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Chen Z, Zhang R, Zhang X, Xu W. Association between baseline glycated hemoglobin level and atrial fibrillation recurrence following cryoballoon ablation among patients with and without diabetes. BMC Cardiovasc Disord 2024; 24:111. [PMID: 38365602 PMCID: PMC10874084 DOI: 10.1186/s12872-024-03784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/12/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVES The study aims to assess the effect of baseline glycated hemoglobin (HbA1c) levels on atrial fibrillation (AF) recurrence following cryoballoon ablation in patients with and without diabetes. METHODS Consecutive AF patients receiving first cryoballoon ablation between April 2018 and April 2021 were included. AF recurrence and other clinical outcomes were recorded for a minimum of 12 months post-ablation, with regular assessments at 3, 6, and 12 months, followed by annual check-ups. The primary outcome was AF recurrence after ablation at longest follow-up. Multivariate Cox proportional hazards regression models were utilized to calculate the hazard ratio (HR) and 95% CI per standard deviation (SD) increase of baseline HbA1c level. RESULTS 335 patients were included in the analysis. The mean age was 61.7 years, 61.8% were male. 12.8% had type 2 diabetes, and 81.7% of patients had paroxysmal AF. The median level of HbA1c was 5.3%, and the mean CHA2DS2-VASc score was 1.8. All cryoballoon ablation procedures, utilizing a 28-mm balloon, achieved successful pulmonary vein isolation. Over a median follow-up of 18 months, 105 patients (31.3%) experienced AF recurrence. In multivariate Cox proportional hazards analysis, a higher HbA1c level, persistent AF (HR 1.91, 95% CI 1.08 to 3.39, P = 0.026), alcohol consumption (HR 2.67, 95% CI 1.33 to 5.37, P = 0.006), and Nadir RSPV (HR 1.04, 95% CI 1.00 to 1.08, P = 0.005) were significant predictors of AF recurrence. Per-SD increase of HbA1c was associated with a 1.75-fold increase risk of AF recurrence (HR 1.75, 95% CI 1.39 to 2.21, P < 0.001). Subgroup analysis revealed that a higher HbA1c level was associated with a higher risk of AF recurrence in patients with and without diabetes, and in patients with paroxysmal and persistent AF. CONCLUSION Baseline HbA1c level was an independent predictor of AF recurrence following cryoablation, both in patients with and without diabetes.
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Affiliation(s)
- Zheng Chen
- Department of Cardiology, Drum Tower Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, China
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, No. 321, Zhongshan Road, Nanjing, 210008, China
| | - Ruixin Zhang
- Cardiovascular Medicine, Baoshan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xinlin Zhang
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, No. 321, Zhongshan Road, Nanjing, 210008, China.
| | - Wei Xu
- Department of Cardiology, Drum Tower Clinical College of Nanjing Medical University, No. 321, Zhongshan Road, Nanjing, 210008, China.
- Department of Cardiology, Affiliated Drum Tower Hospital, Medical School of Nanjing University, No. 321, Zhongshan Road, Nanjing, 210008, China.
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Tijskens M, Abugattas JP, Thoen H, Strazdas A, Schwagten B, Wolf M, De Greef Y. Adding Electroanatomical Mapping to Cryoballoon Pulmonary Vein Isolation Improves 1-Year Clinical Outcome and Durability of Pulmonary Vein Isolation: A Propensity Score-Matched Analysis. J Cardiovasc Dev Dis 2024; 11:57. [PMID: 38392271 PMCID: PMC10889252 DOI: 10.3390/jcdd11020057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Background: Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). Aims: To determine whether the addition of mapping can improve outcome and PVI durability. Methods: One-year outcome and PV reconnection (PVR) rate at first repeat ablation were studied in 400 AF patients in a propensity-matched analysis (age, AF type, CHA2DS2-VASc score) between Achieve catheter-guided CBA with additional EnSite LA voltage maps performed pre- and post-CBA (mapping group; N = 200) and CT- and Achieve catheter-guided CBA (control group; N = 200). Clinical success was defined as freedom of documented AF or atrial tachycardia (AT) > 30 s. PV reconnection patterns were characterized in repeat ablations. Results: At 1 year, 77 (19.25%) patients had recurrence of AF/AT, significantly lower than in the mapping group: 21 (10.5%) vs. 56 (28%), p < 0.001. Procedure time was shorter (72.2 ± 25.4 vs. 78.2 ± 29.3 min, p = 0.034) and radiation exposure lower (4465.0 ± 3454.6 Gy.cm2 vs. 5940.5 ± 4290.5 Gy.cm2, p = 0.037). Use of mapping was protective towards AF/AT recurrence (HR = 0.348; 95% CI 0.210-0.579; p < 0.001), independent of persistent AF type (HR = 1.723; 95% CI 1.034-2.872; p = 0.037), and LA diameter (HR = 1.055; 95% CI 1.015-1.096; p = 0.006). At repeat ablation (N = 90), persistent complete PVI was seen in 14/20 (70.0%) versus 23/70 (32.9%) in the mapping and conventional group, respectively (p = 0.03). Reconnection rate of the right inferior PV was lower with mapping (10.0% vs. 34,3%, p = 0.035). Conclusions: Adding electroanatomical LA voltage mapping to CBA improves 1-year clinical outcome and lowers both procedure time and radiation exposure. At repeat, use of mapping increases complete persistent PVI mainly by improving PVI durability of the RIPV.
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Affiliation(s)
- Maxime Tijskens
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- AZ Rivierenland Hospital, 2840 Bornem, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | | | - Hendrik Thoen
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | - Antanas Strazdas
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | - Bruno Schwagten
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | - Michael Wolf
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
| | - Yves De Greef
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
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Martin CA, Tilz RRR, Anic A, Defaye P, Luik A, de Asmundis C, Champ-Rigot L, Iacopino S, Sommer P, Albrecht EM, Raybuck JD, Richards E, Cielen N, Yap SC. Acute procedural efficacy and safety of a novel cryoballoon for the treatment of paroxysmal atrial fibrillation: Results from the POLAR ICE study. J Cardiovasc Electrophysiol 2023; 34:833-840. [PMID: 36786515 DOI: 10.1111/jce.15861] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION Pulmonary vein isolation (PVI) is well established as a primary treatment for atrial fibrillation (AF). The POLAR ICE study was designed to collect prospective real world data on the safety and effectiveness of the POLARxTM cryoballoon for PVI to treat paroxysmal AF. METHODS POLAR ICE, a prospective, non-randomized, multicenter (international) registry (NCT04250714), enrolled 399 patients across 19 European centers. Procedural characteristics, such as time to isolation, cryoablations per pulmonary vein (PV), balloon nadir temperature, and occlusion grade were recorded. PVI was confirmed with entrance block testing. RESULTS Data on 372 de novo PVI procedures (n = 2190 ablations) were collected. Complete PVI was achieved in 96.8% of PVs. Procedure and fluoroscopy times were 68.2 ± 24.6 and 15.6 ± 9.6 min, respectively. Left atrial dwell time was 46.6 ± 18.3 min. Grade 3 or 4 occlusion was achieved in 98.2% of PVs reported and 71.2% of PVs isolation required only a single cryoablation. Of 2190 cryoapplications, 83% had a duration of at least 120 s; nadir temperature of these ablations averaged -56.3 ± 6.5°C. There were 6 phrenic nerve palsy events, 2 of which resolved within 3 months of the procedure. CONCLUSION This real-world usage data on a novel cryoballoon suggests this device is effective, safe, and relatively fast in centers with cryoballoon experience. These data are comparable to prior POLARx reports and in keeping with reported data on other cryoballoons. Future studies should examine the long-term outcomes and the relationship between biophysical parameters and outcomes for this novel cryoballoon.
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Affiliation(s)
- Claire A Martin
- Royal Papworth Hospital NHS Foundation Trust and Cambridge University, Cambridge, UK
| | - Roland R R Tilz
- Department of Rhythmology, University Heart Center Lübeck, Lübeck, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Ante Anic
- Klinicki Bolnicki Centar Split, Split, Croatia
| | - Pascal Defaye
- University Grenoble Alpes, INSERM unité 1039 and Grenoble university Hospital, Cardiology Department, Grenoble, France
| | - Armin Luik
- Staedtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Laure Champ-Rigot
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Cardiology Department, Caen, France
| | | | - Philipp Sommer
- Clinic for Electrophysiology Herz und Diabeteszentrum NRW, Bad Oeynhausen, Germany
| | | | | | | | - Nele Cielen
- Boston Scientific, Arden Hills, Minnesota, USA
| | - Sing-Chien Yap
- Department of Cardiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Jiang C, Zhao D, Tang K, Wang Y, Li X, Jia P, Xu Y, Han B. Effectiveness and Safety of Cryoablation in Patients With Atrial Fibrillation Episodes of <24 h Duration: A Propensity-Matched Analysis. Front Cardiovasc Med 2021; 8:724378. [PMID: 34765651 PMCID: PMC8576169 DOI: 10.3389/fcvm.2021.724378] [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: 06/13/2021] [Accepted: 09/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Paroxysmal atrial fibrillation (AF) is closely related to pathophysiologic processes and clinical outcomes. However, it is uncertain whether cryoablation of pulmonary veins isolation is effective and safe for patients with symptomatic and drug refractory AF episodes of <24-h duration. Methods: The patients were designed into Group A (253 patients with paroxysmal AF episodes of <24-h duration) and Group B (253 patients with paroxysmal AF lasting for 24 h or longer) on a 1:1 basis by identical propensity scores. Mortality, stroke/transient ischemic attack (TIA), and complications relevant to the cryoablation procedure were compared, and recurrence of atrial tachyarrhythmia was analyzed for clinical independent predictors. Results: The rate of atrial tachyarrhythmia recurrence was 21.74% in Group A and 30.04% in Group B, respectively (P = 0.042). At 12-month follow-up from the procedure, lower incidences of stroke/TIA endpoint of the patients were observed in Group A compared with Group B by Kaplan–Meier analysis [HR 0.34 (0.13–0.87), P = 0.025]. No significant differences in mortality and complications relevant to the cryoablation procedure were observed between Group A and Group B. Moreover, adjusted multivariable Cox regression analysis showed that <24-h paroxysmal AF type (HR 0.644, 95% CI: 0.455–0.913, P = 0.014) and left atrium diameter (LAD) (>40 mm) (HR 1.696, 95% CI: 1.046–2.750, P = 0.032) were independently associated with the incidence of recurrence of atrial tachyarrhythmia in the study. Conclusion: Our findings indicated that <24-h paroxysmal AF type was obviously associated with an increased success rate of cryoablation and reduced incidence of stroke/TIA during the follow-up period. Therefore, there is superior effectiveness and similar safety in patients with AF episodes of <24-h duration compared with patients with longer paroxysmal AF duration.
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Affiliation(s)
- Chunying Jiang
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China.,Department of Cardiology, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital, Xuzhou, China
| | - Dongdong Zhao
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Kai Tang
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yiqian Wang
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Xiang Li
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Peng Jia
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Yawei Xu
- Department of Cardiology, Shanghai Tenth Clinical Medical School of Nanjing Medical University, Shanghai Tenth People's Hospital, Shanghai, China
| | - Bing Han
- Department of Cardiology, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou Central Hospital, Xuzhou, China
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto S, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H, the JCS/JHRS Joint Working Group. JCS/JHRS 2019 guideline on non-pharmacotherapy of cardiac arrhythmias. J Arrhythm 2021; 37:709-870. [PMID: 34386109 PMCID: PMC8339126 DOI: 10.1002/joa3.12491] [Citation(s) in RCA: 110] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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Nogami A, Kurita T, Abe H, Ando K, Ishikawa T, Imai K, Usui A, Okishige K, Kusano K, Kumagai K, Goya M, Kobayashi Y, Shimizu A, Shimizu W, Shoda M, Sumitomo N, Seo Y, Takahashi A, Tada H, Naito S, Nakazato Y, Nishimura T, Nitta T, Niwano S, Hagiwara N, Murakawa Y, Yamane T, Aiba T, Inoue K, Iwasaki Y, Inden Y, Uno K, Ogano M, Kimura M, Sakamoto SI, Sasaki S, Satomi K, Shiga T, Suzuki T, Sekiguchi Y, Soejima K, Takagi M, Chinushi M, Nishi N, Noda T, Hachiya H, Mitsuno M, Mitsuhashi T, Miyauchi Y, Miyazaki A, Morimoto T, Yamasaki H, Aizawa Y, Ohe T, Kimura T, Tanemoto K, Tsutsui H, Mitamura H. JCS/JHRS 2019 Guideline on Non-Pharmacotherapy of Cardiac Arrhythmias. Circ J 2021; 85:1104-1244. [PMID: 34078838 DOI: 10.1253/circj.cj-20-0637] [Citation(s) in RCA: 90] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Akihiko Nogami
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Haruhiko Abe
- Department of Heart Rhythm Management, University of Occupational and Environmental Health, Japan
| | - Kenji Ando
- Department of Cardiology, Kokura Memorial Hospital
| | - Toshiyuki Ishikawa
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University
| | - Katsuhiko Imai
- Department of Cardiovascular Surgery, Kure Medical Center and Chugoku Cancer Center
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kaoru Okishige
- Department of Cardiology, Yokohama City Minato Red Cross Hospital
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University
| | | | | | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University
| | - Naokata Sumitomo
- Department of Pediatric Cardiology, Saitama Medical University International Medical Center
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui
| | | | - Yuji Nakazato
- Department of Cardiovascular Medicine, Juntendo University Urayasu Hospital
| | - Takashi Nishimura
- Department of Cardiac Surgery, Tokyo Metropolitan Geriatric Hospital
| | - Takashi Nitta
- Department of Cardiovascular Surgery, Nippon Medical School
| | - Shinichi Niwano
- Department of Cardiovascular Medicine, Kitasato University School of Medicine
| | | | - Yuji Murakawa
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi
| | - Teiichi Yamane
- Department of Cardiology, Jikei University School of Medicine
| | - Takeshi Aiba
- Division of Arrhythmia, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Koichi Inoue
- Division of Arrhythmia, Cardiovascular Center, Sakurabashi Watanabe Hospital
| | - Yuki Iwasaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine
| | - Kikuya Uno
- Arrhythmia Center, Chiba Nishi General Hospital
| | - Michio Ogano
- Department of Cardiovascular Medicine, Shizuoka Medical Center
| | - Masaomi Kimura
- Advanced Management of Cardiac Arrhythmias, Hirosaki University Graduate School of Medicine
| | | | - Shingo Sasaki
- Department of Cardiology and Nephrology, Hirosaki University Graduate School of Medicine
| | | | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women's Medical University
| | - Tsugutoshi Suzuki
- Departments of Pediatric Electrophysiology, Osaka City General Hospital
| | - Yukio Sekiguchi
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Kyoko Soejima
- Arrhythmia Center, Second Department of Internal Medicine, Kyorin University Hospital
| | - Masahiko Takagi
- Division of Cardiac Arrhythmia, Department of Internal Medicine II, Kansai Medical University
| | - Masaomi Chinushi
- School of Health Sciences, Faculty of Medicine, Niigata University
| | - Nobuhiro Nishi
- Department of Cardiovascular Therapeutics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hitoshi Hachiya
- Department of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital
| | | | | | - Yasushi Miyauchi
- Department of Cardiovascular Medicine, Nippon Medical School Chiba-Hokusoh Hospital
| | - Aya Miyazaki
- Department of Pediatric Cardiology, Congenital Heart Disease Center, Tenri Hospital
| | - Tomoshige Morimoto
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Hiro Yamasaki
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | | | | | - Takeshi Kimura
- Department of Cardiology, Graduate School of Medicine and Faculty of Medicine, Kyoto University
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School
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Anic A, Lever N, Martin A, Breskovic T, Sulkin MS, Duffy E, Saliba WI, Niebauer MJ, Wazni OM, Varma N. Acute safety, efficacy, and advantages of a novel cryoballoon ablation system for pulmonary vein isolation in patients with paroxysmal atrial fibrillation: initial clinical experience. Europace 2021; 23:1237-1243. [PMID: 33729470 PMCID: PMC8350865 DOI: 10.1093/europace/euab018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Cryoballoon pulmonary vein isolation (PVI) is a safe and effective treatment for atrial fibrillation (AF). Current limitations include incomplete vein occlusion due to balloon rigidity and inconsistent electrogram recording, which impairs identification of isolation. We aimed to evaluate the acute safety and performance of a novel cryoballoon system. METHODS AND RESULTS The system includes a steerable sheath, mapping catheter, and a balloon that maintains uniform inflation pressure and size following initiation of ablation. Protocol-directed cryoablation was delivered for 180 s for isolation documented in ≤60 s, otherwise freeze duration was 240 s. Primary endpoints were acute safety and vein isolation. Pulmonary vein isolation was confirmed at ≥30 min post-isolation. Data were compared across vein locations. Thirty patients with paroxysmal AF were enrolled at two centres and underwent PVI. Pulmonary vein isolation was achieved with cryoablation only in 100% of veins (120/120). Nadir temperature was -53.1 ± 5.3°C. The number of applications to achieve PVI was 1.4 ± 0.4 per vein. Of the 120 veins, 89 were isolated with a single cryothermal application (10/30 patients required only 4 total cryoablations). There were no procedural- or device-related serious adverse events at 30 days post-procedure. A subset (24/30) of patients was followed for 1-year and 71% (17/24) remained free of atrial arrhythmias. Six patients with arrhythmia recurrence were remapped and three had durable PVI for all four veins. CONCLUSION In this first human experience, the novel cryoballoon platform was safe, efficacious, and demonstrated a high proportion of successful single ablation isolation.
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Affiliation(s)
- Ante Anic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | - Nigel Lever
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Martin
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Toni Breskovic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | | | - Elizabeth Duffy
- Electrophysiology, Boston Scientific Corp., St. Paul, MN, USA
| | - Walid I Saliba
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Mark J Niebauer
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Oussama M Wazni
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Niraj Varma
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
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Osório TG, Coutiño HE, Brugada P, Chierchia GB, De Asmundis C. Recent advances in cryoballoon ablation for atrial fibrillation. Expert Rev Med Devices 2019; 16:799-808. [PMID: 31389263 DOI: 10.1080/17434440.2019.1653181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Pulmonary vein isolation (PVI), by catheter ablation, represents the current treatment for drug-resistant atrial fibrillation (AF). Nowadays cryoballoon (CB) is a recognized ablation method in patients with atrial fibrillation, mainly due to its ease of use, leading to reproducible and fast procedures. This novel single shot technology literally revolutionized the approach to AF ablation. Areas covered: The historical development of the cryoballoon, ablation techniques and new approaches beyond the ordinary PVI and complications are summarized here. Expert opinion: Although cryoballoon ablation has greatly standardized the approach to PVI a few critical points still need to be clarified scientifically in order to further uniform this procedure in cath labs worldwide. Duration and dosage of the cryoapplication is undoubtedly a topic of great interest.
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Affiliation(s)
- Thiago Guimarães Osório
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Hugo-Enrique Coutiño
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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Avitall B, Lizama KS, Kalinski A, Coulombe N, Laske TG. Determination of single cryoablation outcome within 30 to 60 seconds of freezing based on ice impedance. J Cardiovasc Electrophysiol 2019; 30:2080-2087. [PMID: 31379020 PMCID: PMC6852533 DOI: 10.1111/jce.14097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 06/24/2019] [Accepted: 06/26/2019] [Indexed: 01/13/2023]
Abstract
Background A direct indicator of effective pulmonary vein isolation (PVI) based on early ice formation is presently lacking. Objective The initial impedance rise within 30 to 60 seconds (sec) of single cryoablation relating to ice on the distal surface of the cryoballoon could; predict effective PVI with early termination, the need for prolonging the cryoablation, or failure to achieve effective ablation. Methods Impedance measurements were taken between two ring electrodes, at the anterior balloon surface and at the shaft behind the balloon. Ice covering the anterior ring leads to impedance rise. Single cryoablation (eight animals, 37 veins) was applied for 90 to 180 sec. Cryoapplication was terminated if the impedance reached ≥500 Ω. Impedance levels at ≤60 sec of cryoablation were divided into three groups based on the characteristics of the impedance rise. PVI was confirmed acutely and at 45 ± 9 days recovery by electrophysiology mapping and histopathology. Results At 60 sec of freezing, an impedance rise of 34.1 ± 15.2 Ω (13‐50 Ω) and slope of the impedance rise (measured during 15‐30 sec of cryoapplication) less than 1 Ω/sec resulted in failed PVI. An impedance rise of 104.4 ± 31.5 Ω (76‐159 Ω) and slope of 2 Ω/sec resulted in 100% PVIs. An impedance rise of 130.9 ± 137.8 Ω (40‐590 Ω) and slope of 10 Ω/sec resulted in 100% PVIs with early termination at 90 sec. Conclusion The efficacy of single cryoablation can be defined within 30 to 60 sec based on ice impedance. Three unique impedance profiles described in this investigation are associated with the uniformity and thickness of the ice buildup on the anterior surface of the balloon. One cryoablation with an adequate impedance rise is needed for successful outcomes.
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Affiliation(s)
- Boaz Avitall
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Ken S Lizama
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
| | - Arthur Kalinski
- Division of Cardiology, University of Illinois at Chicago, Chicago, Illinois
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10
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Mugnai G, Manfrin M, de Asmundis C, Ströker E, Longobardi M, Rauhe W, Storti C, Brugada P, Chierchia GB. The assessment of pulmonary vein potentials using the new achieve advance during cryoballoon ablation of atrial fibrillation. Indian Pacing Electrophysiol J 2019; 19:211-215. [PMID: 31238123 PMCID: PMC6904823 DOI: 10.1016/j.ipej.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The new version of inner lumen mapping catheter (Achieve Advance™; Medtronic, Minnesota, USA) includes a new solid core which provides improved rotational response, as compared to the current Achieve Mapping Catheter. In the present study, we sought to analyze the rate of visualisation of real-time recordings using this new device comparing it with a large cohort of patients having undergone second generation cryoballoon (CB) ablation using the previous Achieve mapping catheter. METHODS All patients having undergone CB ablation using the Achieve Advance and the last 150 consecutive patients having undergone CB ablation using the previous Achieve were analysed. Exclusion criteria were presence of an intracavitary thrombus, uncontrolled heart failure, moderate or severe valvular disease and contraindications to general anesthesia. RESULTS A total of 200 consecutive patients (60.1 ± 9.5 years, 75% males) were evaluated (50 Achieve Advance and 150 old Achieve). Real-time recordings were significantly more prevalent in the "new Achieve Advance" population compared with the "old Achieve" group (73.5% vs 56.8%; p = 0.0001). Real-time recordings could be more frequently visualized in the "Achieve Advance" group in all veins except RIPV (LSPV: 86% vs 71.3%, p = 0.04; LIPV: 84% vs 62.7%, p = 0.005; RSPV: 78% vs 52%, p < 0.0001; RIPV: 46% vs 41.3%, p = 0.3). CONCLUSIONS The rate of visualisation of real-time recordings is significantly higher using the new Achieve Advance if compared to the previous Achieve mapping catheter in the setting of CB ablation. Real-time recordings can be visualized in approximately 73.5% of veins with this new device.
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Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium; Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy.
| | - Massimiliano Manfrin
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | | | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Massimo Longobardi
- Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Werner Rauhe
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Cesare Storti
- Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
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11
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Sciarra L, Iacopino S, Palamà Z, De Ruvo E, Filannino P, Borrelli A, Artale P, Caragliano A, Scarà A, Golia P, De Luca L, Grieco D, Rebecchi M, Favale S, Calò L. Impact of the third generation cryoballoon on atrial fibrillation ablation: An useful tool? Indian Pacing Electrophysiol J 2018; 18:127-132. [PMID: 29476904 PMCID: PMC6090001 DOI: 10.1016/j.ipej.2018.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Third-generation cryoballoon (CB3) is characterized by a 40% shorter distal tip designed to increase the rate of pulmonary veins real-time signal recording in order to measure time necessary to isolate veins, the "Time to effect" (TTE). Few data are currently available on clinical follow up of CB3 treated patients. METHODS Sixtyeight consecutive patients (mean age 57.8 ± 9.6 years, 48 male) with paroxysmal or persistent atrial fibrillation (AF) were enrolled. Thirthyfour (25 paroxysmal AF) underwent to a 28 mmCB3 pulmonary veins isolation and were compared to 34 treated (21 paroxysmal AF) with 28 mmCB2. RESULTS CB3 use was correlated to significant increase of the possibility to measure TTE in every treated veins (left superior 82,35% vs 23,53%, left inferior 70,59% vs 38,24%, right superior 58,82% vs 14,71%, right inferior 52,94% vs 17,65%). When it is measured, TTE wasn't different between two groups. Higher nadir temperature was observed in CB3 patients (-39.4 ± 5.2 °C vs -43.0 ± 7.2 °C, p = 0.03). CB3 procedures were shorter (91.4 ± 21.7 vs 110.9 ± 31.8 min, p = 0.018), with a significant reduction in cryoenergy delivery time (24.2 ± 8.5 vs 20.3 ± 6.7 min, p < 0.05), and a significant reduction in left atrium dwell time (59.3 ± 9.8 vs 69.3 ± 10.8 min, p = 0.02, p < 0.05). At one year follow up period the Kaplan-Meier curve didn't show any significant difference in AF-free survival (Log p = 0,49). CONCLUSIONS Novel CB3 is a useful tool in order to simplify AF cryoballoon ablation when compared to second generation cryoballoon, as observed in our experience. Follow up data seem confirm a clinical CB3 efficacy at least comparable CB2.
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Affiliation(s)
- Luigi Sciarra
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Saverio Iacopino
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | | | | | - Pasquale Filannino
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | | | - Paolo Artale
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | - Alberto Caragliano
- Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy
| | - Antonio Scarà
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Paolo Golia
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Lucia De Luca
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | | | - Marco Rebecchi
- Cardiology Department, Policlinico Casilino, Rome, Italy
| | - Stefano Favale
- Cardiac Unit, University of Bari, Policlinico di Bari, Bari, Italy
| | - Leonardo Calò
- Cardiology Department, Policlinico Casilino, Rome, Italy
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12
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Salghetti F, Abugattas JP, Regibus VD, Iacopino S, Takarada K, Ströker E, Coutiño HE, Lusoc I, Sieira J, Capulzini L, Mugnai G, Umbrain V, Beckers S, Brugada P, de Asmundis C, Chierchia GB. Real-Time Recordings in Cryoballoon Pulmonary Veins Isolation: Comparison Between the 25mm and the 20mm Achieve Catheters. J Atr Fibrillation 2018; 10:1855. [PMID: 29988256 PMCID: PMC6009793 DOI: 10.4022/jafib.1855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 02/19/2018] [Accepted: 03/22/2018] [Indexed: 11/10/2022]
Abstract
AIMS Real Time Recordings (RTR) of pulmonary vein (PV) activity provide important information in the setting of the 2nd generation Cryoballoon (CB-A), as a funcion of time to isolation. Visualization of RTR with the standard inner lumen mapping catheter (ILMC) 20mm Achieve (AC) is possible in roughly 50% of PVs. A novel 25mm-Achieve Advance (AC-A) has been developed with the aim of increasing the detection of RTR. The purpose of this study is to compare the AC-A with the AC, to feasibility and improvement of RTR. METHODS We assigned 50 patients with paroxysmal or persistent atrial fibrillation to CB-A PVI, using the AC-A as ILMC. We compared this group with 50 patients, matched for age and left atrial volume, who previously underwent the CB-A PVI using the AC. RESULTS RTR were more frequently observed with the AC-A than with the AC (74% vs 49%; p= 0.02). RTR in the left superior PVs was similar in both groups (74% vs 72%, p= 0.8). RTR with the AC-A were equally appreciated in left or right sided, superior or inferior PVs. No significant differences were found in terms of feasibility, procedure fluoroscopy and freezing times, nadir temperatures, and acute PVI. CONCLUSIONS CB-A PVI with the AC-A is feasible and safe in all PVs. The AC-A has proven significantly superior in visualising RTR if compared to the AC, affording RTR in 74% of PVs.
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Affiliation(s)
- Francesca Salghetti
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | - Juan-Pablo Abugattas
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Valentina De Regibus
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Gruppo Villa Maria - Via Corriera 1, 48033 Cotignola, Italy
| | - Ken Takarada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Hugo-Enrique Coutiño
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ian Lusoc
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lucio Capulzini
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Vincent Umbrain
- Anaesthesiology Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Stefan Beckers
- Anaesthesiology Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
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13
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Meissner A, Maagh P, Christoph A, Oernek A, Plehn G. Pulmonary vein potential mapping in atrial fibrillation with high density and standard spiral (lasso) catheters: A comparative study. J Arrhythm 2017; 33:192-200. [PMID: 28607614 PMCID: PMC5459413 DOI: 10.1016/j.joa.2016.10.562] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 09/04/2016] [Accepted: 10/03/2016] [Indexed: 12/12/2022] Open
Abstract
Background The dominant single-shot procedure for Pulmonary Vein Isolation (PVI) is the Cryoballoon Ablation (CBA) technique using a spiral catheter (Achieve™, AC) for mapping and monitoring purposes. We hypothesized that Basket Catheters, such as the High Density Mesh Mapper (HDMM), with its high-density mapping properties, could detect Pulmonary Vein Potentials (PVPs) that the octapolar AC would not be able to identify. Methods Twenty-four patients (average age 61.8±10 years) with either paroxysmal or persistent atrial fibrillation (AF) (Paroxysmal AF or Persistent AF) were enrolled in the study. While the patients were in sinus rhythm, all pulmonary veins (PVs) were prospectively mapped both prior and subsequent to CBA with a 32-pole HDMM and an 8-pole AC. PVPs were recorded using both catheters, and their location was allocated to one of four PV quadrants. Then, the quadrant findings of the mapping catheters were compared. Results Mapping using the HDMM allowed for more precise identification of PVPs both before and after CBA compared to AC mapping. We identified an average of 83.6±4.8 PVPs in all four PVs (this means 20.9±10.5 PVPs /per single PV per patient [HDMM], 14.5±1.3 PVPs/in all four PVs and 3.6±2.7 PVPs /per single PV per patient [AC]) before ablation, thereby leading to a significant difference in the identification of PVPs per PV quadrant. Of 384 PV quadrants/24 patients analyzed, the HDMM identified PVPs in 279 and AC in only 192 quadrants (P<0.05). Conclusion High-density mapping with a Basket Catheter, such as the HDMM, detects PVPs that remain undetected when using the standard AC catheter in CBA procedures.
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Affiliation(s)
- Axel Meissner
- Department of Cardiology, Rhythmology and Internal Intensive Care, Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109 Cologne, Germany.,Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
| | - Petra Maagh
- Department of Cardiology, Rhythmology and Internal Intensive Care, Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Arnd Christoph
- Department of Cardiology, Rhythmology and Internal Intensive Care, Klinikum Köln-Merheim, Ostmerheimer Str. 200, 51109 Cologne, Germany
| | - Ahmet Oernek
- Department of Diagnostic and Interventional Radiology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
| | - Gunnar Plehn
- Department of Cardiology and Angiology, Johanniter-Krankenhaus Rheinhausen GmbH, Kreuzacker 1-7, 47228 Duisburg, Germany.,Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany
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14
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Miyazaki S, Kajiyama T, Watanabe T, Taniguchi H, Nakamura H, Hamaya R, Kusa S, Igarashi M, Hachiya H, Hirao K, Iesaka Y. Validation of electrical ostial pulmonary vein isolation verified with a spiral inner lumen mapping catheter during second-generation cryoballoon ablation. J Cardiovasc Electrophysiol 2017; 28:870-875. [DOI: 10.1111/jce.13253] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/02/2017] [Accepted: 05/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Shinsuke Miyazaki
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Takatsugu Kajiyama
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Tomonori Watanabe
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Hiroshi Taniguchi
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Hiroaki Nakamura
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Rikuta Hamaya
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Shigeki Kusa
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Miyako Igarashi
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Hitoshi Hachiya
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
| | - Kenzo Hirao
- Heart Rhythm Center; Tokyo Medical and Dental University; Tokyo Japan
| | - Yoshito Iesaka
- Cardiovascular Center; Tsuchiura Kyodo Hospital; Tsuchiura Ibaraki Japan
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15
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De Pooter J, Phlips T, El Haddad M, Van Heuverswyn F, Timmers L, Tavernier R, Knecht S, Vandekerckhove Y, Duytschaever M. Automated verification of pulmonary vein isolation in radiofrequency- and cryoballoon-guided ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 40:779-787. [PMID: 28543788 DOI: 10.1111/pace.13121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 04/27/2017] [Accepted: 05/09/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND Verification of pulmonary vein isolation (PVI) can be challenging due to the coexistence of pulmonary vein potentials and far-field potentials. This study aimed to prospectively validate a novel algorithm for automated verification of PVI in radiofrequency (RF)-guided and cryoballoon (CB)-guided ablation strategies. METHODS A data set of 620 (RF: 516 EGMs and CB: 104 EGMs) bipolar electrograms (EGM), recorded by circular mapping catheter placed at the left atrium-pulmonary vein (PV) junction, were prospectively analyzed by a two-step algorithm. The algorithm differentiates isolated from nonisolated EGMs based on typology and specific parameters of the bipolar EGMs. EGMs were recorded at baseline and after proven isolation in RF- and CB-guided procedures. Additionally, in the RF group, EGMs during encircling of the PVs were analyzed. RESULTS In the RF and CB group, the algorithm correctly identifies EGMs as isolated or nonisolated with respectively 93% and 96% sensitivity and 86% and 90% specificity. In the RF subgroups of (1) baseline and proven isolated EGMs, (2) EGMs during encircling, and (3) EGMs in redo procedures sensitivity was 96%, 88%, and 100%, respectively, with specificity of 81%, 91%, and 100%. Fourteen out of 14 (100%) reconnected PVs were correctly identified as containing PVPs. Eleven out of 12 (92%) failed freeze attempts were correctly identified as being nonisolated. CONCLUSION We validated a two-step algorithm for automated PVI verification, applicable both for RF- and CB-guided PVI. The algorithm automatically differentiates isolated from nonisolated PVs with high accuracy and without the need for pacing maneuvers.
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Affiliation(s)
- Jan De Pooter
- Ghent University Hospital, Heart Center, Ghent, Belgium.,Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | - Thomas Phlips
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | | | | | - René Tavernier
- Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
| | | | | | - Mattias Duytschaever
- Ghent University Hospital, Heart Center, Ghent, Belgium.,Department of Cardiology, Sint-Jan Hospital, Bruges, Belgium
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16
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Kettering K, Gramley F. Radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique : Long-term outcome. Herzschrittmacherther Elektrophysiol 2017; 28:225-231. [PMID: 28243805 DOI: 10.1007/s00399-017-0493-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/02/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation (AF). Cryoablation has been shown to be a safe and effective technique for pulmonary vein (PV) isolation. However, the arrhythmia recurrence rate is high after cryoablation procedures. Radiofrequency catheter ablation has been shown to be an effective strategy for redo procedures in these patients and to provide a favourable outcome during midterm follow-up. The aim of this study was to analyse whether the strategy also provides favourable results during long-term follow-up (5 years). METHODS In this study 30 patients (paroxysmal AF: 22 patients, persistent AF: 8 patients) underwent a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique (Arctic Front Balloon, Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster, Diamond Bar, CA, USA) depending on the intraprocedural findings. RESULTS During the repeat procedure, a mean number of 2.9 reconnected PV (SD ± 1.0) were detected. In 20 patients, a segmental approach was sufficient to eliminate the residual PV conduction because only a few PV fibres were recovered (1-3 reconnected PV; group A). In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the pulmonary vein - left atrial (PV-LA) conduction (group B). All reconnected PV were isolated successfully again. A third or fourth ablation procedure had to be performed in 4 (3 and 1, respectively) patients (13.3%). At 5‑year follow-up, 66.7% of all patients were free from an arrhythmia recurrence (20 out of 30). There were no major complications during long-term follow-up. CONCLUSION In patients with an initial circumferential PV isolation using the cryoballoon technique, a repeat ablation procedure can be safely and effectively performed using radiofrequency catheter ablation providing good long-term follow-up results.
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Affiliation(s)
- Klaus Kettering
- Department of Cardiology, University of Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
| | - Felix Gramley
- HPK Heidelberger Praxisklinik für Innere Medizin, Kardiologie und Pneumologie, Heidelberg, Germany
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17
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Scholz E, Lugenbiel P, Schweizer PA, Xynogalos P, Seyler C, Zitron E, Becker R, Katus HA, Thomas D. Efficacy, High Procedural Safety And Rapid Optimization Of Cryoballoon Atrial Fibrillation Ablation In The Hands Of A New Operator. J Atr Fibrillation 2016; 8:1341. [PMID: 27909474 DOI: 10.4022/jafib.1341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/20/2015] [Accepted: 11/27/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cryoballoon (CB) ablation is successful in eliminating atrial fibrillation (AF). PURPOSE The purpose of this study was to assess procedural efficacy and safety of CB ablation performed by a newly trained operator. METHODS Forty patients with documented paroxysmal AF (58 ± 11 years, 26 male) undergoing CB catheter ablation were prospectively enrolled. RESULTS Electrical pulmonary vein (PV) isolation was achieved in all patients (156 PVs). The primary end point (PV isolation using CB only) was reached in 31 patients (92% PV isolation, 144/156 PVs). In the remaining 9 patients (12 PVs), additional single point cryofocal ablations were required to achieve isolation of all veins (LSPV, n = 5; LIPV, n = 3; LCPV, n = 2; RSPV, n = 1; RIPV, n = 1). There was no vascular access complication, pericardial effusion/tamponade, stroke/transient ischemic attack, phrenic nerve palsy, acute PV stenosis, or atrioesophageal fistula. The procedure duration decreased with experience by 30% from 155 min during the first 10 procedures to 108 min (final 10 treatments). Similar effects were observed with fluoroscopy time (-57%; from 28 min to 12 min), dose area product (-66%; from 22 Gy x cm2 to 8 Gy x cm2), CB time in the left atrium (-24%; from 99 min to 75 min), and cryoenergy delivery time (-19%; from 83 min to 67 min), when comparing cases #1-10 to cases #30-40. CONCLUSIONS CB ablation of AF is effective and safe in the hands of a new operator. Procedure and fluoroscopy times decrease with user experience.
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Affiliation(s)
- Eberhard Scholz
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Patrick Lugenbiel
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Patrick A Schweizer
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Panagiotis Xynogalos
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Claudia Seyler
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Edgar Zitron
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Rüdiger Becker
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Hugo A Katus
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Dierk Thomas
- Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany ; Department of Cardiology, Medical University Hospital, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
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Aryana A, Kowalski M, O’Neill PG, Koo CH, Lim HW, Khan A, Hokanson RB, Bowers MR, Kenigsberg DN, Ellenbogen KA. Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: Short- and long-term results of a multicenter study. Heart Rhythm 2016; 13:2306-2313. [DOI: 10.1016/j.hrthm.2016.08.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Indexed: 11/25/2022]
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19
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Mugnai G, de Asmundis C, Hünük B, Ströker E, Moran D, Hacioglu E, Ruggiero D, Poelaert J, Verborgh C, Umbrain V, Beckers S, Coutino-Moreno HE, Takarada K, de Regibus V, Brugada P, Chierchia GB. Improved visualisation of real-time recordings during third generation cryoballoon ablation: a comparison between the novel short-tip and the second generation device. J Interv Card Electrophysiol 2016; 46:307-14. [DOI: 10.1007/s10840-016-0114-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
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20
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Chierchia GB, Mugnai G, Ströker E, Velagic V, Hünük B, Moran D, Hacioglu E, Poelaert J, Verborgh C, Umbrain V, Beckers S, Ruggiero D, Brugada P, de Asmundis C. Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon. Europace 2016; 18:1158-63. [PMID: 26857185 DOI: 10.1093/europace/euv452] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/23/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS The third-generation Cryoballoon Advance Short-tip (CB-ST) has been designed with a 40% shortened tip length compared with the former second-generation CB Advance device. Ideally, a shorter tip should permit an improved visualization of real-time (RT) recordings in the pulmonary vein (PV) due to a more proximal positioning of the inner lumen mapping catheter. In the present study, we sought to analyse the rate of visualization of RT recordings in our first series of patients with the CB-ST device. METHODS AND RESULTS All consecutive patients having undergone CB ablation using CB-ST technology were analysed. Exclusion criteria were the presence of an intracavitary thrombus, uncontrolled heart failure, moderate or severe valvular disease, and contraindications to general anaesthesia. A total of 60 consecutive patients (60.5 ± 11.2 years, 62% males) were evaluated. Real-time recordings were detected in 209 of 240 PVs (87.1%). Specifically, RT recordings could be visualized in 55 left superior PVs (91.7%), 51 left inferior PVs (85.0%), 53 right superior PVs (88.3%), and 50 right inferior PVs (83.3). CONCLUSION The rate of visualization of RT recordings is significantly high during third-generation CB-ST ablation. Real-time recordings can be visualized in ∼87.1% of veins with this novel cryoballoon.
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Affiliation(s)
| | - Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Vedran Velagic
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Burak Hünük
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Darragh Moran
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ebru Hacioglu
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jan Poelaert
- Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium
| | | | - Vincent Umbrain
- Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium
| | - Stefan Beckers
- Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium
| | - Diego Ruggiero
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
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21
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Aryana A, Mugnai G, Singh SM, Pujara DK, de Asmundis C, Singh SK, Bowers MR, Brugada P, d’Avila A, O’Neill PG, Chierchia GB. Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation. Heart Rhythm 2016; 13:424-32. [DOI: 10.1016/j.hrthm.2015.10.033] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Indexed: 10/22/2022]
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22
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Gang Y, Gonna H, Domenichini G, Sampson M, Aryan N, Norman M, Behr ER, Zuberi Z, Dhillon P, Gallagher MM. Evaluation of the Achieve Mapping Catheter in cryoablation for atrial fibrillation: a prospective randomized trial. J Interv Card Electrophysiol 2015; 45:179-87. [DOI: 10.1007/s10840-015-0092-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 12/14/2015] [Indexed: 11/25/2022]
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23
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Saitoh Y, Ströker E, Irfan G, Mugnai G, Ciconte G, Hünük B, Velagić V, Overeinder I, Tanaka K, Brugada P, de Asmundis C, Chierchia GB. Fluoroscopic position of the second-generation cryoballoon during ablation in the right superior pulmonary vein as a predictor of phrenic nerve injury. Europace 2015; 18:1179-86. [DOI: 10.1093/europace/euv362] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 10/02/2015] [Indexed: 11/14/2022] Open
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Saitoh Y, Irfan G, Ciconte G, Mugnai G, Sieira J, Di Giovanni G, Baltogiannis G, Conte G, Hünük B, Ströker E, Velagić V, Overeinder I, De Asmundis C, Chierchia GB, Brugada P. Persistence of Phrenic Nerve Palsy Following 28-mm Cryoballoon Ablation: A Four-Year Single Center Experience. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:807-14. [PMID: 25851416 DOI: 10.1111/pace.12636] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Revised: 03/24/2015] [Accepted: 03/29/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Phrenic nerve palsy (PNP) is the most frequently observed complication in the setting of cryoballoon (CB) ablation (Arctic Front, Medtronic Inc., Minneapolis, MN, USA). Although, usually transient, resolving before the end of the procedure, persistent PNP (not resolving before the end of procedure) can occur. Literature on persistent PNP after second generation CB ablation is relatively sparse. METHODS A total of 316 consecutive patients having undergone large 28-mm CB ablation as index procedure in the Heart Rhythm Management Center, UZ Brussels, Belgium, from January 2009 to December 2013 were retrospectively reviewed for the study. Of these 117 patients were treated with the first generation CB (CB1) and 199 patients with the second generation CB (CB2). RESULTS PNP occurred in 10% of the total population. Persistent PNP was only observed following CB2 ablation which occurred in 4.5% of the group. At a mean follow-up of 11 months, diaphragmatic contraction in persistent PNP patients resumed in 78% (7/9) of the patients. In a final follow-up at 5 and 20 months, PNP persisted in two patients, respectively. PNP during ablation in the right inferior pulmonary vein was only observed in the CB2 group. No predictors of persistency of PNP were observed. CONCLUSION Persistence of PNP only occurred in the CB2 group in 4.5% of patients. The majority of patients with persistent PNP were asymptomatic. In most of the patients having persistent PNP after ablation, complete phrenic nerve function resumed during follow-up (78%).
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Affiliation(s)
- Yukio Saitoh
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Ghazala Irfan
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Giuseppe Ciconte
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Giacomo Mugnai
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Juan Sieira
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | | | | | - Giulio Conte
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Burak Hünük
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Erwin Ströker
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Vedran Velagić
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Ingrid Overeinder
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Carlo De Asmundis
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | | | - Pedro Brugada
- From the Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
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Ciconte G, Baltogiannis G, de Asmundis C, Sieira J, Conte G, Di Giovanni G, Saitoh Y, Irfan G, Mugnai G, Hunuk B, Chierchia GB, Brugada P. Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation. Europace 2015; 17:559-65. [PMID: 25582875 DOI: 10.1093/europace/euu350] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/10/2014] [Indexed: 12/16/2022] Open
Abstract
AIMS To assess the 1 year efficacy of pulmonary vein isolation (PVI) as index procedure for persistent atrial fibrillation (PersAF) comparing conventional radiofrequency irrigated-tip catheter ablation (RFCA) using contact-force technology and ablation using the second-generation cryoballoon (CB-AdvA). METHODS AND RESULTS One hundred consecutive patients (74 male, 74%; mean age 62.4 ± 9.6 years) with drug-refractory PersAF undergoing PVI using RFCA and CB-AdvA were enrolled. Follow-up was based on outpatient clinic visits including Holter-electrocardiograms. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 s. Among 100 patients, 50 underwent RFCA whereas 50 CB-AdvA. Mean procedure and fluoroscopy times were 90.5 ± 41.7 vs. 140.2 ± 46.9 min and 14.5 ± 6.6 vs. 19.8 ± 6.8 min in the CB-Adv and in the RFCA group, respectively (P < 0.01). At 1 year follow-up, after a 3 months blanking period (BP), freedom from ATas off-drugs after a single procedure was 60% (28/50 patients) in the CB-Adv and 56% (27/50 patients) in the RFCA group (P = 0.71). Multivariate analysis demonstrated that PersAF duration (P = 0.01) and relapses during BP (P = 0.02) were independent predictors of ATa recurrences following the index procedure. CONCLUSION Freedom from ATas following PersAF ablation with RFCA and CB-Adv is comparable at 1 year follow-up after a single procedure. Ablation with the CB-Adv is associated with shorter procedure time and radiation exposure as compared with RFCA. Atrial tachyarrhythmias occurrence during BP and longer time of PersAF seem to be significant predictors of arrhythmia recurrences after the index procedure.
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Affiliation(s)
- Giuseppe Ciconte
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Giannis Baltogiannis
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Giulio Conte
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Giacomo Di Giovanni
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Yukio Saitoh
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Ghazala Irfan
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Burak Hunuk
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Vrije Universiteit Brussel, 101 Laarbeeklaan, 1090 Brussels, Belgium
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26
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Ciconte G, Ottaviano L, de Asmundis C, Baltogiannis G, Conte G, Sieira J, Di Giovanni G, Saitoh Y, Irfan G, Mugnai G, Storti C, Montenero AS, Chierchia GB, Brugada P. Pulmonary vein isolation as index procedure for persistent atrial fibrillation: One-year clinical outcome after ablation using the second-generation cryoballoon. Heart Rhythm 2014; 12:60-6. [PMID: 25281891 DOI: 10.1016/j.hrthm.2014.09.063] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND No data are available about the clinical outcome of pulmonary vein isolation (PVI) as an index procedure for persistent atrial fibrillation (PersAF) ablation using the second-generation cryoballoon (CB-Adv). OBJECTIVE The purpose of this study was to assess the 1-year efficacy of PVI as an index procedure for PersAF ablation using the novel CB-Adv. METHODS Sixty-three consecutive patients (45 male [71.4%], mean age 62.7 ± 9.7 years) with drug-refractory PersAF undergoing PVI using the novel CB-Adv were enrolled. Follow-up was based on outpatient clinic visits including Holter ECGs. Recurrence of atrial tachyarrhythmias (ATas) was defined as a symptomatic or documented episode >30 seconds. RESULTS A total of 247 PVs were identified and successfully isolated with a mean of 1.7 ± 0.4 freezes. Mean procedural and fluoroscopy times were 87.1 ± 38.2 minutes and 14.9 ± 6.1 minutes, respectively. Among 26 of 63 patients (41.3%) presenting with AF at the beginning of the procedure, 7 of 26 (26.9%) converted to sinus rhythm during ablation. Phrenic nerve palsy occurred in 4 of 63 patients (6.3%). At 1-year follow-up, after a 3-month blanking period (BP), 38 of 63 patients (60.3%) were in sinus rhythm. Because of ATa recurrences, 9 patients underwent a second procedure with radiofrequency ablation showing a pulmonary vein reconnection in 4 right-sided PVs (44.4%) and 3 left-sided PVs (33.3%). Multivariate analysis demonstrated that PersAF duration (P = .01) and relapses during BP (P = .04) were independent predictors of AT recurrences. CONCLUSION At 1-year follow-up, freedom from ATas following PersAF ablation with the novel CB-Adv is 60%. Phrenic nerve palsy is the most common complication. PersAF duration and relapses during the BP appear to be significant predictors of arrhythmic recurrences.
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Affiliation(s)
- Giuseppe Ciconte
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium.
| | - Luca Ottaviano
- Cardiovascular Department, IRCCS Multimedica, Sesto S. Giovanni, Milan, Italy
| | | | | | - Giulio Conte
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | | | - Yukio Saitoh
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Ghazala Irfan
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
| | - Cesare Storti
- Electrophisiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | | | | | - Pedro Brugada
- Heart Rhythm Management Centre, UZ Brussel-VUB, Brussels, Belgium
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CICONTE GIUSEPPE, CHIERCHIA GIANBATTISTA, DE ASMUNDIS CARLO, SIEIRA JUAN, CONTE GIULIO, JULIÁ JUSTO, DI GIOVANNI GIACOMO, WAUTERS KRISTEL, BALTOGIANNIS GIANNIS, SAITOH YUKIO, MUGNAI GIACOMO, CATANZARITI DOMENICO, TONDO CLAUDIO, BRUGADA PEDRO. Spontaneous and Adenosine-Induced Pulmonary Vein Reconnection After Cryoballoon Ablation with the Second-Generation Device. J Cardiovasc Electrophysiol 2014; 25:845-851. [DOI: 10.1111/jce.12421] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2014] [Revised: 03/04/2014] [Accepted: 03/14/2014] [Indexed: 11/30/2022]
Affiliation(s)
- GIUSEPPE CICONTE
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
| | | | | | - JUAN SIEIRA
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
| | - GIULIO CONTE
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
| | - JUSTO JULIÁ
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
| | | | - KRISTEL WAUTERS
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
| | | | - YUKIO SAITOH
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
| | - GIACOMO MUGNAI
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
| | | | - CLAUDIO TONDO
- Cardiac Arrhythmia Research Centre; Centro Cardiologico Monzino IRCCS; Milan Italy
| | - PEDRO BRUGADA
- Heart Rhythm Management Centre; UZ Brussel-VUB; Brussels Belgium
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28
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GIOVANNI GIACOMODI, WAUTERS KRISTEL, CHIERCHIA GIANBATTISTA, SIEIRA JUAN, LEVINSTEIN MOISES, CONTE GIULIO, DE ASMUNDIS CARLO, BALTOGIANNIS GIANNIS, SAITOH YUKIO, CICONTE GIUSEPPE, JULIA JUSTO, MUGNAI GIACOMO, IRFAN GHAZALA, BRUGADA PEDRO. One-Year Follow-Up After Single Procedure Cryoballoon Ablation: A Comparison Between the First and Second Generation Balloon. J Cardiovasc Electrophysiol 2014; 25:834-839. [DOI: 10.1111/jce.12409] [Citation(s) in RCA: 138] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/04/2014] [Accepted: 03/10/2014] [Indexed: 12/12/2022]
Affiliation(s)
- GIACOMO DI GIOVANNI
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - KRISTEL WAUTERS
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - GIAN-BATTISTA CHIERCHIA
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - JUAN SIEIRA
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - MOISES LEVINSTEIN
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - GIULIO CONTE
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - CARLO DE ASMUNDIS
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - GIANNIS BALTOGIANNIS
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - YUKIO SAITOH
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - GIUSEPPE CICONTE
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - JUSTO JULIA
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - GIACOMO MUGNAI
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - GHAZALA IRFAN
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
| | - PEDRO BRUGADA
- Heart Rhythm Management Center; Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel; Brussels Belgium
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Straube F, Dorwarth U, Schmidt M, Wankerl M, Ebersberger U, Hoffmann E. Comparison of the First and Second Cryoballoon. Circ Arrhythm Electrophysiol 2014; 7:293-9. [DOI: 10.1161/circep.113.000899] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Florian Straube
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Uwe Dorwarth
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Martin Schmidt
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Michael Wankerl
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Ulrich Ebersberger
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Ellen Hoffmann
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
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Chierchia GB, Di Giovanni G, Ciconte G, de Asmundis C, Conte G, Sieira-Moret J, Rodriguez-Manero M, Casado R, Baltogiannis G, Namdar M, Saitoh Y, Paparella G, Mugnai G, Brugada P. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-up. Europace 2014; 16:639-44. [DOI: 10.1093/europace/eut417] [Citation(s) in RCA: 139] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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31
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Initial experience of three-minute freeze cycles using the second-generation cryoballoon ablation: acute and short-term procedural outcomes. J Interv Card Electrophysiol 2013; 39:145-51. [DOI: 10.1007/s10840-013-9855-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 10/18/2013] [Indexed: 01/08/2023]
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Kettering K, Gramley F. Catheter ablation of atrial fibrillation: Radiofrequency catheter ablation for redo procedures after cryoablation. World J Cardiol 2013; 5:280-287. [PMID: 24009817 PMCID: PMC3761181 DOI: 10.4330/wjc.v5.i8.280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 05/20/2013] [Accepted: 07/19/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the effectiveness of two different strategies using radiofrequency catheter ablation for redo procedures after cryoablation of atrial fibrillation.
METHODS: Thirty patients (paroxysmal atrial fibrillation: 22 patients, persistent atrial fibrillation: 8 patients) had to undergo a redo procedure after initially successful circumferential pulmonary vein (PV) isolation with the cryoballoon technique (Arctic Front Balloon, CryoCath Technologies/Medtronic). The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy (CARTO; Biosense Webster) depending on the intra-procedural findings. After discharge, patients were scheduled for repeated visits at the arrhythmia clinic. A 7-day Holter monitoring was performed at 3, 12 and 24 mo after the ablation procedure.
RESULTS: During the redo procedure, a mean number of 2.9 re-conducting pulmonary veins (SD ± 1.0 PVs) were detected (using a circular mapping catheter). In 20 patients, a segmental approach was sufficient to eliminate the residual pulmonary vein conduction because there were only a few recovered pulmonary vein fibres. In the remaining 10 patients, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction. All recovered pulmonary veins could be isolated successfully again. At 2-year follow-up, 73.3% of all patients were free from an arrhythmia recurrence (22/30). There were no major complications.
CONCLUSION: In patients with an initial circumferential pulmonary vein isolation using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation.
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Chierchia GB, Casado-Arroyo R, de Asmundis C, Rodriguez-Manero M, Sarkozy A, Conte G, Sieira J, Levinstein M, Baltogiannis G, di Giovanni G, Overeinder I, Ocello S, Rosas E, Isola F, Brugada P. Impact of transseptal puncture site on acute and mid-term outcomes during cryoballoon ablation: a comparison between anterior, medial and posterior transatrial access. Int J Cardiol 2013; 168:4098-102. [PMID: 23928339 DOI: 10.1016/j.ijcard.2013.07.079] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 05/22/2013] [Accepted: 07/07/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cryoballoon ablation (CBA) (Arctic Front, Medtronic, USA) has proven very effective in achieving pulmonary vein isolation (PVI). Different transseptal (TS) puncture sites might influence CBA procedure. The aim of the present study was to analyze the influence of different TS puncture sites (anterior, medial and posterior) on the acute and midterm outcomes of CBA in a series of patients undergoing PVI for drug resistant AF. METHODS AND RESULTS A total 103 patients (78 males, mean age: 57 ± 13 years) formed the study group. Transseptal punctures were performed in the anterior, medial and posterior portion of the FO in 41 (39.8%), 35 (34%) and 27 (26.2%) patients respectively. We found no statistical significant difference between the various sites of TS puncture in 1) the grade of PV occlusion (p = ns), the rate of PV isolation (p = ns), freedom from AF at a mean 12 month follow-up (p = ns) and complication rates (p = ns). Mean grade of occlusion was slightly lower in the RIPV when puncturing in the posterior FO but did not reach statistical significance. Mean procedural and fluoroscopy times were significantly lower when using the inner lumen mapping catheter (ILMC) (Achieve, Medtronic, USA) than the circular mapping catheter (CMC) (Lasso, Biosense Webster, California, USA) (107.24 mn vs 97.74 (p ≤ 0.001) and 25.7 mn vs 19.2 mn (p ≤ 0.001)). CONCLUSION Different sites of TS puncture on the horizontal axis of the FO (anterior, medial and posterior) did not influence grades of PV occlusion, rates of isolation, mid-term outcome and rates of complications during CB ablation.
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Affiliation(s)
- Gian-Battista Chierchia
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium; Modulo di Elettrofisiologia Cardiaca, Ospedale Santissima Trinità, Cagliari, Italy.
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BORDIGNON STEFANO, CHUN KRJULIAN, GUNAWARDENE MELANIE, FUERNKRANZ ALEXANDER, URBAN VERENA, SCHULTE-HAHN BRITTA, NOWAK BERND, SCHMIDT BORIS. Comparison of Balloon Catheter Ablation Technologies for Pulmonary Vein Isolation: The Laser Versus Cryo Study. J Cardiovasc Electrophysiol 2013; 24:987-94. [DOI: 10.1111/jce.12192] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 04/13/2013] [Accepted: 05/14/2013] [Indexed: 12/11/2022]
Affiliation(s)
| | - KR JULIAN CHUN
- Cardioangiologisches Centrum Bethanien; Frankfurt/Main Germany
| | | | | | - VERENA URBAN
- Cardioangiologisches Centrum Bethanien; Frankfurt/Main Germany
| | | | - BERND NOWAK
- Cardioangiologisches Centrum Bethanien; Frankfurt/Main Germany
| | - BORIS SCHMIDT
- Cardioangiologisches Centrum Bethanien; Frankfurt/Main Germany
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Cronin EM, Wisnoskey BJ, Rizzo RA, Niebauer MJ, Dresing TJ, Cantillon DJ. Real-time guidewire localization using impedance-based electroanatomic mapping: experimental results and clinical validation during cryoballoon ablation of atrial fibrillation. Europace 2013; 15:1669-76. [PMID: 23736804 DOI: 10.1093/europace/eut144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS Cryoballoon ablation is an emerging therapy for atrial fibrillation (AF). However, the Arctic Front cryoballoon (Medtronic) cannot be localized on current electroanatomic mapping (EAM) systems. We describe a technique to visualize guidewires in an impedance-based EAM system. METHODS AND RESULTS A novel technique for real-time guidewire localization in an EAM (Ensite Velocity, St Jude Medical) was prospectively evaluated among patients referred for cryoballoon AF ablation. The guidewire was visualized as an 'orb' on the EAM and localization in each of the pulmonary veins (PVs) compared with orthogonal fluoroscopy, contrast venography, and intra-cardiac echocardiography. Application of the technique in 21 consecutive patients [median age 58 (interquartile range 21); 71.4% male; 85.7% paroxysmal AF] demonstrated agreement with respect to guidewire localization in 82 of 82 (100%) PVs. Discrimination of guidewire position in the left atrial appendage from the left PVs was also demonstrated. When compared with 21 consecutive cryoballoon procedures over the same time period in which the technique was not used, fluoroscopy time was reduced [median 53.2 (25.9) vs. 72.3 (47.6) min, P = 0.008], and a trend towards reduced radiation exposure [median 372 (656.0) vs. 581 (849.9) mGy, P = 0.08] was noted, without effect on acute procedural or mid-term endpoints. Ex vivo assessment of the technique in a saline bath left atrial model demonstrated that the 'orb' localizes to the centroid of the exposed portion of the guidewire. CONCLUSION This simple, novel technique provides real-time, accurate guidewire localization to enable guidewire and catheter navigation during cryoballoon AF ablation.
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Duytschaever M, De Meyer G, Acena M, El-Haddad M, De Greef Y, Van Heuverswyn F, Vandekerckhove Y, Tavernier R, Lee G, Kistler P. Lessons from dissociated pulmonary vein potentials: entry block implies exit block. Europace 2012; 15:805-12. [PMID: 23275474 PMCID: PMC3663332 DOI: 10.1093/europace/eus353] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Aims Prior reports using pacing manoeuvres, demonstrated an up to 42% prevalence of residual pulmonary vein to left atrium (PV–LA) exit conduction after apparent LA–PV entry block. We aimed to determine in a two-centre study the prevalence of residual PV–LA exit conduction in the presence of unambiguously proven entry block and without pacing manoeuvres. Methods and results Of 378 patients, 132 (35%) exhibited spontaneous pulmonary vein (PV) potentials following circumferential PV isolation guided by three-dimensional mapping and a circular mapping catheter. Pulmonary vein automaticity was regarded as unambiguous proof of LA–PV entry block. We determined the prevalence of spontaneous exit conduction of the spontaneous PV potentials toward the LA. Pulmonary vein automaticity was observed in 171 PVs: 61 right superior PV, 33 right inferior PV, 47 left superior PV, and 30 left inferior PV. Cycle length of the PV automaticity was >1000 ms in all cases. Spontaneous PV–LA exit conduction was observed in one of 171 PVs (0.6%). In a subset of 69 PVs, pacing from within the PV invariably confirmed PVLA exit block. Conclusion Unidirectional block at the LA–PV junction is unusual (0.6%). This observation is supportive of LA–PV entry block as a sufficient electrophysiological endpoint for PV isolation.
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Affiliation(s)
- Mattias Duytschaever
- Department of Cardiology, St Jan Hospital Bruges, Ruddershove 10, 8000 Bruges, Belgium.
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Adragão P, Cavaco D. 'Unblinding' the cryoballoon. Europace 2012; 14:1677-8. [PMID: 22865580 DOI: 10.1093/europace/eus248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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