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Tan MC, Tan JL, Lee WJ, Srivathsan K, Sorajja D, El Masry H, Scott LR, Lee JZ. Adverse events in cryoballoon ablation for pulmonary vein isolation: Insight from the Food and Drug Administration Manufacturer and User Facility Device Experience. J Arrhythm 2023; 39:784-789. [PMID: 37799789 PMCID: PMC10549805 DOI: 10.1002/joa3.12898] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/13/2023] [Accepted: 07/03/2023] [Indexed: 10/07/2023] Open
Abstract
Background Real-world clinical data on the adverse events related to the use of cryoballoon catheter for pulmonary vein isolation remains limited. Objective To report and describe the adverse events related to the use of Artic Front cryoballoon catheters (Arctic Front, Arctic Front Advance, and Arctic Front Advance Pro) reported in the Food and Drug Administration's (FDA) Manufacturers and User Defined Experience (MAUDE) database. Methods We reviewed all the adverse events reported to the FDA MAUDE database over a 10.7-year study period from January 01, 2011 to September 31, 2021. All events were independently reviewed by two physicians. Results During the study period, a total of 320 procedural-related adverse events reported in the MAUDE database were identified. The most common adverse event was transient or persistent phrenic nerve palsy (PNP), accounting for 48% of all events. This was followed by cardiac perforation (15%), pulmonary vein stenosis (8%), transient ischemic attack or stroke (6%), vascular injury (4%), transient or persistent ST-elevation myocardial infarction (3%), hemoptysis (2%), pericarditis (2%), and esophageal ulcer or fistula (1%). There were six reported intra-procedural death events as a result of cardiac perforation. Conclusion The two most common procedural adverse events associated with cryoballoon ablation were PNP and cardiac perforation. All cases of procedural mortality were due to cardiac perforation.
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Affiliation(s)
- Min Choon Tan
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
- Department of Internal MedicineNew York Medical College at Saint Michael's Medical CenterNewarkNew JerseyUSA
| | - Jian Liang Tan
- Department of Cardiovascular MedicineHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Wei Jun Lee
- International Medical UniversityKuala LumpurMalaysia
| | | | - Dan Sorajja
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
| | - Hicham El Masry
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
| | - Luis R. Scott
- Department of Cardiovascular MedicineMayo Clinic ArizonaPhoenixArizonaUSA
| | - Justin Z. Lee
- Department of Cardiovascular MedicineCleveland ClinicClevelandOhioUSA
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Metzner A, Straube F, Tilz RR, Kuniss M, Noelker G, Tebbenjohanns J, Andresen D, Wieneke H, Stellbrink C, Franke J, Dorwarth U, Carion PL, Holbrook R, Hochadel M, Senges J, Hoffmann E, Kuck KH, Garcia-Alberola A, Massa T, Sabin G, Franke A, Souza JJ, Stanley A, Spitzer SG, Willems S, Dierk T, Chun KRJ, Borchard R, Seidl KH, Zahn R, Groschup G, Obel IWP, Brachmann J, Gerds-Li JH, Gopal RR, Schrickel J, Lewalter T, Stanley A, Moshage W, Eckardt L, Jung W, Kremer P, Lubinski A, Schumacher B, Lickfett L, Münzel T, Steinwender C, Efremidis M, Deneke T, Nguyen DQ. Electrophysiology lab efficiency comparison between cryoballoon and point-by-point radiofrequency ablation: a German sub-analysis of the FREEZE Cohort study. BMC Cardiovasc Disord 2023; 23:8. [PMID: 36624380 PMCID: PMC9830778 DOI: 10.1186/s12872-022-03015-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Pulmonary vein isolation (PVI) is recommended to treat paroxysmal and persistent atrial fibrillation (AF). This analysis aimed to assess the hospital efficiency of single-shot cryoballoon ablation (CBA) and point-by-point radiofrequency ablation (RFA). METHODS The discrete event simulation used PVI procedure times from the FREEZE Cohort study to establish the electrophysiology (EP) lab occupancy time. 1000 EP lab days were simulated according to an illustrative German hospital, including 3 PVI cases per day using CBA at one site and RFA at the other. RESULTS The analysis included 1560 CBA patients and 1344 RFA patients from the FREEZE Cohort. Some baseline patients' characteristics were different between groups (age, AF type, and some concomitant diseases), without being statistically associated to ablation procedure time. Mean procedure time was 122.2 ± 39.4 min for CBA and 160.3 ± 53.5 min for RFA (p < 0.0001). RFA was associated with a more than five-fold increase of cumulative overtime compared to CBA over the simulated period (1285 h with RFA and 253 h with CBA). 70.7% of RFA lab days included overtime versus 25.7% for CBA. CBA was associated with more days with an additional hour at the end of the EP lab shift compared to RFA (47.8% vs 11.5% days with one hour left, respectively). CONCLUSION CBA is faster and more predictable than point-by-point RFA, and enables improvements in EP lab efficiency, including: fewer cumulative overtime hours, more days where overtime is avoided and more days with remaining time for the staff or for any EP lab usage. Clinical trial registration NCT01360008 (first registration 25/05/2011).
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Affiliation(s)
- Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. .,Department of Cardiology, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, Gebäude Ost 70, 20246, Hamburg, Germany.
| | - Florian Straube
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Roland R. Tilz
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany ,grid.412468.d0000 0004 0646 2097Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital Schleswig-Holstein, University Heart Centre Luebeck, Lübeck, Germany
| | - Malte Kuniss
- grid.419757.90000 0004 0390 5331Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
| | - Georg Noelker
- grid.418457.b0000 0001 0723 8327Herz- Und Diabeteszentrum Nordrhein-Westfalen, Bad Oeynhausen, Germany
| | - Juergen Tebbenjohanns
- HELIOS Klinikum Hildesheim, Medizinische Klinik I – Kardiologie, Hildesheim, Germany
| | - Dietrich Andresen
- grid.417953.d0000 0004 0560 5172Department of Cardiology Paul Gerhardt Diakonie gAG, Evangelisches Krankenhaus Hubertus, Berlin, Germany
| | - Heinrich Wieneke
- Klinik Für Kardiologie und Angiologie, Contilia Herz- Und Gefäßzentrum, Essen, Germany
| | - Christoph Stellbrink
- grid.461805.e0000 0000 9323 0964Department of Cardiology, Klinikum Bielefeld, Bielefeld, Germany
| | - Jennifer Franke
- grid.476904.8CardioVascular Center Frankfurt, Frankfurt, Germany
| | - Uwe Dorwarth
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Phuong Lien Carion
- grid.471158.e0000 0004 0384 6386Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Reece Holbrook
- grid.419673.e0000 0000 9545 2456Medtronic, Inc., Mounds View, MN USA
| | - Matthias Hochadel
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Jochen Senges
- grid.488379.90000 0004 0402 5184Stiftung Institut Fur Herzinfarktforschung, Ludwigshafen, Germany
| | - Ellen Hoffmann
- grid.419595.50000 0000 8788 1541Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen - Munich Municipal Hospital Group, Munich, Germany
| | - Karl-Heinz Kuck
- grid.459389.a0000 0004 0493 1099Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
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Manfrin M, Verlato R, Arena G, Pieragnoli P, Molon G, Tondo C, Perego GB, Rovaris G, Sciarra L, Mantica M, Sacchi R, Ricciardi D, Marini M, Iacopino S. Second versus fourth generation of cryoballoon catheters: the 1STOP real-world multicenter experience. Pacing Clin Electrophysiol 2022; 45:968-974. [PMID: 35417055 DOI: 10.1111/pace.14494] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/25/2022] [Accepted: 03/18/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION It has been observed that the fourth-generation cryoballoon (CB4) ablation catheter increased the rate of acute real-time recordings of pulmonary vein isolation (PVI) during the ablation for the treatment of atrial fibrillation (AF). The aim of this analysis was to compare the long-term outcome results between patients treated with the CB4 and second-generation cryoballoon (CB2). METHODS In total, 492 patients suffering from AF, underwent PVI ablation with either the CB2 or CB4 catheter within this examination of the 1STOP real-world Italian project and were included in the analysis. Specifically, 246 consecutive patients treated by CB4 were compared to 246 propensity-matched control patients who underwent PVI using CB2. RESULTS When comparing the patient cohorts treated with CB2 versus CB4, acute success rate (99.6±4.7% vs. 99.7±3.6%, P = 0.949) and peri-procedural complications (3.7% vs.1.2%, P = 0.080) were similar in both groups, respectively. However, procedure time (100 vs.75 min, P<0.001) and fluoroscopy duration (21 vs.17 min, P<0.001) were all significantly lower in the CB4 treated patient cohort. At the 12-month follow-up, the freedom from AF recurrence after a 90-day blanking period was significant higher in the CB4 as compared with the CB2 group (93.3% vs.81.3%, P<0.001). CONCLUSIONS In summary, usage of the CB4 ablation catheter increased the rate of acute PVI recording capability and resulted in a higher rate of long-term PVI success, as demonstrated by the reduced rate of AF recurrence in comparison to the CB2 cohort at the 12-month follow-up period. This article is protected by copyright. All rights reserved.
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Affiliation(s)
| | - Roberto Verlato
- ULSS 6 Euganea, Ospedale di Cittadella-Camposampiero, Padova, Italy
| | | | | | | | - Claudio Tondo
- Heart Rhythm Center, Department of Clinical Electrophysiology&Cardiac Pacing Monzino Cardiac Center, IRCCS Dept. of Biochemical, Surgical and Dentist Sciences University of Milan, Milan, Italy
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Ferrero-De-Loma-Osorio Á, Cózar R, García-Alberola A, Valles E, Barrera A, Toquero J, Ormaetxe JM, Sánchez JM, Ruiz-Granell R, Amador PB, Rubio JM, Martí-Amor J, Pascual P, Molina I, Martínez-Alday JD. Primary results of the Spanish Cryoballoon Ablation Registry: acute and long-term outcomes of the RECABA study. Sci Rep 2021; 11:17268. [PMID: 34446764 PMCID: PMC8390492 DOI: 10.1038/s41598-021-96655-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/10/2021] [Indexed: 11/10/2022] Open
Abstract
Cryoablation is safe and effective for the treatment of atrial fibrillation (AF) in controlled clinical trials, but contemporary real-world usage and outcomes are limited. The Report of the Spanish Cryoballoon Ablation Registry (RECABA) was designed to evaluate acute and 12-month outcomes of cryoballoon ablation for the treatment of AF in Spain. Patients from 27 Spanish centers were prospectively enrolled. Patients were treated with cryoballoon ablation and managed according to standard of care protocols at each center. The primary endpoint was ≥ 30 s freedom from AF at 12-month after a 3-month blanking period. Secondary endpoints included a description of patient characteristics, cryoablation procedural strategy and safety, and predictors of efficacy. In total, 1742 patients (71.4% PAF, 68.8% male, mean age 58.02 ± 10.40 years, 76.1% overweight or obese, CHA2DS2-VASc index 1.40 ± 1.28) were enrolled. Patients received 7.2 ± 2.67 cryo-applications. PV potentials could be detected in 61% of the PVs during ablation, with a mean time to block of 52.9 ± 37.02 s. Acute PVI was observed in 97% of PVs with 75.8% isolated with the first cryo-application. Mean procedural time was 113 ± 41 min. Acute complications occurred in 4.4% of the cases. With follow-up in 1628 patients, AF-free survival was 78.5% (PAF: 80.6% vs PersAF 73.3%; p < 0.001). Left atrium enlargement, female sex, non-PAF, and early recurrence were independent predictors of AF recurrence (p < 0.05). RECABA provides detailed insight into current dosing practices and demonstrates cryoablation is safe and effective in real-world use.ClinicalTrials.gov number: NCT02785991.
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Affiliation(s)
- Ángel Ferrero-De-Loma-Osorio
- Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario, INCLIVA Foundation, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain.
| | - Rocío Cózar
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Arcadio García-Alberola
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Ermengol Valles
- Arrhythmia Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain
| | - Alberto Barrera
- Arrhythmia Unit, Cardiology Department Hospital Virgen de la Victoria Málaga, Málaga, Spain
| | - Jorge Toquero
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | | | - Juan Martínez Sánchez
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Ricardo Ruiz-Granell
- Arrhythmia Unit, Cardiology Department, Hospital Clínico Universitario, INCLIVA Foundation, Avenida Blasco Ibáñez 17, 46010, Valencia, Spain
| | - Pablo Bastos Amador
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Jose Manuel Rubio
- Arrhythmia Unit, Cardiology Department, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Julio Martí-Amor
- Arrhythmia Unit, Cardiology Department, Hospital del Mar, Barcelona, Spain
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5
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Kochi AN, Moltrasio M, Tundo F, Riva S, Ascione C, Dessanai MA, Pizzamiglio F, Vettor G, Cellucci S, Gasperetti A, Tondo C, Fassini G. Cryoballoon atrial fibrillation ablation: Single-center safety and efficacy data using a novel cryoballoon technology compared to a historical balloon platform. J Cardiovasc Electrophysiol 2021; 32:588-594. [PMID: 33537996 DOI: 10.1111/jce.14930] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/19/2020] [Accepted: 01/02/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Catheter ablation is superior to drugs regarding atrial fibrillation (AF) recurrence, symptoms improvement, and mortality reduction in heart failure. POLARx™ is a novel cryoballoon, with technical improvements seeking to improve outcomes. So far, its clinical evidence is restricted to a case report. METHODS To compare the POLARx™ cryoballoon procedural safety and efficacy to the already established Arctic Front Advance PRO™ (AFAP) in a single-center cohort study, consecutive patients undergoing AF cryoablation with the POLARx™ were enrolled. Data were prospectively gathered. POLARx™ patients were compared with a historical cohort of patients submitted to AF cryoablation with the AFAP. RESULTS Seventy patients were analyzed, 20 in POLARx™, and 50 in the AFAP group. They all underwent first-time pulmonary vein isolation, 77% were male, 94% had paroxysmal AF, median age was 62.5 years, median CHA2 DS2 -VASc 1, left-atrium size 34 ml/m², and 65% were receiving anticoagulation. The primary end-point, all pulmonary veins isolation, was 100% in both groups. The complication rate was similar (0% POLARx™ vs. 5.7% AFAP, p = .39). The median total procedural time was longer in the POLARx™ group (90 min vs. 60 min, p < .001), but the overall time-to-isolation (TTI; 44.8 s vs. 39 s, p = .253) and ablation time (15 min vs. 13.7 min, p = .122) was similar between POLARx™ and AFAP groups, respectively. Despite equal TTI, the POLARx™ had a lower minimal temperature reached (-57°C vs -47°C, p < .001). CONCLUSION The novel POLARx™ cryoballoon had similar efficacy and safety compared with the AFAP. It was also associated with longer procedural times, similar TTI, and lower minimum temperature reached.
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Affiliation(s)
- Adriano N Kochi
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy.,Nossa Senhora da Conceição Hospital, Porto Alegre, Brazil
| | - Massimo Moltrasio
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Fabrizio Tundo
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Stefania Riva
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Ciro Ascione
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maria A Dessanai
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Giulia Vettor
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Selene Cellucci
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
| | | | - Claudio Tondo
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Biochemical, Surgical and Dentist Sciences, University of Milan, Milan, Italy
| | - Gaetano Fassini
- Heart Rhythm Center at Centro Cardiologico Monzino IRCCS, Milan, Italy
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Wissner E. Ablation of atrial fibrillation using the fourth-generation cryoballoon Arctic Front Advance PRO. Future Cardiol 2020; 17:81-87. [PMID: 32744064 DOI: 10.2217/fca-2020-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The cryoballoon (CB) is a popular ablation technology used for pulmonary vein isolation. The fourth-generation CB, Arctic Front Advance PRO features a 40% shorter distal tip but retains the internal design from its second-generation predecessor. The Arctic Front Advance PRO and the second-generation CB demonstrated similar thermodynamic characteristics in a computational model. Several observational and retrospective studies established the acute safety and efficacy of the Arctic Front Advance PRO. Real-time electrical isolation was observed in 75-85% of pulmonary veins targeted with the Arctic Front Advance PRO resulting in shorter fluoroscopy and procedure times.
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Affiliation(s)
- Erik Wissner
- Division of Cardiology, University of Illinois at Chicago 840 S Wood St, 905S (MC715) Chicago, IL 60612, USA
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Kukendrarajah K, Papageorgiou N, Jewell P, Hunter RJ, Ang R, Schilling R, Providencia R. Systematic review and network meta-analysis of atrial fibrillation percutaneous catheter ablation technologies using randomized controlled trials. J Cardiovasc Electrophysiol 2020; 31:2192-2205. [PMID: 32495462 DOI: 10.1111/jce.14598] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Abstract
AIMS We sought out to make comparisons between all atrial fibrillation (AF) catheter ablation technologies using randomized controlled trial data. Our comparisons were freedom from AF, procedural duration, and fluoroscopy duration. METHODS Searches were made of EMBASE, MEDLINE, and CENTRAL databases, and studies were selected which had cryoballoon, conventional radiofrequency (RF), multipolar RF catheters, and laser technology as an arm in the study and were identified as randomized controlled trials (RCTs). These studies were analyzed for direct comparisons using conventional meta-analysis and a combination of indirect and direct comparisons via a network meta-analysis (NMA). RESULTS With respect to freedom from AF both direct comparisons and NMA did not demonstrate any significant difference. However in analysis of procedural and fluoroscopy duration (minutes) for the pulmonary vein ablation catheter (PVAC), both conventional analysis and NMA revealed significantly shorter procedure times, RF vs PVAC (conventional: 61.99 [38.03-85.94], P <.00001; NMA: 54.76 [36.64-72.88], P < .0001) and fluoroscopy times, RF vs PVAC (conventional: 12.96 [6.40-19.53], P = .0001; NMA: 8.89 [3.27-14.51], P < .01). The procedural duration was also shorter for the cryoballoon with NMA, RF vs CRYO (20.56 [3.47-37.65], P = .02). DISCUSSION Our analysis demonstrated that while there was no difference in the efficacy of the individual catheter technologies, there are significant differences in the procedural duration for the PVAC and the cryoballoon. While they may seem an attractive solution for high-volume centers, further RCTs of next-generation technologies should be examined.
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Affiliation(s)
- Kishore Kukendrarajah
- The Farr Institute of Health Informatics Research, University College London, London, UK
| | | | - Paul Jewell
- Department of Critical Care, Royal Free Hospital, London, UK
| | - Ross J Hunter
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | - Richard Ang
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
| | | | - Rui Providencia
- The Farr Institute of Health Informatics Research, University College London, London, UK
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Use of figure of eight suture for groin closure with no heparin reversal in patients undergoing cryoballoon ablation for atrial fibrillation. J Interv Card Electrophysiol 2020; 60:433-438. [PMID: 32445011 DOI: 10.1007/s10840-020-00776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/04/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE We aimed to demonstrate the feasibility of figure of eight (FoE) suture for groin access closure in cryoballoon (CB) ablation and its impact on the lab workflow. METHODS We retrospectively analyzed all patients who underwent CB ablation in our institution from June 2018. From June 2019, we have been consistently using FoE suture for hemostasis (FoE+ group), and before that conventional manual compression was utilized (FoE- group). Ablations were performed under uninterrupted oral anticoagulant strategy. Both femoral veins were punctured, and a single introducer was placed in each vein. In the FoE- group, after ablation, protamine was administered, and manual compression was applied. In the FoE+ group, the suture was placed in both groins without protamine administration and manual compression. All patients were in decubitus position until the next morning. RESULTS A total of 190 consecutive patients (73.2% male, 59.7 ± 11.0 years old) were evaluated, 90 being in the FoE+ group. There was no difference in the mean procedure duration between two groups (72.7 ± 23.1 min vs 73.7 ± 27.1 min, p = 0.784). However, the total lab time was significantly longer in FoE- group (132.9 ± 35.3 min vs 109.9 ± 32.6 min, p < 0.0001). There was no difference in complication rates. No major vascular complications were found in our cohort. CONCLUSIONS Utilization of FoE sutures for hemostasis seems to be a safe and effective after cryoballoon ablation. It abolishes the need for protamine administration which can cause serious adverse events. As manual compression is unrequired, EP lab workflow improves due to significantly shortened total lab time per patient.
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Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6720481. [PMID: 32337265 PMCID: PMC7166274 DOI: 10.1155/2020/6720481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 03/24/2020] [Indexed: 11/18/2022]
Abstract
Atrial fibrillation (AF) is a common arrhythmia contributing to severe outcomes, including cardiac dysfunction and stroke, and it has drawn great attention around the world. Drug therapies have been available for many years to terminate AF and control heart rate. However, the results from clinical studies on drug therapies have been discouraging. Mounting evidence indicates that radiofrequency catheter ablation (RFCA) is a safe and effective method to maintain sinus rhythm, especially in patients who are drug intolerant or for whom the drugs are ineffective, although it is a technically demanding and complex procedure. Fortunately, a novel application, cryoballoon ablation (CBA), with outstanding characteristics has been widely used. Great outcomes based on CBA have manifested its significant role in the treatment of AF. However, how to improve the safety and efficacy of CBA is a question that has not been well-answered. Would it be helpful to develop a different generation of cryoballoon? Is bonus freezing beneficial, or not? Is it better to prolong freezing time? Dose CBA combined with RFCA bring higher success rates? In this review, we comprehensively summarized useful applications for improving outcomes of CBA in AF patients.
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