Hamburg, Germany (A.M.).,University Heart Center Hamburg, Germany (A.M.)
| | - Osamu Inaba
- Japanese Red Cross Saitama Hospital, Saitama, Japan (O.I.)
| | - Florian Straube
- München Klinik Bogenhausen und Schwabing, Klinik für Kardiologie und Internistische Intensivmedizin, München, Germany (F.S.).,Ludwig-Maximilians-University, Faculty Munich University Clinic, Germany (F.S.)
| | | | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA (A.A.)
| | | | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Ankara City Hospital, Turkey (S.C.)
| | | | | | | | - Ardan M Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (A.M.S.)
| | - Verena Tscholl
- Charité Campus Benjamin Franklin, Berlin, Germany (V.T.)
| | - Kivanc Yalin
- #x0130;stanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey (K.Y.)
| | | | - Wilber Su
- Division of Cardiology, University of Illinois at Chicago (E.W.)
| | | | | | - Alessio Gasperetti
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,Department of Cardiology, Johns Hopkins University, Baltimore (A.G.).,Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital "Umberto I-Lancisi-Salesi", Marche Polytechnic University, Ancona, IT, Italy (A.G.)
| | - Riccardo Proietti
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy (R.P.)
| | | | | | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan (M.K.)
| | - Hisaki Makimoto
- Universitätsklinik Düsseldorf, Abteilung für Kardiologie, Germany (H.M.)
| | | | - Tolga Aksu
- Kocaeli Derince Training and Research, Turkey (T.A.)
| | - Julian K R Chun
- CCB / Med. Klinik III, Kardiologie, Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C.)
| | - Kudret Aytemir
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey (K.A.)
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland (E.J.-P.)
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.).,LANS Cardio, Hamburg, Germany (K.-H.K.)
| | - Tillman Dahme
- Department of Cardiology, University of Ulm, Germany (A.P., T.D.)
| | - Daniel Steven
- Universität zu Köln, Abteilung für Elektrophysiologie, Köln, Germany (D.S.)
| | - Philipp Sommer
- Herz- und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., P.S.)
| | - Roland Richard Tilz
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.).,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (C.-H.H., R.R.T.)
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27
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Sanchez-Somonte P, Verma A. Hybrid Ablation for Atrial Fibrillation: 1 Step Forward, or 2 Steps Back? JACC Clin Electrophysiol 2021; 7:1530-1532. [PMID: 34949421 DOI: 10.1016/j.jacep.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/12/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Paula Sanchez-Somonte
- Department of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Atul Verma
- Department of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada; Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
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28
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Chun J, Maurer T, Rillig A, Bordignon S, Iden L, Busch S, Steven D, Tilz RR, Shin DI, Estner H, Bourier F, Duncker D, Sommer P, Ewertsen NC, Jansen H, Johnson V, Bertagnolli L, Althoff T, Metzner A. [Practical guide for safe and efficient cryoballoon ablation for atrial fibrillation : Practical procedure, tips and tricks]. Herzschrittmacherther Elektrophysiol 2021; 32:550-562. [PMID: 34735629 DOI: 10.1007/s00399-021-00820-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
Abstract
In the current guidelines on treatment of atrial fibrillation, cryoballoon-based catheter ablation of atrial fibrillation is recommended in addition to radiofrequency ablation and has become established as a standard procedure in the clinical routine of many centers for index pulmonary vein isolation. A safe, simplified and often durable pulmonary vein isolation can be achieved by a systematic approach. This review article provides a practical guide for all steps of cryoballoon-based pulmonary vein isolation, including preprocedural preparation and postinterventional follow-up. Both cryoballoon systems currently available on the market are considered.
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Affiliation(s)
- Julian Chun
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland. .,Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland.
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Stefano Bordignon
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Medizinische Klinik II, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Felix Bourier
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Nils-Christian Ewertsen
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berliner-Herzrhythmus-Zentrum, Berlin, Deutschland
| | | | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
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29
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Straube F, Pongratz J, Hartl S, Brueck B, Tesche C, Ebersberger U, Helmberger T, Crispin A, Wankerl M, Dorwarth U, Hoffmann E. Cardiac computed tomography angiography-derived analysis of left atrial appendage morphology and left atrial dimensions for the prediction of atrial fibrillation recurrence after pulmonary vein isolation. Clin Cardiol 2021; 44:1636-1645. [PMID: 34651337 PMCID: PMC8571558 DOI: 10.1002/clc.23743] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/23/2021] [Accepted: 10/06/2021] [Indexed: 11/12/2022] Open
Abstract
Background Left atrial appendage (LAA) is a potential source of atrial fibrillation (AF) triggers. Hypothesis LAA morphology and dimensions are associated with AF recurrence after pulmonary vein isolation (PVI). Methods From cardiac computed tomography angiography (CCTA), left atrial (LA), pulmonary vein (PV), and LAA anatomy were assessed in cryoballoon ablation (CBA) patients. Results Among 1103 patients undergoing second‐generation CBA, 725 (65.7%) received CCTA with 473 (42.9%) qualifying for detailed LAA analysis (66.3 ± 9.5 years). Symptomatic AF reoccurred in 166 (35.1%) patients during a median follow‐up of 19 months. Independent predictors of recurrence were LA volume, female sex, and mitral regurgitation ≥°II. LAA volume and AF‐type were dependent predictors of recurrence due to their strong correlations with LA volume. LA volumes ≥122.7 ml (sensitivity 0.53, specificity 0.69, area under the curve [AUC] 0.63) and LAA volumes ≥11.25 ml (sensitivity 0.39, specificity 0.79, AUC 0.59) were associated with recurrence. LA volume was significantly smaller in females. LAA volumes showed no sex‐specific difference. LAA morphology, classified as windsock (51.4%), chicken‐wing (20.7%), cactus (12.5%), and cauliflower‐type (15.2%), did not predict successful PVI (log‐rank; p = 0.596). Conclusions LAA volume was strongly correlated to LA volume and was a dependent predictor of recurrence after CBA. Main independent predictors were LA volume, female sex, and mitral regurgitation ≥°II. Gender differences in LA volumes were observed. Individual LAA morphology was not associated with AF recurrence after cryo‐PVI. Our results indicate that preprocedural CCTA might be a useful imaging modality to evaluate ablation strategies for patients with recurrences despite successful PVI.
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Affiliation(s)
- Florian Straube
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.,Faculty of Medicine and the University Hospital, Dept. of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Janis Pongratz
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | - Stefan Hartl
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | - Benedikt Brueck
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.,Internal Medicine and Cardiology, Kardiologie Erkelenz, Erkelenz, Germany
| | - Christian Tesche
- Department of Cardiology, St. Johannes Hospital Dortmund, Dortmund, Germany.,Faculty of Medicine and the University Hospital, Dept. of Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Ullrich Ebersberger
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany.,Faculty of Medicine and the University Hospital, Dept. of Cardiology, Ludwig-Maximilians-University, Munich, Germany.,KMN, Kardiologie Muenchen Nord, Munich, Germany
| | - Thomas Helmberger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Wankerl
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | - Uwe Dorwarth
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
| | - Ellen Hoffmann
- Heart Center Munich-Bogenhausen, Department of Cardiology and Internal Intensive Care Medicine, Munich Clinic Bogenhausen, Academic Teaching Hospital of the Technical University Munich, Munich, Germany
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30
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Sakamoto Y, Osanai H, Tanaka Y, Hiramatsu S, Matsumoto H, Tagahara K, Hosono H, Miyamoto S, Kondo S, Kanbara T, Nakashima Y, Asano H, Ajioka M. Contrast-enhanced computed tomography for optimizing the outcomes of pulmonary vein isolation with cryoablation -the role of isolation of PVs including carina. J Interv Card Electrophysiol 2021; 64:455-461. [PMID: 34435295 PMCID: PMC9399060 DOI: 10.1007/s10840-021-01052-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/16/2021] [Indexed: 11/16/2022]
Abstract
Purpose Compared with conventional pulmonary vein isolation (PVI) with radiofrequency ablation, PVI with cryoballoon is an easier and shorter procedure without reconnection, particularly in the superior pulmonary vein. However, the durability of the cryoballoon may be reduced due to anatomical factors and the position of the pulmonary vein (PV). Further, inadequate isolation of the carina leads to recurrence of atrial fibrillation (AF). We aimed to determine whether using contrast-enhanced computed tomography (CT) for patient selection improves the early success rate and prevents the recurrence of AF in PVI with cryoballoon. Methods We evaluated patients who underwent ablation for paroxysmal atrial fibrillation in our hospital between July 2019 and November 2020. After excluding patients with contraindications for cryoablation, 50 patients were selected through visual inspection of the results of preoperative contrast-enhanced CT. A treatment plan was established, and the clinical course and outcomes were followed up. Results Of the 200 PVs of the 50 patients, only 8 PVs (4%) were incompletely isolated with a single cryoablation. Six of the eight PVs were successfully isolated with additional cryoablation. Only 2 patients (4%) underwent additional PVI with radiofrequency ablation. Four patients had AF recurrence within a mean follow-up period of 14.3 ± 5.1 months. The rate of sinus rhythm maintenance was 92%. PV reconnection was observed in 2 patients. None of the patients had postoperative atrial flutter. Conclusions Selecting patients for cryoablation according to contrast-enhanced CT findings made the procedure easier to perform, leading to improved early success rates and clinical course.
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Affiliation(s)
- Yusuke Sakamoto
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan.
| | - Hiroyuki Osanai
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Yuki Tanaka
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Shotaro Hiramatsu
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Hikari Matsumoto
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Kensuke Tagahara
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Hirotaka Hosono
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Shun Miyamoto
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Shun Kondo
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Takahiro Kanbara
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Yoshihito Nakashima
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
| | - Masayoshi Ajioka
- Department of Cardiology, Tosei General Hospital, 160 Nishi-Oiwake-cho, Seto-city, Aichi, 489-8642, Japan
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31
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Kareem M, Lei N, Ali A, Ciaccio EJ, Acharya UR, Faust O. A review of patient-led data acquisition for atrial fibrillation detection to prevent stroke. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Aryana A. Rationale and Outcomes of Cryoballoon Ablation of the Left Atrial Posterior Wall in Conjunction with Pulmonary Vein Isolation. J Innov Card Rhythm Manag 2021; 12:4633-4646. [PMID: 34476116 PMCID: PMC8384303 DOI: 10.19102/icrm.2021.120801] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/15/2021] [Indexed: 12/12/2022] Open
Abstract
There is strong evidence in support of pulmonary vein isolation (PVI) with concomitant left atrial (LA) posterior wall (PW) isolation (PWI) for the treatment of patients with persistent atrial fibrillation (persAF). While this may be achieved using surgical and catheter-based strategies, there is growing interest in performing this approach using the cryoballoon. There are several potential advantages to this strategy. First, lesions created using the current-generation cryoballoons are typically large and durable. Second, cryoballoon ablation offers a simple technique to directly ablate and debulk the LAPW. Moreover, some consider cryoenergy a safer modality specifically with regard to collateral structures (ie, the esophagus). Based on the available data, cryoballoon PVI + PWI is associated with greater intraprocedural AF terminations and reductions in long-term AF recurrence (typically by ~20%), as compared to PVI alone in patients with persAF, but with similar rates of adverse events. As such, PVI + PWI has emerged as a significant predictor of freedom from recurrent AF (odds ratio: 3.67, 95% confidence interval: 1.44-9.34; p = 0.006) as well as all atrial arrhythmias (hazard ratio: 2.04, 95% confidence interval: 1.15-3.61; p = 0.015). Adjunct radiofrequency ablation to complete PWI is required in at least one-third of the patients, and this need is highly predicted by the LA size (significantly increased with an LA diameter > 48 mm). LAPW reconnection also seems to be associated with LA dimension, particularly an LA diameter greater than 48 mm (negative predictive value: 89.7%). Nevertheless, based on the analysis of patients who underwent repeat electrophysiology study for arrhythmia recurrences, cryoballoon PVI + PWI yields acceptable long-term durability (> 80%).
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Affiliation(s)
- Arash Aryana
- Dignity Health Heart and Vascular Institute, Sacramento, CA, USA
- Cardiac Catheterization Laboratory, Mercy General Hospital, Sacramento, CA, USA
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33
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Hoffmann R, Parade U, Bauerle H, Winter KD, Rauschenbach U, Mischke K, Schaefer C, Gutleben KJ, Rana OR, Willich T, Schlößer M, Rötzer A, Breithardt OA, Middendorf S, Waldecker B, Grove R, Mosa J, Krug J, Imnadze G, Saygili E, Michaelsen J. Safety and acute efficacy of cryoballoon ablation for atrial fibrillation at community hospitals. Europace 2021; 23:1744-1750. [PMID: 34374746 DOI: 10.1093/europace/euab132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/02/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) is an established procedure for treating symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI performed at community hospitals are unknown. We aimed to determine the safety and acute efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. METHODS AND RESULTS This registry study included 1004 consecutive patients who had PVI performed for symptomatic paroxysmal (n = 563) or persistent AF (n = 441) from January 2019 to September 2020 at 20 hospitals. Each hospital performed fewer than 100 CBA-PVI procedures/year according to local standards. Procedural data, efficacy, and complication rates were determined. The mean number of CBA procedures performed/year at each centre was 59 ± 25. The average procedure time was 90.1 ± 31.6 min and the average fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins was documented in 97.9% of patients. The most frequent reason for not achieving complete isolation was development of phrenic nerve palsy. No hospital deaths were observed. Two patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in six patients (0.6%), two of whom (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), two of whom (0.2%) required vascular surgery. Phrenic nerve palsy occurred in 48 patients (4.8%) and persisted up to hospital discharge in six patients (0.6%). CONCLUSION Pulmonary vein isolation procedures for paroxysmal or persistent AF using CBA can be performed at community hospitals with high acute efficacy and low complication rates.
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Affiliation(s)
- Rainer Hoffmann
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Wilhelmstr. 13 49808 Lingen, Germany
| | - Ulli Parade
- Department of Cardiology, Rems-Murr-Klinikum Winnenden, Winnenden, Germany
| | - Hansjörg Bauerle
- Department of Cardiology, Klinikum Friedrichshafen, Friedrichshafen, Germany
| | - Klaus-Dieter Winter
- Department of Cardiology, Ev. Luth. Diakonissenanstalt Flensburg, Flensburg, Germany
| | - Ulrich Rauschenbach
- Department of Cardiology, Hermann-Josef-Krankenhaus Erkelenz, Erkelenz, Germany
| | - Karl Mischke
- Department of Cardiology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
| | - Carl Schaefer
- Department of Cardiology, Elbe Kliniken Stade-Buxtehude, Buxtehude, Germany
| | - Klaus-Jürgen Gutleben
- Department of Cardiology, Helios St. Marienberg-Klinik Helmstedt, Helmstedt, Germany
| | - Obaida R Rana
- Department of Cardiology, Klinikum Herford, Herford, Germany
| | - Tobias Willich
- Kardiologische Gemeinschaftspraxis Brilon, Brilon, Germany
| | - Marc Schlößer
- Department of Cardiology, Dreifaltigkeits-Hospital Lippstadt, Lippstadt, Germany
| | - Alfons Rötzer
- Department of Cardiology, medius KLINIK Ostfildern, Ostfildern, Germany
| | - Ole A Breithardt
- Department of Cardiology, Agaplesion Diakonie Kliniken Kassel, Kassel, Germany
| | | | - Berndt Waldecker
- Department of Cardiology, GRN Klinik Schwetzingen, Schwetzingen, Germany
| | - Rainer Grove
- Department of Cardiology, St. Josefs-Hospital Cloppenburg, Cloppenburg, Germany
| | - Jörg Mosa
- Department of Cardiology, Krankenhaus Freudenstadt, Freudenstadt, Germany
| | - Joachim Krug
- Department of Cardiology, Klinikum Fulda, Fulda, Germany
| | - Guram Imnadze
- Department of Cardiology, Klinikum Osnabrück, Osnabrück, Germany
| | - Erol Saygili
- Department of Cardiology, St. Antonius Krankenhaus, Köln, Germany
| | - Jochen Michaelsen
- Department of Cardiology, Angiology and Sleep Medicine, Bonifatius Hospital Lingen, Wilhelmstr. 13 49808 Lingen, Germany
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34
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Imberti JF, Ding WY, Kotalczyk A, Zhang J, Boriani G, Lip G, Andrade J, Gupta D. Catheter ablation as first-line treatment for paroxysmal atrial fibrillation: a systematic review and meta-analysis. Heart 2021; 107:1630-1636. [PMID: 34261737 DOI: 10.1136/heartjnl-2021-319496] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To assess the efficacy and safety of catheter ablation (CA) compared with antiarrhythmic drugs (AADs) as first-line treatment for symptomatic paroxysmal atrial fibrillation (AF). METHODS Systematic review and meta-analysis of randomised controlled trials identified using MEDLINE, Cochrane Library and Embase published between 01/01/2000 and 19/03/2021. The primary efficacy endpoint was the first documented recurrence of atrial arrhythmias following the blanking period. The primary safety endpoint was a composite of all serious adverse events (SAEs). RESULTS From 441 records, 6 studies met the inclusion criteria. 609 patients received CA, while 603 received AAD therapy. 212/609 patients in the CA group had a recurrence of atrial arrhythmias as compared with 318/603 in the AADs group resulting in a 36% relative risk reduction (risk ratio: 0.64, 95% CI 0.51 to 0.80, p<0.01). The risk of all SAEs was not statistically different between CA and AAD (0.87, 0.58 to 1.30, p=0.49); 107/609 SAE in the CA group vs 126/603 in the AAD group. Both recurrence of symptomatic atrial arrhythmias (109/505 vs 186/504) and healthcare utilisation (126/397 vs 185/394) were significantly lower in the CA group (0.53, 0.35 to 0.79 and 0.65, 0.48 to 0.89, respectively). There was a 79% reduction in the crossover rate during follow-up among patients randomised to CA compared with AAD (0.21, 0.13 to 0.32, p<0.01). CONCLUSIONS First-line treatment with CA is superior to AAD therapy in patients with symptomatic paroxysmal AF, as it significantly reduces the recurrence of any atrial arrhythmias and symptomatic atrial arrhythmias, and healthcare resource utilisation with comparable safety profile.
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Affiliation(s)
- Jacopo F Imberti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, Modena, Italy
| | - Wern Yew Ding
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Agnieszka Kotalczyk
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK.,Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Silesian Centre for Heart Diseases, Zabrze, Poland
| | - Juqian Zhang
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Giuseppe Boriani
- Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, Modena, Italy
| | - Gregory Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Jason Andrade
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Dhiraj Gupta
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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35
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Miyazaki S, Hasegawa K, Iesaka Y. Durability of a right superior pulmonary vein isolation after an inevitably interrupted single short freeze during cryoballoon ablation. J Cardiovasc Electrophysiol 2021; 32:2418-2423. [PMID: 34258810 DOI: 10.1111/jce.15163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/22/2021] [Accepted: 07/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In cryoballoon ablation, applications for right superior pulmonary veins (RSPVs) inevitably need to be interrupted for some safety reasons. We retrospectively investigated the RSPV isolation durability after single interrupted short freezes. METHODS Data from 30 patients who underwent repeat procedures 8.2 (4.1-13.8) months after an inevitably interrupted single short freeze (<180 s) for RSPVs during the index cryoballoon procedures were analyzed. It was interrupted by active deflation due to phrenic nerve injury (PNI) (Group 1: n = 14) or passive deflation due to a balloon temperature of -60°C (Group 2: n = 16). RESULTS The freezing time was 145 (107-166) and 142 (127-160) s and nadir balloon temperature -50.7 ± 3.6 and -60°C in Groups 1 and 2, respectively. Pulmonary vein isolation was achieved after interrupted freezing in all except in one patient requiring touch-up ablation in Group 1. All PNI was asymptomatic and recovered during the follow-up. Eight/13 (61.5%) and 16/16 (100%) RSPVs were durable during the second procedure in Groups 1 and 2. In Group 1, the freezing time was significantly longer in durable than reconnected RSPVs (p = .032), and the optimal cutoff point for the freezing duration to predict the durability was 94.0 s (sensitivity 100%, specificity 60.0%). When the freezing time was ≥120 s, 80% of the RSPVs were durable. However, when the freezing time was ≤68 s, all RSPVs were reconnected. CONCLUSIONS The feasibility of second cryoapplications for RSPVs should be discussed considering the freezing time of the interrupted initial applications in Group 1, however, it was not necessary in Group 2.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.,Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan
| | - Yoshito Iesaka
- Cardiovascular Center, Tsuchiura Kyodo Hospital, Tsuchiura, Ibaraki, Japan
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Straube F, Dorwarth U, Hartl S, Brueck B, Pongratz J, Kosmalla A, Wankerl M, Hoffmann E. Benefit of ultra-high-density mapping-guided radiofrequency reablation in pulmonary vein isolation non-responders after initial cryoballoon procedure. Europace 2021; 22:906-915. [PMID: 32361733 DOI: 10.1093/europace/euaa055] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 02/28/2020] [Indexed: 01/20/2023] Open
Abstract
AIMS Symptomatic atrial arrhythmias despite complete pulmonary vein isolation (PVI) are common. The purpose was to evaluate ultra-high-density multi-electrode electroanatomical mapping-guided radiofrequency ablation (RFA) in PVI non-responders. METHODS AND RESULTS Ultra-high-density multi-electrode electroanatomical mapping-guided RFA in consecutive symptomatic atrial fibrillation (AF) patients after initial cryoballoon PVI was performed. Patients were included if all pulmonary veins (PVs) were still isolated. Radiofrequency targets were atrial tachycardia (AT), extra-PV trigger, and/or substrate. Procedural results and outcome were evaluated. Of 95 patients, 67 (70.5%) with complete PVI were included (70 years, CHA2DS2Vasc 2.9, left atrium 45 mm, persistent AF 45%, AT 45%). The median time to reablation was 26 months. One hundred and seven maps (1.6/patient) and 11.890 ± 9.018 electrograms were acquired in 33 ± 12 min. Twenty-eight percent of the left atrial (LA) wall showed pathological voltage signals, predominantly at the anterior (37%) and septal wall (26%). Atrial tachycardia (49 left, 4 right) were ablated in 35 patients (52%), extra-PV trigger in two patients (3%). One atrioventricular nodal re-entry tachycardia and seven right atrial isthmus ablation (10%) were performed. In 32 patients (48%), no AT was present and substrate-based ablation was performed. Mean LA area ablated was 7 ± 6 cm2 (7%). No major complication occurred. The mean follow-up time was 772 ± 317 days. Freedom from atrial arrhythmia recurrence off antiarrhythmic drugs was 49% at 12 months. CONCLUSION Pulmonary vein isolation non-responders are older, mainly suffering from complex atrial arrhythmias. Left atrial substrate is predominantly located at the anterior and septal wall. Ultra-high-density multi-electrode electroanatomical mapping-guided RFA is safe and effective. At 1 year, 5 out of 10 patients were in stable sinus rhythm off antiarrhythmic drugs.
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Affiliation(s)
- Florian Straube
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Uwe Dorwarth
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Stefan Hartl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Benedikt Brueck
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Janis Pongratz
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Alexander Kosmalla
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Michael Wankerl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
| | - Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Hospital Bogenhausen, Englschalkinger Str. 77, 81925 Munich, Germany
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Dulai R, Uy CP, Kassir Y, Maravilla VA, Patel N, Furniss S, Sulke N, Veasey RA. The long-term effect of thermal-guided second-generation cryoablation in paroxysmal and persistent atrial fibrillation. Indian Pacing Electrophysiol J 2021; 21:261-266. [PMID: 34038768 PMCID: PMC8414182 DOI: 10.1016/j.ipej.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/23/2021] [Accepted: 05/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Second-generation cryoballoon ablation is safe and effective in patients with paroxysmal (PAF) and persistent atrial fibrillation (AF). OBJECTIVE This study aimed to assess the long-term clinical outcomes and freedom from AF in patients undergoing thermal-guided cryoablation without the use of an electrical mapping catheter. METHODS All patients who had undergone thermal-guided second-generation cryoablation without electrical mapping between January 2015 and April 2018 at Eastbourne District General Hospital were retrospectively analysed. Success was defined as freedom from atrial arrhythmia lasting >30 s during the follow up period. RESULTS The study included 234 patients with a mean age of 65.3 ± 10.6 years. There were 134 (57.0%) and 100 (42.7%) patients who had PAF and persistent AF respectively. Arrhythmia recurrence occurred in 38 of 134 (28.4%) PAF and 42 of 100 (42.0%) persistent AF patients after mean follow up of 40 ± 9.2 months. The patients with PAF had a significantly greater freedom from arrhythmia than patients with persistent AF (p = .040). The mean procedure time was 55.5 ± 12.2 min and the mean fluoroscopy time was 10.9 ± 4.8 min 73.5% of patients were discharged on the same day. CONCLUSION Thermal-guided cryoablation is feasible, safe and results in freedom from arrhythmia in the majority of paroxysmal and persistent AF patients in the long term. Randomised controlled trials are required to confirm the findings of this study.
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Affiliation(s)
- Rajdip Dulai
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK.
| | - Christopher Patrick Uy
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK
| | - Yasmin Kassir
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK
| | - Veniza Anne Maravilla
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK
| | - Nikhil Patel
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK
| | - Stephen Furniss
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK
| | - Neil Sulke
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK
| | - Rick A Veasey
- Cardiology Research Department, Eastbourne District General Hospital, Kings Drive, Eastbourne, BN21 2UD, UK
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Reddy VY, Dukkipati SR, Neuzil P, Anic A, Petru J, Funasako M, Cochet H, Minami K, Breskovic T, Sikiric I, Sediva L, Chovanec M, Koruth J, Jais P. Pulsed Field Ablation of Paroxysmal Atrial Fibrillation: 1-Year Outcomes of IMPULSE, PEFCAT, and PEFCAT II. JACC Clin Electrophysiol 2021; 7:614-627. [PMID: 33933412 DOI: 10.1016/j.jacep.2021.02.014] [Citation(s) in RCA: 197] [Impact Index Per Article: 65.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study sought to determine whether durable pulmonary vein isolation (PVI) using pulsed field ablation (PFA) translates to freedom from atrial fibrillation recurrence without an increase in adverse events. BACKGROUND PFA is a nonthermal ablative modality that, in preclinical studies, is able to preferentially ablate myocardial tissue with minimal effect on surrounding tissues. Herein, we present 1-year clinical outcomes of PFA. METHODS In 3 multicenter studies (IMPULSE [A Safety and Feasibility Study of the IOWA Approach Endocardial Ablation System to Treat Atrial Fibrillation], PEFCAT [A Safety and Feasibility Study of the FARAPULSE Endocardial Ablation System to Treat Paroxysmal Atrial Fibrillation], and PEFCAT II [Expanded Safety and Feasibility Study of the FARAPULSE Endocardial Multi Ablation System to Treat Paroxysmal Atrial Fibrillation]), paroxysmal atrial fibrillation patients underwent PVI using a basket or flower PFA catheter. Invasive remapping was performed at ∼2 to 3 months, and reconnected PVs were reisolated with PFA or radiofrequency ablation. After a 90-day blanking period, arrhythmia recurrence was assessed over 1-year follow-up. RESULTS In 121 patients, acute PVI was achieved in 100% of PVs with PFA alone. PV remapping, performed in 110 patients at 93.0 ± 30.1 days, demonstrated durable PVI in 84.8% of PVs (64.5% of patients), and 96.0% of PVs (84.1% of patients) treated with the optimized biphasic energy PFA waveform. Primary adverse events occurred in 2.5% of patients (2 pericardial effusions or tamponade, 1 hematoma); in addition, there was 1 transient ischemic attack. The 1-year Kaplan-Meier estimates for freedom from any atrial arrhythmia for the entire cohort and for the optimized biphasic energy PFA waveform cohort were 78.5 ± 3.8% and 84.5 ± 5.4%, respectively. CONCLUSIONS PVI with a "single-shot" PFA catheter results in excellent PVI durability and acceptable safety with a low 1-year rate of atrial arrhythmia recurrence. These data mitigate concern that the nonthermal ablative mechanism of PFA might mask undiscovered compromises to clinical success. (IMPULSE: A Safety and Feasibility Study of the IOWA Approach Endocardial Ablation System to Treat Atrial Fibrillation, NCT03700385; A Safety and Feasibility Study of the FARAPULSE Endocardial Ablation System to Treat Paroxysmal Atrial Fibrillation, NCT03714178; PEFCAT II Expanded Safety and Feasibility Study of the FARAPULSE Endocardial Multi Ablation System to Treat Paroxysmal Atrial Fibrillation [PEFCAT II], NCT04170608).
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Affiliation(s)
- Vivek Y Reddy
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic; Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Srinivas R Dukkipati
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Petr Neuzil
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Ante Anic
- Department of Cardiology, University Clinical Hospital Split, Split, Croatia
| | - Jan Petru
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | | | - Hubert Cochet
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Kentaro Minami
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Toni Breskovic
- Department of Cardiology, University Clinical Hospital Split, Split, Croatia
| | - Ivan Sikiric
- Department of Cardiology, University Clinical Hospital Split, Split, Croatia
| | - Lucie Sediva
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Milan Chovanec
- Department of Cardiology, Homolka Hospital, Prague, Czech Republic
| | - Jacob Koruth
- Helmsley Electrophysiology Center, Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pierre Jais
- IHU LIRYC ANR-10-IAHU-04, Centre Hospitalier Universitaire Bordeaux, Bordeaux University, Bordeaux, France
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Aryana A, Su W, Kuniss M, Okishige K, de Asmundis C, Tondo C, Chierchia GB. Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III. Heart Rhythm 2021; 18:1435-1444. [PMID: 33905811 DOI: 10.1016/j.hrthm.2021.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 04/18/2021] [Accepted: 04/20/2021] [Indexed: 11/19/2022]
Abstract
Although cryoballoon ablation of atrial fibrillation (AF) traditionally has been guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in performing segmental, nonocclusive cryoballoon ablation to target not only large/common PVs but extra-PV structures such as the left atrial (LA) roof and posterior wall in conjunction with PV isolation. A number of studies have demonstrated improved clinical efficacy associated with nonocclusive cryoballoon ablation of the LA roof and posterior wall in addition to PV isolation, particularly in patients with persistent AF. Not only can the cryoballoon be used for targeting extra-PV structures through segmental, nonocclusive ablation, but the large size and durability of cryolesions coupled with the enhanced stability afforded through cryoadhesion render the cryoballoon an effective tool for such an approach. This article reviews the rationale and practical approach to segmental, nonocclusive cryoballoon ablation of large/common PV antra and the LA roof and posterior wall.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California.
| | - Wilber Su
- Banner University Medical Center, Phoenix, Arizona
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | | | - Claudio Tondo
- Heart Rhythm Center, Centro Cardiologico Monzino IRCCS; Department of Biochemical, Surgical and Dental Sciences, University of Milan, Milan, Italy
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40
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Sørensen SK, Johannessen A, Worck R, Hansen ML, Hansen J. Radiofrequency Versus Cryoballoon Catheter Ablation for Paroxysmal Atrial Fibrillation: Durability of Pulmonary Vein Isolation and Effect on Atrial Fibrillation Burden: The RACE-AF Randomized Controlled Trial. Circ Arrhythm Electrophysiol 2021; 14:e009573. [PMID: 33835823 PMCID: PMC8136462 DOI: 10.1161/circep.120.009573] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Supplemental Digital Content is available in the text. Background: Recurrent paroxysmal atrial fibrillation (AF) after catheter ablation is presumably caused by failure to achieve durable pulmonary vein isolation (PVI). The primary methods of PVI are radiofrequency catheter ablation (RF) and cryoballoon catheter ablation (CRYO), but these methods have not been directly compared with respect to PVI durability and the effect thereof on AF burden (% of time in AF). Methods: Accordingly, we performed a randomized trial including 98 patients (68% male, 61 [55–67] years) with paroxysmal AF assigned 1:1 to PVI by contact-force sensing, irrigated radiofrequency catheter, or second-generation cryoballoon catheter. Implantable cardiac monitors were inserted ≥1 month before PVI for assessment of AF burden and recurrence, and all patients, irrespective of AF recurrence, underwent a second procedure 4 to 6 months after PVI to determine PVI durability. Results: In the second procedure, 152 out of 199 (76%) pulmonary veins (PVs) were found durably isolated after RF and 161 out of 200 (81%) after CRYO (P=0.32), corresponding to durable isolation of all veins in 47% of patients in both groups (P=1.0). Median AF burden before PVI was 5.4% (interquartile range, 0.5%–13.0%) versus 4.0% (0.6%–18.1%), RF versus CRYO (P=0.71), and reduced to 0.0% (0.0%–0.1%) and 0.0% (0.0%–0.5%), respectively (P=0.58)—a reduction of 99.9% (92.9%–100.0%) and 99.3% (85.9%–100.0%; P=0.36). AF burden after PVI significantly correlated to the number of durably isolated PVs (P<0.01), but 9 out of 45 (20%) patients with durable isolation of all veins had recurrence of AF within 4 to 6 months after PVI (excluding a 3-month blanking period). Conclusions: PVI by RF and CRYO produce similar moderate to high PVI durability. Both treatments lead to marked reductions in AF burden, which is related to the number of durably isolated PVs. However, for one-fifth of paroxysmal AF patients, complete and durable PVI was not sufficient to prevent even short-term AF recurrence. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03805555.
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Affiliation(s)
- Samuel K Sørensen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Arne Johannessen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - René Worck
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Morten L Hansen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
| | - Jim Hansen
- Copenhagen University Hospital Gentofte, Gentofte Hospitalsvej 1, Hellerup, Denmark
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41
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Heeger CH, Bohnen JE, Popescu S, Meyer-Saraei R, Fink T, Sciacca V, Kirstein B, Hatahet S, Traub A, Lopez LD, Schlüter M, Kuck KH, Eitel C, Vogler J, Richard Tilz R. Experience and procedural efficacy of pulmonary vein isolation using the fourth and second generation cryoballoon: The shorter, the better? J Cardiovasc Electrophysiol 2021; 32:1553-1560. [PMID: 33760304 DOI: 10.1111/jce.15009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome. The novel fourth-generation cryoballoon (CB4) incorporates a 40% shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE). METHODS AND RESULTS Three hundred consecutive patients with paroxysmal or persistent atrial fibrillation were prospectively enrolled. The first 150 consecutive patients underwent CB2 based PVI (CB2 group) and the last 150 consecutive patients were treated with the CB4 (CB4 group). A total of 594/594 (100%, CB4) and 589/594 (99.2%, CB2) pulmonary veins (PVs) were successfully isolated utilizing the CB4 and CB2, respectively (p = .283). The real-time PVI visualization rate was 47% (CB4) and 39% (CB2; p = .005) and the mean freeze cycle duration 200 ± 90 s (CB4) and 228 ± 110 s (CB2; p < .001), respectively. The total procedure time did not differ between the groups (CB4: 64 ± 32 min) and (CB2: 62 ± 29 min, p = .370). No differences in periprocedural complications were detected. CONCLUSIONS A higher rate of real-time electrical PV recordings are seen using the CB4 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.
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Affiliation(s)
- Christian-Hendrik Heeger
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Jan-Eric Bohnen
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sorin Popescu
- Carol Davila, University of Medicine and Pharmacy, Bucharest, Romania
| | - Roza Meyer-Saraei
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Thomas Fink
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Vanessa Sciacca
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Bettina Kirstein
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sascha Hatahet
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Anna Traub
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Lisbeth D Lopez
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Karl-Heinz Kuck
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.,LANS Cardio, Hamburg, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Julia Vogler
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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Miyazaki S, Hasegawa K, Mukai M, Aoyama D, Nodera M, Shiomi Y, Tama N, Ikeda H, Ishida K, Uzui H, Tada H. The advantages and disadvantages of the novel fourth-generation cryoballoon as compared to the second-generation cryoballoon in the current short freeze strategy. J Interv Card Electrophysiol 2021; 63:143-152. [PMID: 33575920 DOI: 10.1007/s10840-021-00957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The novel fourth-generation cryoballoon (4th-CB) is characterized by a shorter-tip that potentially facilitates better time-to-isolation (TTI) monitoring. We sought to clarify the advantages and disadvantages of the 4th-CB compared to the second-generation cryoballoon (2nd-CB) in pulmonary vein isolation (PVI). METHODS Forty-one and 49 consecutive atrial fibrillation patients underwent 2nd-CB and 4th-CB PVIs using 28-mm balloons and short freeze strategies. When effective freezing was not obtained, the CB was switched to the other CB. RESULTS The rate of successful PVIs was significantly higher for 2nd-CBs than 4th-CBs (162/162[100%] vs. 178/193[92.2%] PVs, p < 0.0001). The difference was significant for lower PVs, especially right inferior PVs (RIPVs)(p = 0.005). In a total of 15 PVs in 11 patients, 4th-CBs were switched to 2nd-CBs, and 14/15(93.3%) PVs were successfully isolated. The balloon temperature tended to reach -55℃ more frequently with 2nd-CBs than 4th-CBs during RIPV ablations (15/41[36.6%] vs. 12/49[24.5%], p = 0.21). The TTI monitoring capability was significantly higher with 4th-CBs than 2nd-CBs (131/188[69.7%] vs. 83/160[51.9%] PVs, p = 0.0007). The difference was significant for right superior and left inferior PVs, but not for left superior PVs. Even if PVs requiring crossover were excluded, the total freeze duration (715±152 vs. 755±215 seconds, p = 0.31) tended to be shorter for 2nd-CBs than 4th-CBs. The incidence of phrenic nerve injury was similar for 2nd-CB and 4th-CB ablation (0/41 vs. 2/49, p = 0.12) CONCLUSIONS: The 4th-CB's shorter balloon tip enabled a significantly higher capability of TTI monitoring; however, it resulted in significantly lower rates of successful PVIs than the 2nd-CB, especially for the RIPVs.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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43
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Garg L, Santangeli P. Arctic Front versus POLARx cryoballoon: Is there a winner? J Cardiovasc Electrophysiol 2021; 32:595-596. [PMID: 33533084 DOI: 10.1111/jce.14926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 01/25/2023]
Affiliation(s)
- Lohit Garg
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Pasquale Santangeli
- Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mizutani Y, Inden Y, Yanagisawa S, Kanashiro M, Makino Y, Satake A, Kurobe M, Ichimiya H, Uchida Y, Watanabe J, Ichimiya S, Murohara T. Disappearance pattern and the last remaining earliest pulmonary vein potential during cryoballoon ablation in predicting recurrence and conduction gap site of pulmonary veins. Heart Vessels 2021; 36:1190-1200. [PMID: 33496818 DOI: 10.1007/s00380-021-01785-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Electrophysiological studies have rarely evaluated the sites prone to pulmonary vein (PV) conduction gap during cryoballoon ablation (CBA) for atrial fibrillation (AF). In addition, no studies have analyzed the sequence of PV potentials just before PV isolation during CBA for AF. Of the 238 patients who underwent first-time CBA for paroxysmal AF, 115 PVs of 29 patients who underwent repeat session due to recurrence after the procedure were retrospectively evaluated in the study. We evaluated the disappearance pattern of PV potential and PV reconnection on intracardiac electrograms and investigated whether the conduction gap site of the PV was related to the last remaining earliest PV potential (EP) and sequence pattern during the first-time CBA. Time to isolation was observed in 81 PVs during the first-time CBA. At the repeat session, PV reconnection was only observed in 22 of 81 PVs. PV potentials disappeared with sequence changes in 36 PVs and without sequence changes in 38 PVs. Multivariate analysis demonstrated that disappearance of PV potentials without change in the EP site but with delay or disappearance of other PV potentials was independently associated with PV reconnection (12/22 PVs [55%] vs. 4/59 PVs [6.8%]; odds ratio 14.4; 95% confidence interval 3.75-55.5; p < 0.001). In 19 of 22 (86%) reconnected PVs, PV conduction gap sites at repeat ablation corresponded with the last remaining EP sites during first-time CBA. In conclusion, disappearance pattern of the PV potential and the last remaining EP during the CBA can predict PV reconnection and gap site.
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Affiliation(s)
- Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan. .,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Yuichiro Makino
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Akinori Satake
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Masanari Kurobe
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Hitoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Yasuhiro Uchida
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Junji Watanabe
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Satoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Hoffmann E, Straube F, Wegscheider K, Kuniss M, Andresen D, Wu LQ, Tebbenjohanns J, Noelker G, Tilz RR, Chun JKR, Franke A, Stellbrink C, Garcia-Alberola A, Dorwarth U, Metzner A, Ouarrak T, Brachmann J, Kuck KH, Senges J. Outcomes of cryoballoon or radiofrequency ablation in symptomatic paroxysmal or persistent atrial fibrillation. Europace 2020; 21:1313-1324. [PMID: 31199860 PMCID: PMC6735953 DOI: 10.1093/europace/euz155] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022] Open
Abstract
Aims To evaluate the effectiveness and safety of cryoballoon ablation (CBA) compared with radiofrequency ablation (RFA) for symptomatic paroxysmal or drug-refractory persistent atrial fibrillation (AF). Methods and results Prospective cluster cohort study in experienced CBA and RFA centres. Primary endpoint was ‘atrial arrhythmia recurrence’, secondary endpoints were as follows: procedural results, safety, and clinical course. A total of 4189 patients were included: CBA 2329 (55.6%) and RFA 1860 (44.4%). Cryoballoon ablation population was younger, with fewer comorbidities. Procedure time was longer in the RFA group (P = 0.01). Radiation exposure was 2487 (CBA) and 1792 cGycm2 (RFA) (P < 0.001). Follow-up duration was 441 (CBA) and 511 days (RFA) (P < 0.0001). Primary endpoint occurred in 30.7% (CBA) and 39.4% patients (RFA) [adjusted hazard ratio (adjHR) 0.85, 95% confidence interval (CI) 0.70–1.04; P = 0.12). In paroxysmal AF, CBA resulted in a lower risk of recurrence (adjHR 0.80, 95% CI 0.64–0.99; P = 0.047). In persistent AF, the primary outcome was not different between groups. Major adverse cardiovascular and cerebrovascular event rates were 1.0% (CBA) and 2.8% (RFA) (adjHR 0.53, 95% CI 0.26–1.10; P = 0.088). Re-ablations (adjHR 0.46, 95% CI 0.34–0.61; P < 0.0001) and adverse events during follow-up (adjHR 0.64, 95% CI 0.48–0.88; P = 0.005) were less common after CBA. Higher rehospitalization rates with RFA were caused by re-ablations. Conclusions The primary endpoint did not differ between CBA and RFA. Cryoballoon ablation was completed rapidly; the radiation exposure was greater. Rehospitalization due to re-ablations and adverse events during follow-up were observed significantly less frequently after CBA than after RFA. Subgroup analysis suggested a lower risk of recurrence after CBA in paroxysmal AF. Trial Registration ClinicalTrials.gov (NCT01360008), https://clinicaltrials.gov/ct2/show/NCT01360008.
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Affiliation(s)
- Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Englschalkinger Str. 77, Munich, Germany
| | - Florian Straube
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Englschalkinger Str. 77, Munich, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Malte Kuniss
- Department of Cardiology, Kerckhoff Clinic, Bad Nauheim, Germany
| | - Dietrich Andresen
- Department of Cardiology at Evangelisches Krankenhaus Hubertus, Paul Gerhardt Diakonie gAG, Berlin, Germany
| | - Li-Qun Wu
- Department of Cardiology, Rui Jin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jürgen Tebbenjohanns
- HELIOS Klinikum Hildesheim, Medizinische Klinik I - Kardiologie, Hildesheim, Germany
| | - Georg Noelker
- Department of Cardiology, Herz-und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Centre Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.,Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | | | - Andreas Franke
- Department of Cardiology, KRH Klinikum Siloah-Oststadt-Heidehaus, Hannover, Germany
| | | | - Arcadi Garcia-Alberola
- Department of Cardiology, University Hospital Virgen de la Arrixaca, El-Palmar, Murcia, Spain
| | - Uwe Dorwarth
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Englschalkinger Str. 77, Munich, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Taoufik Ouarrak
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | | | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Clinic St. Georg, Hamburg, Germany
| | - Jochen Senges
- Stiftung Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
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Hong KL, Borges J, Glover B. Catheter ablation for the management of atrial fibrillation: current technical perspectives. Open Heart 2020; 7:openhrt-2019-001207. [PMID: 32393656 PMCID: PMC7223467 DOI: 10.1136/openhrt-2019-001207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/16/2020] [Accepted: 04/06/2020] [Indexed: 01/22/2023] Open
Abstract
Atrial fibrillation (AF) is the most common arrhythmia encountered in clinical practice, with a prevalence that increases alongside the ageing population worldwide. The management of AF involves restoration of sinus rhythm through antiarrhythmic drug therapy. Yet, these medications have only modest efficacy in achieving long-term success, have not shown to result in a mortality benefit, are frequently not tolerated and have associated adverse side effects. Therefore, catheter ablation has become a valuable treatment approach for AF and even a viable first-line strategy in select cases. Traditionally, the combination of radiofrequency energy and a three-dimensional electroanatomical mapping system has been used to guide catheter ablation for AF. However, single-procedural efficacy and long-term outcomes still remain suboptimal for many patients, particularly those with persistent or long-standing AF. Recent advances in ablation technology and strategy, therefore, provide new procedural approaches for catheter-based treatment with the aim of overcoming current challenges in procedural duration and overall success. The aim of this paper was to provide an updated review of the current practices and techniques relating to ablation for AF and to compare the use of these strategies for paroxysmal and persistent AF.
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Affiliation(s)
- Kathryn Lauren Hong
- Cardiology, University of Toronto, Toronto, Canada.,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jazlyn Borges
- Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Benedict Glover
- Cardiology, University of Toronto, Toronto, Canada .,Cardiology, Sunnybrook Health Sciences Centre, Toronto, Canada
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Keeping it Simple: Balloon Devices for Atrial Fibrillation Ablation Therapy. JACC Clin Electrophysiol 2020; 6:1577-1596. [PMID: 33213820 DOI: 10.1016/j.jacep.2020.08.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 08/31/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
Atrial fibrillation is a common disease of increasing prevalence. Catheter ablation has evolved into an established therapeutic option that mainly aims to electrically isolate the pulmonary veins from atrial myocardium. The traditional method comprises point-by-point radiofrequency current ablation guided by electroanatomical mapping and has proven to be effective and safe in experienced hands. However, this approach is technically highly demanding and associated with a long learning curve, limiting its widespread utilization. To address these shortcomings, simplified ablation tools for pulmonary vein isolation are needed. In this context, balloon devices promise to ease the procedure by approaching the entire orifice of a targeted pulmonary vein in a single maneuver. This requires less catheter manipulation in the left atrium and often allows ablation of a large volume of tissue with a single application of ablative energy. Two balloon devices-one using cryoenergy, the other laser energy-have already been established in clinical routine and have demonstrated noninferiority when compared with radiofrequency ablation in large randomized trials. More balloon devices are on the verge of being introduced into clinical practice and bear the potential to expand the interventional electrophysiologist's armamentarium when treating atrial fibrillation. The authors review the use of the established balloon devices available for atrial fibrillation ablation and provide a detailed outlook on upcoming balloon technologies, including 3 different balloons utilizing radiofrequency energy as well as a novel cryoballoon.
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48
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Association between the locations of non-pulmonary vein triggers and ablation outcomes in repeat procedures after cryoballoon ablation of paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2020; 62:381-389. [PMID: 33159266 DOI: 10.1007/s10840-020-00913-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/01/2020] [Indexed: 01/24/2023]
Abstract
PURPOSE We examined the characteristics of non-pulmonary vein (PV) triggers in repeat ablation after cryoballoon ablation for paroxysmal atrial fibrillation (PAF). METHODS This study evaluated 119 patients undergoing a second ablation procedure for recurrent atrial tachyarrhythmia (ATA) after cryoballoon PV isolation (CB-PVI) for PAF. RESULTS Fifty-three of 119 (45%) patients had PV reconnection. All reconnected PVs were isolated. No non-PV triggers were elicited in 42/119 (35%) patients (NNPV group). In 77/119 (65%) patients, 139 isoproterenol-induced non-PV triggers, including 45 triggers that initiated AF, were identified. Non-PV triggers initiating AF were observed at the superior vena cava (SVC), left atrial posterior wall (LAPW) including the PV antra, interatrial septum, right atrium, left atrial appendage/mitral anulus, and coronary sinus in 14 (12%), 10 (8%), 8 (7%), 7 (6%), 4 (3%), and 2 (2%) patients, respectively. Non-PV triggers originated from only the SVC and/or LAPW including the PV antra, and the SVC and/or LAPW was isolated in 18/119 (15%) patients (SVC/LAPW group). Non-PV triggers originating from other sites were focally ablated in 59/119 (50%) patients (OS group). During a median 461 days of follow-up, 39/42 (93%), 17/18 (94%), and 38/59 (64%) patients in the NNPV, SVC/LAPW, and OS groups, respectively, remained ATA recurrence-free. The recurrence rate was higher in the OS group than in the NNPV (P = 0.005) or SVC/LAPW groups (P = 0.042). CONCLUSIONS Over half of patients had non-PV triggers at subsequent ablation after CB-PVI. Non-PV triggers from the SVC/LAPW can be eliminated more successfully than triggers from other sites.
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Mirolo A, Chaumont C, Savoure A, Godin B, Raitière O, Eltchaninoff H, Anselme F. Are routine cryoballoon procedural characteristics predictive of atrial arrhythmia recurrence in the long term? Arch Cardiovasc Dis 2020; 114:105-114. [PMID: 33129697 DOI: 10.1016/j.acvd.2020.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/01/2020] [Accepted: 06/27/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cryoballoon ablation is an effective procedure to treat atrial fibrillation (AF). However, AF recurrence rate at 1-year follow-up is approximately 20% despite improvements in ablation technique. AIM To find factors predictive of AF recurrence following a first pulmonary vein isolation procedure using a second-generation cryoballoon (PVI-2CB). METHODS This was an observational, retrospective, single-centre study. From June 2012 to April 2017, all patients who had a PVI-2CB procedure and a scheduled follow-up at Rouen University Hospital were included. The primary endpoint was atrial arrhythmia (AA) recurrence (e.g. AF, flutter or tachycardia), considering a blanking period of 2 months following the procedure. Secondary endpoints were procedural variables for each pulmonary vein (successful isolation, time to disconnection, total cryoballoon application time, number of cryoballoon applications, level of occlusion during cryoballoon application leading to successful disconnection and lowest temperature reached during successful cryoballoon application), occurrence of redo procedures, use of antiarrhythmic drugs and adverse events. RESULTS The initial population consisted of 239 patients; six were excluded for lack of procedural variable data, giving an analysed population of 233 patients. The AA recurrence rate was 36.9% (mean follow-up 25±14 months). Mean time to AA recurrence was 10±12 months. No procedural variable was found to be predictive of AA recurrence. Only major left atrial enlargement (defined as diameter>50mm or left atrial area>30cm2 or left atrial volume>50mL/m2) was predictive (odds ratio 2.70, 95% confidence interval 1.54-4.72; P=0.001). Forty-one patients had redo procedures (17.6% of analysed population); in this subgroup, 75.6% had at least one pulmonary vein reconnected, mainly the right inferior pulmonary vein. CONCLUSIONS At long-term follow-up, up to one-third of patients had AA recurrence after PVI-2CB. Important atrial remodelling was the only factor predictive of AA recurrence, whereas no procedural variable was found to be predictive.
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Affiliation(s)
- Adrian Mirolo
- Department of Cardiology, CHU de Rouen, 76000 Rouen, France.
| | | | - Arnaud Savoure
- Department of Cardiology, CHU de Rouen, 76000 Rouen, France
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50
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Aryana A, Allen SL, Pujara DK, Bowers MR, O'Neill PG, Yamauchi Y, Shigeta T, Vierra EC, Okishige K, Natale A. Concomitant Pulmonary Vein and Posterior Wall Isolation Using Cryoballoon With Adjunct Radiofrequency in Persistent Atrial Fibrillation. JACC Clin Electrophysiol 2020; 7:187-196. [PMID: 33602399 DOI: 10.1016/j.jacep.2020.08.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/22/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of this multicenter, randomized, single-blind study was to prospectively evaluate the short-and long-term outcomes of pulmonary vein isolation (PVI) versus PVI with concomitant left atrial posterior wall isolation (PWI) using the cryoballoon in patients with symptomatic persistent/long-standing persistent atrial fibrillation (P/LSP-AF). BACKGROUND Some studies have suggested a clinical benefit associated with PVI+PWI in patients with P/LSP-AF. However, there are limited safety and efficacy data on this approach using cryoballoon ablation. METHODS The immediate and long-term outcomes in patients with P/LSP-AF randomized to PVI (n = 55) versus PVI+PWI (n = 55) using the cryoballoon were prospectively examined. RESULTS Baseline characteristics were similar. PVI was achieved in all patients (21 ± 11 min). PWI was attained using 23 ± 8 min of cryoablation. Adjunct radiofrequency ablation was required in 4 of 110 patients (7.3%) to complete PVI (3 ± 2 min) and in 25 of 55 patients (45.5%) to complete PWI (4 ± 6 min). Although left atrial dwell time (113 ± 31 min vs. 75 ± 32 min; p < 0.001) and total procedure time (168 ± 34 min vs. 127 ± 40 min; p < 0.001) were longer with PVI+PWI, this cohort required fewer intraprocedural cardioversions (89.1% vs. 96.4%; p = 0.04). Adverse events occurred in 5.5% in each group (p = 1.00). However, the incidence of recurrent atrial fibrillation at 12 months was significantly lower with PVI+PWI (25.5% vs. 45.5%; p = 0.028). Additionally, in a multivariate analysis, PVI+PWI emerged as a significant predictor of freedom from recurrent atrial fibrillation (odds ratio: 3.67; 95% confidence interval: 1.44 to 9.34; p = 0.006). CONCLUSIONS In patients with P/LSP-AF, PVI+PWI using the cryoballoon is associated with a significant reduction in atrial fibrillation recurrence, but similar safety, as compared with PVI alone.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA.
| | - Shelley L Allen
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | | | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Takatoshi Shigeta
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Eleanor C Vierra
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California, USA
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama, Japan
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, Texas, USA
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