1
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Ming J, Wei Y, Sun H, Wong G, Yang G, Pong R, Chen Y. Cost-Effectiveness of Cryoballoon Ablation Versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation in China: Results Based on Real-World Data. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:863-870. [PMID: 31426926 DOI: 10.1016/j.jval.2019.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/27/2019] [Accepted: 02/03/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Paroxysmal atrial fibrillation (AF) presents a significant economic burden to the healthcare system. Catheter ablations is a commonly adopted treatment for paroxysmal AF. OBJECTIVES To evaluate the cost effectiveness of cryoballoon ablation versus radiofrequency ablation in patients with drug-refractory paroxysmal AF in a tertiary hospital in China. METHODS A Markov model was developed to study the effects and costs. Cost and probability input data were obtained mainly from a retrospective real-world study conducted in a tertiary hospital. Propensity score matching was used to overcome retrospective bias. Input data gaps were remedied by means of literature review and advice from experts. A simulation was performed for the post-procedure lifetime years. Univariate and probabilistic sensitivity analyses were conducted. RESULTS In the base-case analysis of a lifetime time horizon, a patient treated with cryoballoon ablation was associated with 7.85 quality-adjusted life-years (QALYs) and ¥132 222 ($19 913) total costs, whereas a radiofrequency ablation treated patient was associated with 7.71 QALYs and ¥147 304 ($22 184) total costs. The cryoballoon group had slightly better health outcomes (with a difference of 0.14 QALY) and lower total costs (with a difference of ¥15 082) (USD $2 271), and it may be considered as cost-effective or cost-saving strategy (incremental cost-effectiveness ratio -¥110 158 [$16 590] per QALY) for the management of paroxysmal AF. Different scenarios were tested with sensitivity analyses, but still, the outcomes remained cost-effective or cost-saving for cryoballoon ablation. CONCLUSIONS An economic evaluation based on real-world data suggests that, relative to radiofrequency ablation, cryoballoon ablation may be considered as a more cost-effective or cost-saving long-term strategy for drug-refractory paroxysmal AF in this tertiary hospital in China. However, further evidence is needed using data from large-scale studies in order to reflect a national perspective.
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Affiliation(s)
- Jian Ming
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Yan Wei
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Hui Sun
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Gongru Wong
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| | - Gang Yang
- Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Raymond Pong
- Centre for Rural and Northern Health Research, Northern Ontario School of Medicine, Laurentian University, Sudbury, Ontario, Canada
| | - Yingyao Chen
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China.
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2
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Khidr S, Doyle M, Rayarao G, Abdel Ghany M, Hasan-Ali H, Fouad DA, Belden W, Biederman RW. Pulmonary vein remodeling following pulmonary vein isolation in patients with atrial fibrillation-do pulmonary veins represent only an epiphenomenon? A cardiac MRI study. Cardiovasc Diagn Ther 2019; 9:8-17. [PMID: 30881872 DOI: 10.21037/cdt.2018.09.07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background After successful pulmonary vein isolation (PVI) for atrial fibrillation (AF), the left atrium (LA) undergoes reverse remodeling. However, few studies have directly studied pulmonary vein (PV) remodeling and focused on whether pre PVI-PV conditions could predict outcome of the procedure. We hypothesize that: (I) post PVI, in addition to LA remodeling the PVs undergo a parallel degree of remodeling; and (II) that PV characteristics pre PVI can be used to identify patients more likely to sustain normal sinus rhythm (NSR). Methods Patients (n=100) scheduled for PVI had a cardiovascular magnetic resonance (CMR) imaging before and 6±2 months following PVI. PV cross sectional areas (CSA) within 0.5 cm of the ostium and LA volumes were measured. Patients were categorized as responders (R) or non-responders (NR), based on two separate 14-day Holter monitoring. Results PVs CSA were significantly reduced post procedure in both groups, R (233±53 to 192±52 mm2, P<0.001) and NR (241±54 to 207±44 mm2, P<0.001), however, the difference between R and NR post PVI was not significant (192±52 to 207±44 mm2, P=0.19). Reduction in PVs CSAs post procedure moderately correlated with the 3D LA volume reduction (r=0.48, P<0.001). Conclusions PVs mirror the LA in that they significantly change in size following PVI yet they were not found to directly predict maintenance of NSR.
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Affiliation(s)
- Shimaa Khidr
- Cardiovascular Medicine Department, Assiut University Hospital, Assiut, Egypt
| | - Mark Doyle
- Cardiac MRI Unit, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Geetha Rayarao
- Cardiac MRI Unit, Allegheny General Hospital, Pittsburgh, PA, USA
| | - Mohamed Abdel Ghany
- Cardiovascular Medicine Department, Assiut University Hospital, Assiut, Egypt
| | - Hosam Hasan-Ali
- Cardiovascular Medicine Department, Assiut University Hospital, Assiut, Egypt
| | - Doaa A Fouad
- Cardiovascular Medicine Department, Assiut University Hospital, Assiut, Egypt
| | - William Belden
- Cardiac MRI Unit, Allegheny General Hospital, Pittsburgh, PA, USA
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3
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Cone AK. The Role of Echocardiography in Determining the Method of Ablation for the Treatment of Paroxysmal Atrial Fibrillation: A Literature Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318755672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Atrial fibrillation is the most common cardiac arrhythmia, affecting approximately 1 out of every 250 people. It is associated with thrombus formation in the left atrium, decreased cardiac output, and deterioration of the myocardium. There are multiple treatments available for paroxysmal atrial fibrillation. This literature review will assess the benefits, risks, and complications associated with radiofrequency ablation and cryoablation, which utilize heat and freezing mechanisms, respectively. The review will also assess the role of echocardiography in determining which treatment, if any, is appropriate for atrial fibrillation.
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4
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Murray MI, Arnold A, Younis M, Varghese S, Zeiher AM. Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials. Clin Res Cardiol 2018; 107:658-669. [DOI: 10.1007/s00392-018-1232-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/08/2018] [Indexed: 12/30/2022]
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5
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Buiatti A, von Olshausen G, Barthel P, Schneider S, Luik A, Kaess B, Laugwitz KL, Hoppmann P. Cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: an updated meta-analysis of randomized and observational studies. Europace 2017; 19:378-384. [PMID: 27702864 DOI: 10.1093/europace/euw262] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/28/2016] [Indexed: 12/30/2022] Open
Abstract
Aims Radiofrequency (RF) ablation represents a standard of care for pulmonary vein isolation in patients with drug-refractory paroxysmal atrial fibrillation (AF). In this setting, cryoballoon (CB) ablation has emerged as alternative therapy. However, the efficacy and safety of CB vs. RF ablation in patients with paroxysmal AF remain a matter of debate. Methods and results We searched electronic scientific databases for studies of CB vs. RF ablation in patients with paroxysmal AF. Aggregate data were pooled to perform a meta-analysis. The primary efficacy and safety outcomes were the recurrence of any atrial arrhythmia and procedure-related complications, respectively. A total of 6473 participants from 10 studies (CB, n = 2232 vs. RF, n = 4241) were studied. After a median follow-up of 16 months, the risk of any atrial arrhythmia recurrence (risk ratio, RR 95% confidence interval [95% CI] = 1.01 [0.90-1.14], P = 0.83) and procedure-related complications (RR [95% CI] = 0.92 [0.66-1.28], P = 0.61) were comparable between CB vs. RF ablation. Cryoballoon ablation led to a higher risk of persistent phrenic nerve palsy (RR [95% CI] = 13.60 [3.87-47.81], P < 0.01) and a lower risk of cardiac tamponade (RR [95% CI] = 0.48 [0.25-0.89], P = 0.02) compared with RF ablation. There was a trend of statistically significant interaction between the type of CB and the duration of ablation (P for interaction = 0.09). Conclusion In patients with paroxysmal AF, ablation therapy with CB is associated with efficacy and safety comparable to that of RF. Second-generation CB catheters seem to reduce procedure duration. Further studies are warranted to disclose the impact of second-generation CB catheters compared with RF for ablation of paroxysmal AF.
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Affiliation(s)
- Alessandra Buiatti
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Gesa von Olshausen
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Petra Barthel
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Simon Schneider
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Bernhard Kaess
- Deutsches Herzzentrum München, Technische Universität München and Medizinische Klinik I, St. Josefs-Hospital, Wiesbaden, Germany
| | - Karl-Ludwig Laugwitz
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Petra Hoppmann
- I. Medizinische Klinik, Klinikum rechts der Isar, Technische Universität München, Ismaninger Strasse 22, 81675 Munich, Germany
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6
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Fenelon G, Scuotto F, Fischer C, Perin MA, Makdisse M, Paola AAVD. Balloon Cryoablation for the Treatment of Paroxysmal Atrial Fibrillation. Arq Bras Cardiol 2017; 109:266-269. [PMID: 28977063 PMCID: PMC5586236 DOI: 10.5935/abc.20170108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 06/27/2016] [Indexed: 11/22/2022] Open
Affiliation(s)
- Guilherme Fenelon
- Hospital Israelita Albert Einstein, São Paulo, SP.,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | - Frederico Scuotto
- Hospital Israelita Albert Einstein, São Paulo, SP.,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
| | - Claudio Fischer
- Hospital Israelita Albert Einstein, São Paulo, SP.,Universidade Federal de São Paulo (UNIFESP), São Paulo, SP - Brazil
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7
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Garg J, Chaudhary R, Palaniswamy C, Shah N, Krishnamoorthy P, Bozorgnia B, Natale A. Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation: A Meta-analysis of 16 Clinical Trials. J Atr Fibrillation 2017; 9:1429. [PMID: 28496925 DOI: 10.4022/jafib.1429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022]
Abstract
Introduction: We aimed to study the procedural characteristics, efficacy and safety of cryoballoon ablation (CBA) versus radiofrequency ablation (RFA) for catheter ablation of paroxysmal atrial fibrillation (AF). Methods: A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to clinical trials comparing CBA and RFA for AF. Outcomes were evaluated for efficacy, procedure characteristics and safety. For each study, odd ratio (OR) and 95% confidence intervals (CIs) were calculated for endpoints for both approaches. Results: We analyzed a total of 9,957 participants (3,369 in the CBA and 6,588 in RFA group) enrolled in 16 clinical trials. No significant difference was observed between CBA and RFA with regards to freedom from atrial arrhythmia at 12-months, recurrent atrial arrhythmias or repeat catheter ablation. CBA group had a significantly higher transient phrenic nerve injury (OR 14.19, 95% CI: 6.92-29.10; p<0.001) and persistent phrenic nerve injury (OR 4.62, 95% CI: 1.97-10.81; p<0.001); and a significantly lower pericardial effusion/cardiac tamponade (OR 0.43, 95% CI: 0.26-0.72; p=0.001), and groin site complications (OR 0.60, 95% CI: 0.38-0.93; p=0.02). No significant difference was observed in overall complications, stroke/thromboembolic events, major bleeding, and minor bleeding. Conclusion: CBA was non-inferior to RFA for catheter ablation of paroxysmal AF. RF ablation was associated with a higher groin complications and pericardial effusion/cardiac tamponade, whereas CBA was associated with higher rates of transient and persistent phrenic nerve injury.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Rahul Chaudhary
- Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD
| | | | - Neeraj Shah
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | | | - Babak Bozorgnia
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
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8
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Galand V, Pavin D, Behar N, Auffret V, Fénéon D, Behaghel A, Daubert JC, Mabo P, Martins RP. Localization of gaps during redo ablations of paroxysmal atrial fibrillation: Preferential patterns depending on the choice of cryoballoon ablation or radiofrequency ablation for the initial procedure. Arch Cardiovasc Dis 2016; 109:591-598. [PMID: 27692658 DOI: 10.1016/j.acvd.2016.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/18/2016] [Accepted: 03/10/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pulmonary vein (PV) isolation, using cryoballoon or radiofrequency ablation, is the cornerstone therapy for symptomatic paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drugs. One-third of the patients have recurrences, mainly due to PV reconnections. AIMS To describe the different locations of reconnection sites in patients who had previously undergone radiofrequency or cryoballoon ablation, and to compare the characteristics of the redo procedures in both instances. METHODS Demographic data and characteristics of the initial ablation (cryoballoon or radiofrequency) were collected. Number and localization of reconduction gaps, and redo characteristics were reviewed. RESULTS Seventy-four patients scheduled for a redo ablation of paroxysmal AF were included; 38 had been treated by radiofrequency ablation and 36 by cryoballoon ablation during the first procedure. For the initial ablation, procedural and fluoroscopy times were significantly shorter for cryoballoon ablation (147.8±52.6min vs. 226.6±64.3min [P<0.001] and 37.0±17.7min vs. 50.8±22.7min [P=0.005], respectively). Overall, an identical number of gaps was found during redo procedures of cryoballoon and radiofrequency ablations. However, a significantly higher number of gaps were located in the right superior PV for patients first ablated with radiofrequency (0.9±1.0 vs. 0.5±0.9; P=0.009). Gap localization displayed different patterns. Although not significant, redo procedures of cryoballoon ablation were slightly shorter and needed shorter durations of radiofrequency to achieve PV isolation. CONCLUSIONS During redo procedures, gap localization pattern is different for patients first ablated with cryoballoon or radiofrequency ablation, and right superior PV reconnections occur more frequently after radiofrequency ablation. Redo ablation of a previous cryoballoon ablation appears to be easier.
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Affiliation(s)
- Vincent Galand
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France.
| | - Dominique Pavin
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
| | - Nathalie Behar
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
| | - Vincent Auffret
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
| | - Damien Fénéon
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
| | - Albin Behaghel
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
| | - Jean-Claude Daubert
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
| | - Philippe Mabo
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
| | - Raphaël P Martins
- Service de Cardiologie et Maladies Vasculaires, CHU de Rennes, 2, rue Henri-Le-Guilloux, 35000 Rennes, France; Université de Rennes 1, CIC-IT 1414, 35000 Rennes, France; Inserm, U1099, 35000 Rennes, France
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9
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Jiang J, Li J, Zhong G, Jiang J. Efficacy and safety of the second-generation cryoballoons versus radiofrequency ablation for the treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2016; 48:69-79. [DOI: 10.1007/s10840-016-0191-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/16/2016] [Indexed: 12/29/2022]
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10
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Barnett AS, Bahnson TD, Piccini JP. Recent Advances in Lesion Formation for Catheter Ablation of Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:CIRCEP.115.003299. [PMID: 27103088 DOI: 10.1161/circep.115.003299] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 02/12/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Adam S Barnett
- From the Duke Center for Atrial Fibrillation, Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC
| | - Tristram D Bahnson
- From the Duke Center for Atrial Fibrillation, Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC
| | - Jonathan P Piccini
- From the Duke Center for Atrial Fibrillation, Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC.
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11
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CARDOSO RHANDERSON, MENDIRICHAGA RODRIGO, FERNANDES GILSON, HEALY CHRIS, LAMBRAKOS LITSAK, VILES-GONZALEZ JUANF, GOLDBERGER JEFFREYJ, MITRANI RAULD. Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta-Analysis. J Cardiovasc Electrophysiol 2016; 27:1151-1159. [DOI: 10.1111/jce.13047] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 01/15/2023]
Affiliation(s)
- RHANDERSON CARDOSO
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - RODRIGO MENDIRICHAGA
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - GILSON FERNANDES
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - CHRIS HEALY
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - LITSA K. LAMBRAKOS
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - JUAN F. VILES-GONZALEZ
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - JEFFREY J. GOLDBERGER
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - RAUL D. MITRANI
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
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12
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Kabunga P, Phan K, Ha H, Sy RW. Meta-Analysis of Contemporary Atrial Fibrillation Ablation Strategies. JACC Clin Electrophysiol 2016; 2:377-390. [DOI: 10.1016/j.jacep.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/01/2015] [Accepted: 12/27/2015] [Indexed: 12/21/2022]
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13
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Chan NY. Catheter ablation of peri-nodal and pulmonary veno-atrial substrates: should it be cool? Europace 2016; 17 Suppl 2:ii19-30. [DOI: 10.1093/europace/euv230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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14
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Sardu C, Santamaria M, Paolisso G, Marfella R. microRNA expression changes after atrial fibrillation catheter ablation. Pharmacogenomics 2015; 16:1863-77. [PMID: 26554530 DOI: 10.2217/pgs.15.117] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Atrial fibrillation (AF) is most common arrhythmia in general population, with increasing trend in mortality and morbidity. Electrophysiological and structural abnormalities, promoting abnormal impulse formation and propagation, lead to this disease. AF catheter ablation is related to a not small percentage of nonresponder patients. microRNAs (miRs) have been used as AF fibrotic and electrical alterations biomarkers. miRs may differentiate responders patients to ablative approach. Selective miR target therapy, as upregulation by adenovirus transfection and/or miR downregulation by antagomiR, may be used to treat AF patients. Catheter ablation of triggering electrical pulmonary veins activity or fibrotic areas defragmentation may be upgraded by miR therapy to prevent cardiac electrical and fibrotic remodeling after AF ablation.
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Affiliation(s)
- Celestino Sardu
- Medical, Surgical, Neurological, Metabolic & Aging Sciences Department, Second University study of Naples, Naples, Italy.,Cardiovascular & Arrhythmias Department, Giovanni Paolo II Research & Care Foundation, Campobasso, Italy
| | - Matteo Santamaria
- Cardiovascular & Arrhythmias Department, Giovanni Paolo II Research & Care Foundation, Campobasso, Italy
| | - Giuseppe Paolisso
- Medical, Surgical, Neurological, Metabolic & Aging Sciences Department, Second University study of Naples, Naples, Italy
| | - Raffaele Marfella
- Medical, Surgical, Neurological, Metabolic & Aging Sciences Department, Second University study of Naples, Naples, Italy
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15
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Aryana A, Bowers MR, O'Neill PG. Outcomes Of Cryoballoon Ablation Of Atrial Fibrillation: A Comprehensive Review. J Atr Fibrillation 2015; 8:1231. [PMID: 27957187 DOI: 10.4022/jafib.1231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/10/2022]
Abstract
Over the last decade, cryoballoon ablation has emerged as an effective alternate strategy to point-by-point radiofrequency ablation for treatment of symptomatic atrial fibrillation. There are several reasons for this. First, the acute and long-term safety and efficacy associated with cryoablation appear comparable to that of radiofrequency ablation in patients with both paroxysmal and also persistent atrial fibrillation. Second, cryoablation offers certain advantages over conventional radiofrequency ablation including a gentler learning curve, shorter ablation and procedure times as well as lack of need for costly electroanatomical mapping technologies commonly utilized with radiofrequency ablation. Lastly, with the recent advent of the second-generation cryoballoon, the effectiveness of cryoablation has further improved dramatically. This comprehensive review examines the gradual evolution of the cryoablation tools as well as the rationale and data in support of the currently-available cryoballoon technologies for catheter ablation of atrial fibrillation.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
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Luik A, Radzewitz A, Kieser M, Walter M, Bramlage P, Hörmann P, Schmidt K, Horn N, Brinkmeier-Theofanopoulou M, Kunzmann K, Riexinger T, Schymik G, Merkel M, Schmitt C. Cryoballoon Versus Open Irrigated Radiofrequency Ablation in Patients With Paroxysmal Atrial Fibrillation: The Prospective, Randomized, Controlled, Noninferiority FreezeAF Study. Circulation 2015; 132:1311-9. [PMID: 26283655 PMCID: PMC4590523 DOI: 10.1161/circulationaha.115.016871] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 08/06/2015] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is available in the text. There is a lack of data on the comparative efficacy and procedural safety of open irrigated radiofrequency (RF) and cryoballoon catheter (CB) ablation for pulmonary vein isolation in patients with paroxysmal atrial fibrillation.
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Affiliation(s)
- Armin Luik
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.).
| | - Andrea Radzewitz
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Meinhard Kieser
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Marlene Walter
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Peter Bramlage
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Patrick Hörmann
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Kerstin Schmidt
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Nicolas Horn
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Maria Brinkmeier-Theofanopoulou
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Kevin Kunzmann
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Tobias Riexinger
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Gerhard Schymik
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Matthias Merkel
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
| | - Claus Schmitt
- From Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany (A.L., A.R., M.W., P.H., K.S., N.H., M.B.-T., T.R., G.S., M.M., C.S.); Institute of Medical Biometry and Informatics, University of Heidelberg, Germany (M.K., K.K.); and Institute for Pharmacology and Preventive Medicine, Mahlow, Germany (P.B.)
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Bhatty S, Saliaris AP. Atrial fibrillation ablation in the era of cryoballoon and force-sensing catheters: freeze or burn? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:374. [PMID: 25791081 DOI: 10.1007/s11936-015-0374-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OPINION STATEMENT Atrial fibrillation can adversely affect the quality of life for many patients. Though antiarrhythmic drug therapy remains an option for the treatment of atrial fibrillation, the drugs are associated with numerous side effects. Atrial fibrillation ablation has been shown to be as efficacious as antiarrhythmic drug therapy. The field of atrial fibrillation ablations has evolved over time from utilizing radiofrequency energy to using cryoenergy. Newer technologies are being developed with efforts to improve outcomes in patients undergoing atrial fibrillation ablations. This article will highlight two such technologies: cryoballoon ablation catheters and contact force-sensing catheters. These novel catheters appear to be further revolutionizing this young field in electrophysiology.
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Affiliation(s)
- Shaun Bhatty
- University of Maryland Medical Center, 22 South Greene Street, Baltimore, MD, 21201, USA,
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[Advances in cryoballoon technology: benefits and risks in daily practice]. Herzschrittmacherther Elektrophysiol 2014; 25:230-5. [PMID: 25081597 DOI: 10.1007/s00399-014-0329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cryoballoon ablation is nowadays a standard approach for pulmonary vein isolation in symptomatic atrial fibrillation. The second generation cryoballoon was introduced in 2012 and modifications and enhancement to the system promised a higher efficiency. OBJECTIVES, MATERIALS AND METHODS A comprehensive overview of advances in cryoballoon ablation is provided and the consequences for daily practice are described based on a PubMed literature search, taking into account own experiences. RESULTS AND CONCLUSION Advances in cryoballoon ablation result in a significantly higher efficiency. To maintain the overall safety of the procedure and to avoid phrenic nerve palsy and esophageal lesions, special care needs to be taken by following some safety aspects and cut-off criteria. More data are necessary to clarify if recommendations for cryoenergy titration with the new balloon are reasonable. Ongoing prospective studies comparing cryoballoon and radiofrequency (RF) ablation will give answers to the question which energy source is more favorable, and upcoming studies will evaluate the impact of cryoballoon ablation as a first line treatment option.
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