1
|
van Waaij K, Keçe F, de Riva M, Alizadeh Dehnavi R, Wijnmaalen AP, Piers SRD, Mertens BJ, Zeppenfeld K, Trines SA. Validation of a prediction model for early reconnection after cryoballoon ablation. J Interv Card Electrophysiol 2024:10.1007/s10840-024-01811-0. [PMID: 38743141 DOI: 10.1007/s10840-024-01811-0] [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: 12/21/2023] [Accepted: 04/17/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND We previously developed an early reconnection/dormant conduction (ERC) prediction model for cryoballoon ablation to avoid a 30-min waiting period with adenosine infusion. We now aimed to validate this model based on time to isolation, number of unsuccessful cryo-applications, and nadir balloon temperature. METHODS Consecutive atrial fibrillation patients who underwent their first cryoballoon ablation in 2018-2019 at the Leiden University Medical Center were included. Model performance at the previous and at a new optimal cutoff value was determined. RESULTS A total of 201 patients were included (85.57% paroxysmal AF, 139 male, median age 61 years (IQR 53-69)). ERC was found in 35 of 201 included patients (17.41%) and in 41 of 774 veins (5.30%). In the present study population, the previous cutoff value of - 6.7 provided a sensitivity of 37.84% (previously 70%) and a specificity of 89.07% (previously 86%). Shifting the cutoff value to - 7.2 in both study populations resulted in a sensitivity of 72.50% and 72.97% and a specificity of 78.22% and 78.63% in data from the previous and present study respectively. Negative predictive values were 96.55% and 98.11%. Applying the model on the 101 patients of the present study with all necessary data for all veins resulted in 43 out of 101 patients (43%) not requiring a 30-min waiting period with adenosine testing. Two patients (2%) with ERC would have been missed when applying the model. CONCLUSIONS The previously established ERC prediction model performs well, recommending its use for centers routinely using adenosine testing following PVI.
Collapse
Affiliation(s)
- Kevin van Waaij
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Fehmi Keçe
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
- Department of Electrophysiology, Heart Center, University of Cologne, Cologne, Germany
| | - Marta de Riva
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Reza Alizadeh Dehnavi
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Sebastiaan R D Piers
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Bart J Mertens
- Bioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands
| | - Serge A Trines
- Department of Cardiology, Willem Einthoven Center for Cardiac Arrhythmia Research and Management, Heart Lung Center, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
| |
Collapse
|
2
|
Zuk A, Piotrowski R, Sikorska A, Kowalik I, Kulakowski P, Baran J. Variability of baroreceptor reflex assessed by tilt table test in a patient undergoing pulmonary vein isolation. J Interv Card Electrophysiol 2023:10.1007/s10840-023-01690-x. [PMID: 37955758 DOI: 10.1007/s10840-023-01690-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 11/03/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND The autonomic nervous system (ANS) plays a significant role in atrial fibrillation (AF). Catheter ablation (CA) affects the ANS balance. The assessment of baroreceptor (BR) function is an established method to measure parasympathetic activity; however, it has been rarely used in patients undergoing CA of AF. AIMS This study is to assess changes in BR function caused by CA and to compare these changes between two different types of CA: point-by-point radiofrequency (RF) versus cryoballoon (CB). METHODS In this observational, prospective, single center study, 78 patients (25 females, mean age 58 ± 9) with paroxysmal AF and first CA were included: 39 patients (RF group) and 39 (CB group). The BR function was assessed non-invasively using tilt testing and three parameters: event count (BREC) depicting overall BR activity, slope mean depicting BR sensitivity (BRS), and BR effectiveness index (BEI). RESULTS The groups did not differ in clinical or demographic data. Before CA, tilting caused a marked decrease in BR function parameters in the whole study group (BREC (29 ± 14.0-50.0 vs 28 ± 9.0-44.0, p < 0.068), BRS (10.2 ± 7.1-13.2 vs 5.8 ± 4.9-8.5; p < 0.001), and BEI (52.9 ± 39.9-65.5 vs 39.6 ± 23.6-52.1; p < 0.001), supine vs tilting, respectively). These changes were similar in the both groups. After CA, BR function decreased in the whole group (BREC 12.0 ± 3.0-22.0 vs 6.0 ± 3.0-18.0, p = 0.004; BRS 4.8 ± 3.6-6.8 vs 4.0 ± 3.0-5.8, p = 0.014; BEI 18.7 ± 8.3-27.4 vs 12.0 ± 5.1-21.0, p = 0.009). BREC was significantly more decreased in the CB vs RF. Similar trend was noted for BRS and BEI. CONCLUSIONS CA significantly affects BR function. These changes were more pronounced following CB rather than RF CA.
Collapse
Affiliation(s)
- Anna Zuk
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Roman Piotrowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland.
| | - Agnieszka Sikorska
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Ilona Kowalik
- Clinical Research Support Center, National Institute of Cardiology, Warsaw, Poland
| | - Piotr Kulakowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| |
Collapse
|
3
|
Leo M, De Maria GL, Briosa E Gala A, Pope M, Banerjee A, Kelion A, Pedersen M, Rajappan K, Ginks M, Bashir Y, Hunter RJ, Betts T. INtra-procedural ultraSound Imaging for DEtermination of atrial wall thickness and acute tissue changes after isolation of the pulmonary veins with radiofrequency, cryoballoon or laser balloon energy: the INSIDE PVs study. Int J Cardiovasc Imaging 2021; 37:3525-3535. [PMID: 34554367 DOI: 10.1007/s10554-021-02417-7] [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: 06/18/2021] [Accepted: 09/13/2021] [Indexed: 11/30/2022]
Abstract
Preliminary data in human suggest that both Intracardiac echocardiography (ICE) and Intravascular ultrasound (IVUS) can be used for real-time information on the left atrial (LA) wall thickness and on the acute tissue changes produced by energy delivery. This pilot study was conducted to compare ICE and IVUS for real-time LA wall imaging and assessment of acute tissue changes produced by radiofrequency (RF), cryo and laser catheter ablation. Patients scheduled for RF, cryoballoon or laser balloon Pulmonary Vein Isolation (PVI) catheter ablation were enrolled. Each pulmonary vein (PV) was imaged before and immediately after ablation with either ICE or IVUS. The performance of ICE and IVUS for imaging were compared. Pre- and post-ablation measurements (lumen and vessel diameters, areas and sphericity indexes, wall thickness and muscular sleeve thickness) were taken at the level of each PV ostium. A total of 48 PVs in 12 patients were imaged before and after ablation. Both ICE and IVUS showed acute tissue changes. Compared to IVUS, ICE showed higher imaging quality and inter-observer reproducibility of the PV measurements obtained. Acute wall thickening suggestive of oedema was observed after RF treatment (p = 0.003) and laser treatment (p = 0.003) but not after cryoablation (p = 0.69). Our pilot study suggests that ICE might be preferable to IVUS for LA wall thickness imaging at the LA-PV junctions during ablation. Ablation causes acute wall thickening when using RF or laser energy, but not cryoenergy delivery. Larger studies are needed to confirm these preliminary findings.
Collapse
Affiliation(s)
- Milena Leo
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK.
| | | | - Andre Briosa E Gala
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK
| | - Michael Pope
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK
| | - Abhirup Banerjee
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew Kelion
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK
| | - Michala Pedersen
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK
| | - Kim Rajappan
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK
| | - Matthew Ginks
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK
| | - Yaver Bashir
- Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford, OX3 7BA, UK
| | | | - Tim Betts
- Oxford NIHR Biomedical Research Centre, Oxford, UK
| |
Collapse
|
4
|
van Rijn D, Hendriks AA, Noten AMME, van Heerebeek L, Khan M. Practical Applications of Concomitant Pulmonary Vein Isolation and Left Atrial Appendix Closure Device Implantation. JACC Case Rep 2021; 3:1409-1412. [PMID: 34557681 PMCID: PMC8446027 DOI: 10.1016/j.jaccas.2021.06.016] [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: 01/22/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022]
Abstract
Pulmonary vein isolation (PVI) using cryoballoon causes acute tissue edema of the osteal region of the pulmonary veins and the left atrium. In two cases combining PVI with an implantation of a left atrial appendage closure device led to malsizing of the device, device shouldering, and a paraprosthetic residual flow. (Level of Difficulty: Advanced.)
Collapse
Affiliation(s)
- Dafne van Rijn
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Astrid A Hendriks
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Anne-Marie M E Noten
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Loek van Heerebeek
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Muchtiar Khan
- Department of Clinical Electrophysiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| |
Collapse
|
5
|
Keçe F, de Riva M, Alizadeh Dehnavi R, Wijnmaalen AP, Mertens BJ, Schalij MJ, Zeppenfeld K, Trines SA. Predicting early reconnection after cryoballoon ablation with procedural and biophysical parameters. Heart Rhythm O2 2021; 2:290-297. [PMID: 34337580 PMCID: PMC8322820 DOI: 10.1016/j.hroo.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Predicting early reconnection/dormant conduction (ERC) immediately after pulmonary vein isolation (PVI) can avoid a waiting period with adenosine testing. OBJECTIVE To identify procedural and biophysical parameters predicting ERC. METHODS Consecutive atrial fibrillation (AF) patients undergoing a first cryoballoon ablation (Arctic Front Advance) between 2014 and 2017 were included. ERC was defined as manifest or dormant pulmonary vein (PV) reconnection with adenosine 30 minutes after PVI. Time to isolation (TTI), balloon temperatures (BT), and thawing times were evaluated as potential predictors for ERC. Based on a multivariable model, cut-off-values were defined and a formula was constructed to be used in clinical practice. RESULTS A total of 136 patients (60 ± 10 years, 96 male, 95% paroxysmal AF) were included. ERC was found in 40 (29%) patients (ERC group) and in 53 of 575 (9%) veins. Procedural and total ablation time and the number of unsuccessful freezes were significantly longer/higher in the ERC group compared to the non-ERC group (150 ± 40 vs 125 ± 34 minutes; 24 ± 5 vs 17 ± 4 minutes, and 38% vs 24%, respectively (P = .028). Multivariable analysis showed that a higher nadir balloon temperature (hazard ratio [HR] 1.17 [1.09-1.23, P < .001), a higher number of unsuccessful freezes (HR 1.69 [1.15-2.49], P = .008) and a longer TTI (HR 1.02 [1.01-1.03], P < .001) were independently associated with ERC, leading to the following formula: 0.02 × TTI + 0.5 × number of unsuccessful freezes + 0.2 × nadir BT with a cut-off value of ≤-6.7 to refrain from a waiting period with adenosine testing. CONCLUSION Three easily available parameters were associated with ERC. Using these parameters during ablation can help to avoid a 30-minute waiting period and adenosine testing.
Collapse
Affiliation(s)
- Fehmi Keçe
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta de Riva
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Reza Alizadeh Dehnavi
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Adrianus P. Wijnmaalen
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Bart J. Mertens
- Bioinformatics Center of Expertise, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J. Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Serge A. Trines
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
6
|
Kulakowski P, Sikorska A, Piotrowski R, Kryński T, Baran J. Ablation for paroxysmal atrial fibrillation-real-life results from a middle-volume electrophysiology laboratory. J Interv Card Electrophysiol 2021; 62:549-556. [PMID: 33423186 PMCID: PMC8645536 DOI: 10.1007/s10840-020-00937-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/28/2020] [Indexed: 12/01/2022]
Abstract
Introduction A significant improvement in safety and efficacy of ablation for paroxysmal atrial fibrillation (PAF) has been reported by experienced centers over recent years; however, data from real-life surveys and smaller electrophysiology (EP) laboratories have been less optimistic. Aim To asses efficacy of ablation for PAF in a middle-volume EP center over last years. Methods Retrospective analysis of 1 year efficacy and safety of ablation for PAF in three cohorts of patients treated between 2011 and 2014 (period I), 2015–2017 (period II), and 2018–2019 (period III). Results Of 234 patients (mean age 57 ± 9 years, 165 males), 81 (35%) were treated in period I, 84 (36%) in period II, and 69 (29%) in period III. The overall efficacy of ablation during all analyzed periods was 67%. The overall efficacy of ablation increased over time—from 56% in period I to 68% in period II and 81% in period III. Significant improvement was achieved using radiofrequency ablation (RF) (53% in period I vs 82% in period III, and 55% in period II vs 82% in period III, p = 0.003 and 0.0012, respectively) whereas positive trend in the improvement of cryoballoon efficacy was NS. The rate of peri-procedural complications was 9% and it did not change significantly over time. Conclusions This real-life observational study from a medium volume EP center shows that progress in PAF ablation, especially RF, reported by highly-skilled centers, can be reproduced in real life by less experienced operators.
Collapse
Affiliation(s)
- Piotr Kulakowski
- Electrophysiology Laboratory, Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Agnieszka Sikorska
- Electrophysiology Laboratory, Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Roman Piotrowski
- Electrophysiology Laboratory, Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Grenadierow 51/59, 04-073, Warsaw, Poland.
| | - Tomasz Kryński
- Electrophysiology Laboratory, Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Grenadierow 51/59, 04-073, Warsaw, Poland
| | - Jakub Baran
- Electrophysiology Laboratory, Department of Cardiology, Centre for Postgraduate Medical Education, Grochowski Hospital, Grenadierow 51/59, 04-073, Warsaw, Poland
| |
Collapse
|
7
|
Abstract
Cryoballoon ablation for the treatment of atrial fibrillation has established itself as an effective and efficient modality for achieving pulmonary vein isolation. Over the past 13 years more than 100,000 Cryoballoon ablation procedures have been performed with the first to fourth generation cryoballoons. Over that time there have been significant advances in our understanding regarding the optimal procedural techniques. The purpose of this "topic in review" is to focus on the practical aspects of performing a Cryoballoon ablation procedure, within the context of the contemporary literature. Specifically there is a focus on how contemporary studies can inform clinical decision making and ensure operators are able to perform a safe and effective procedure.
Collapse
Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada.,Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, Canada.,Center for Cardiovascular Innovation, Vancouver, Canada
| |
Collapse
|
8
|
Aksu T, Yalin K, Guler TE, Bozyel S, Heeger CH, Tilz RR. Acute Procedural Complications of Cryoballoon Ablation: A Comprehensive Review. J Atr Fibrillation 2019; 12:2208. [PMID: 32435335 DOI: 10.4022/jafib.2208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/14/2019] [Accepted: 08/26/2019] [Indexed: 12/15/2022]
Abstract
Catheter ablation is increasingly performed for treatment of atrial fibrillation (AF). Balloon based procedures have been developed aiming at safer, easier and more effective treatment as compared to point to point ablation. In the present review article, we aimed to discuss acute procedural complications of cryoballoon ablation.
Collapse
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Kivanc Yalin
- Istanbul University- Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.,University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Tumer Erdem Guler
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, University of Health Sciences, Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey
| | - Christian-H Heeger
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland R Tilz
- University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany
| |
Collapse
|
9
|
Fukuda K. Evidence of Acute Tissue Edema after Cryoballoon Ablation for Atrial Fibrillation. Int Heart J 2019; 60:497-498. [DOI: 10.1536/ihj.19-163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Koji Fukuda
- Department of Cardiovascular Medicine, International University of Health and Welfare Hospital
| |
Collapse
|
10
|
Miyazaki S, Nakamura H, Kajiyama T, Watanabe T, Iesaka Y. Early Tissue Reaction After Second-Generation Cryoballoon Ablation Evaluated with Intracardiac Echocardiography. Int Heart J 2019; 60:618-623. [PMID: 30971628 DOI: 10.1536/ihj.18-413] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Radiofrequency energy applications immediately produce tissue edema. This study aimed to investigate the acute tissue reaction immediately after second-generation cryoballoon applications using 3-dimensional intracardiac echocardiography (ICE) imaging technology.This study consisted of 10 patients with paroxysmal atrial fibrillation who underwent pulmonary vein isolation (PVI) using second-generation cryoballoons. Ablation was performed with a single 3-minute freeze strategy and exclusively 28-mm balloons. The left atrial and right pulmonary vein (PV) antra geometries were created with 3-dimensional ICE technology before and immediately after the PVI.Out of 20 right PVs, 19 were isolated exclusively with cryoballoons, and one right inferior PV (RIPV) required touch-up ablation. All 10 right superior PVs (RSPVs) were isolated by single cryoballoon applications, and RIPVs were isolated by a mean of 1.2 ± 0.4 applications. The total application time was 171 ± 19 and 203 ± 71 seconds, and nadir balloon temperature was -56.0 ± 4.9 and -53.8 ± 5.4°C for the RSPVs and RIPVs, respectively. In all patients, diffuse wall thickening of the antra and ostium of the right PVs was observed as compared to baseline. The wall thickening was 0-0.25 mm in 3 patients, and 0.25-0.5 mm in the remaining 7. During the median follow-up of 13 [10.2-17.2] months, 8 (80%) patients were free from arrhythmia recurrences. Nine (90%) patients underwent repeat cardiac computed tomography at a median of 6.0 [4.5-12.0] months after the initial procedure, and no PV stenosis was observed in all.Tissue edema and wall thickening appeared in the human left atrium immediately after second-generation cryoballoon ablation.
Collapse
|
11
|
Keçe F, de Riva M, Naruse Y, Alizadeh Dehnavi R, Wijnmaalen AP, Schalij MJ, Zeppenfeld K, Trines SA. Optimizing ablation duration using dormant conduction to reveal incomplete isolation with the second generation cryoballoon: A randomized controlled trial. J Cardiovasc Electrophysiol 2019; 30:902-909. [PMID: 30884006 PMCID: PMC6850340 DOI: 10.1111/jce.13913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/10/2019] [Accepted: 03/13/2019] [Indexed: 12/02/2022]
Abstract
Introduction Efficacy of cryoballoon ablation depends on balloon‐tissue contact and ablation duration. Prolonged duration may increase extracardiac complications. The aim of this study is to determine the optimal additional ablation duration after acute pulmonary vein isolation (PVI). Methods Consecutive patients with paroxysmal AF were randomized to three groups according to additional ablation duration (90, 120, or 150 seconds) after acute PVI (time‐to‐isolation). Primary outcome was reconnection/dormant conduction (DC) after a 30 minutes waiting period. If present, additional 240 seconds ablations were performed. Ablations without time‐to‐isolation <90 seconds, esophageal temperature <18°C or decreased phrenic nerve capture were aborted. Patients were followed with 24‐hour Holter monitoring at 3, 6, and 12 months. Results Seventy‐five study patients (60 ± 11 years, 48 male) were included. Reconnection/DC per vein significantly decreased (22%, 6% and 4%) while aborted ablations remained stable (respectively 4, 5, and 7%) among the 90, 120, and 150 seconds groups. A shorter cryo‐application time, longer time‐to‐isolation, higher balloon temperature and unsuccessful ablations predicted reconnection/DC. Freedom of atrial fibrillation was, respectively, 52, 56, and 72% in 90, 120, and 150 seconds groups (
P = 0.27), while repeated procedures significantly decreased from 36% to 4% (
P = 0.041) in the longer duration group compared to shorter duration group (150 seconds vs 90 seconds group). In multivariate Cox‐regression only reconnection/DC predicted recurrence. Conclusion Prolonging ablation duration after time‐to‐isolation significantly decreased reconnection/DC and repeated procedures, while recurrences and complications rates were similar. In a time‐to‐isolation approach, an additional ablation of 150 seconds ablation is the most appropriate.
Collapse
Affiliation(s)
- Fehmi Keçe
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Marta de Riva
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Yoshihisa Naruse
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Reza Alizadeh Dehnavi
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Adrianus P Wijnmaalen
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin J Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| | - Serge A Trines
- Department of Cardiology, Heart Lung Center, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
12
|
Yamashita K, Kholmovski E, Ghafoori E, Kamali R, Kwan E, Lichter J, MacLeod R, Dosdall DJ, Ranjan R. Characterization of edema after cryo and radiofrequency ablations based on serial magnetic resonance imaging. J Cardiovasc Electrophysiol 2018; 30:255-262. [PMID: 30375090 DOI: 10.1111/jce.13785] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 10/16/2018] [Accepted: 10/23/2018] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Radiofrequency (RF) and cryoablation are routinely used to treat arrhythmias, but the extent and time course of edema associated with the two different modalities is unknown. Our goal was to follow the lesion maturation and edema formation after RF and cryoablation using serial magnetic resonance imaging (MRI). METHODS AND RESULTS Ventricular ablation was performed in a canine model (n = 11) using a cryo or an irrigated RF catheter. T2-weighted (T2w) edema imaging and late gadolinium enhancement (LGE)-MRI were done immediately (0 day: acute), 1 to 2 weeks (subacute), and 8 to 12 weeks (chronic) after ablation. After the final MRI, excised hearts underwent pathological evaluation. As a result, 45 ventricular lesions (cryo group: 20; RF group: 25) were evaluated. Acute LGE volume was not significantly different but acute edema volume in cryo group was significantly smaller (1225.0 ± 263.5 vs 1855.2 ± 520.5 mm3 ; P = 0.01). One week after ablation, edema still existed in both group but was similar in size. Two weeks after ablation there was no edema in either of the groups. In the chronic phase, the lesion volume for cryo and RF in LGE-MRI (296.7 ± 156.4 vs 281.6 ± 140.8 mm3 ; P = 0.73); and pathology (243.3 ± 125.9 vs 214.5 ± 148.6 mm3 ; P = 0.49), as well as depth, was comparable. CONCLUSIONS When comparing cryo and RF lesions of similar chronic size, acute edema is larger for RF lesions. Edema resolves in both cryo and RF lesions in 1 to 2 weeks.
Collapse
Affiliation(s)
- Kennosuke Yamashita
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Eugene Kholmovski
- Department of Radiology and Imaging Sciences, UCAIR, University of Utah, Salt Lake City, Utah.,CARMA Center, Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah
| | - Elyar Ghafoori
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Roya Kamali
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Eugene Kwan
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Justin Lichter
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah
| | - Robert MacLeod
- Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| | - Derek J Dosdall
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah.,Department of Surgery, Division of Cardiothoracic Surgery, University of Utah, Salt Lake City, Utah
| | - Ravi Ranjan
- Department of Medicine, Division of Cardiovascular Medicine, University of Utah, Salt Lake City, Utah.,Nora Eccles Harrison Cardiovascular Research and Training Institute, University of Utah, Salt Lake City, Utah.,Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
| |
Collapse
|