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Liu D, Li Y, Zhao Q. Effects of Inflammatory Cell Death Caused by Catheter Ablation on Atrial Fibrillation. J Inflamm Res 2023; 16:3491-3508. [PMID: 37608882 PMCID: PMC10441646 DOI: 10.2147/jir.s422002] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 08/08/2023] [Indexed: 08/24/2023] Open
Abstract
Atrial fibrillation (AF) poses a serious healthcare burden on society due to its high morbidity and the resulting serious complications such as thrombosis and heart failure. The principle of catheter ablation is to achieve electrical isolation by linear destruction of cardiac tissue, which makes AF a curable disease. Currently, catheter ablation does not have a high long-term success rate. The current academic consensus is that inflammation and fibrosis are central mechanisms in the progression of AF. However, artificially caused inflammatory cell death by catheter ablation may have a significant impact on structural and electrical remodeling, which may affect the long-term prognosis. This review first focused on the inflammatory response induced by apoptosis, necrosis, necroptosis, pyroptosis, ferroptosis and their interaction with arrhythmia. Then, we compared the differences in cell death induced by radiofrequency ablation, cryoballoon ablation and pulsed-field ablation. Finally, we discussed the structural and electrical remodeling caused by inflammation and the association between inflammation and the recurrence of AF after catheter ablation. Collectively, pulsed-field ablation will be a revolutionary innovation with faster, safer, better tissue selectivity and less inflammatory response induced by apoptosis-dominated cell death.
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Affiliation(s)
- Dishiwen Liu
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People’s Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People’s Republic of China
| | - Yajia Li
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People’s Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People’s Republic of China
| | - Qingyan Zhao
- Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, 430060, People’s Republic of China
- Cardiovascular Research Institute, Wuhan University, Wuhan, 430060, People’s Republic of China
- Hubei Key Laboratory of Cardiology, Wuhan, 430060, People’s Republic of China
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2
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Theis C, Kaiser B, Kaesemann P, Hui F, Pirozzolo G, Bekeredjian R, Huber C. Pulmonary vein isolation using Cryoballoon ablation versus RF ablation using ablation index following the CLOSE protocol: a Prospective Randomized Trial. J Cardiovasc Electrophysiol 2022; 33:866-873. [DOI: 10.1111/jce.15383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 12/17/2021] [Accepted: 01/01/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Cathrin Theis
- Department of CardiologyRobert‐Bosch Hospital StuttgartGermany
| | - Bastian Kaiser
- Department of CardiologyRobert‐Bosch Hospital StuttgartGermany
| | | | - Felix Hui
- Department of CardiologyRobert‐Bosch Hospital StuttgartGermany
| | | | | | - Carola Huber
- Department of CardiologyRobert‐Bosch Hospital StuttgartGermany
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3
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Cryoballoon ablation of atrial fibrillation in patients with atypical right pulmonary vein anatomy. Arch Cardiovasc Dis 2020; 113:690-700. [PMID: 32896517 DOI: 10.1016/j.acvd.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/23/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cryoballoon ablation is widely used for pulmonary vein isolation in patients with atrial fibrillation. There are no data regarding the clinical efficacy of cryoballoon ablation in patients with atypical right pulmonary vein anatomy. AIM We aimed to evaluate the impact of right pulmonary vein anatomy on the safety and efficacy of cryoballoon ablation. METHODS Patients referred for cryoballoon ablation of paroxysmal atrial fibrillation were enrolled prospectively. Left atrial computed tomography was performed before cryoballoon ablation to determine whether the right pulmonary vein anatomy was "normal" or "atypical". For patients with atypical anatomy, cryoballoon ablation was only performed for right superior and right inferior pulmonary veins, neglecting accessory pulmonary veins. RESULTS Overall, 303 patients were included: 254 (83.8%) with normal and 49 (16.2%) with atypical right pulmonary vein anatomy. First-freeze isolation for right superior and right inferior pulmonary veins occurred in 44 (89.8%) and 37 (75.5%) patients with atypical pulmonary vein anatomy, and in 218 (85.8%) and 217 (85.4%) patients with typical pulmonary vein anatomy, respectively (P not significant). Phrenic nerve palsies were only observed in patients with normal anatomy (0 vs. 26 [8.6%]; P=0.039). Mid-term survival free from atrial arrhythmia was similar, regardless of right pulmonary vein anatomy. CONCLUSIONS A significant proportion of patients have atypical right pulmonary vein anatomy. Procedural characteristics, acute pulmonary vein isolation success and mid-term procedural efficacy were similar, regardless of right pulmonary vein anatomy. In addition to left-side pulmonary vein isolation, cryoballoon ablation of right superior and right inferior pulmonary veins only, neglecting accessory pulmonary veins, is sufficient to obtain acute right-side pulmonary vein isolation and mid-term sinus rhythm maintenance in patients with atypical anatomy.
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4
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Mugnai G, de Asmundis C, Chierchia GB. Long-term follow up of second-generation cryoballoon-based pulmonary vein isolation: Lights and shadows. Int J Cardiol 2020; 312:71-72. [PMID: 32360214 DOI: 10.1016/j.ijcard.2020.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
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5
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Wasserlauf J, Kaplan RM, Walega DR, Arora R, Chicos AB, Kim SS, Lin AC, Verma N, Patil KD, Knight BP, Passman RS. Patient‐reported outcomes after cryoballoon ablation are equivalent between moderate sedation and general anesthesia. J Cardiovasc Electrophysiol 2020; 31:1579-1584. [DOI: 10.1111/jce.14547] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/27/2020] [Accepted: 04/15/2020] [Indexed: 01/28/2023]
Affiliation(s)
- Jeremiah Wasserlauf
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Rachel M. Kaplan
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - David R. Walega
- Department of Anesthesiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Rishi Arora
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Alexandru B. Chicos
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Susan S. Kim
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Albert C. Lin
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Nishant Verma
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Kaustubha D. Patil
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Bradley P. Knight
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
| | - Rod S. Passman
- Division of Cardiology Northwestern University Feinberg School of Medicine Chicago Illinois
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6
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Fortuni F, Casula M, Sanzo A, Angelini F, Cornara S, Somaschini A, Mugnai G, Rordorf R, De Ferrari GM. Meta-Analysis Comparing Cryoballoon Versus Radiofrequency as First Ablation Procedure for Atrial Fibrillation. Am J Cardiol 2020; 125:1170-1179. [PMID: 32087997 DOI: 10.1016/j.amjcard.2020.01.016] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/11/2020] [Accepted: 01/15/2020] [Indexed: 01/20/2023]
Abstract
Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. Radiofrequency (RF) represents a standard of care for pulmonary vein isolation, whereas cryoballoon (CB) ablation has emerged as a valid alternative. The aim of our meta-analysis was to explore the efficacy and safety of CB compared with RF as first ablation procedure for AF. We searched the literature for studies that investigated this issue. The primary efficacy outcome was AF recurrence. The safety outcomes were: pericardial effusion, cardiac tamponade, phrenic nerve palsy, vascular complications, and major bleedings. Fourteen randomized controlled studies and 34 observational studies were included in the analysis. A total of 7,951 patients underwent CB ablation, whereas 9,641 received RF ablation. Mean follow-up was 14 ± 7 months. Overall, CB reduced the incidence of AF recurrence compared with RF ablation (relative risk [RR] 0.86; 95% confidence interval [CI] 0.78 to 0.94; p = 0.001), and this result was consistent across different study design and AF type. CB had a significantly higher rate of phrenic nerve palsy, whereas it was related to a lower incidence of pericardial effusion, cardiac tamponade (RR 0.58; 95% CI 0.38 to 0.88; p = 0.011) and vascular complications (RR 0.61; 95% CI 0.48 to 0.77; p <0.001) compared with RF. There was no significant difference in major bleedings between the 2 strategies. CB ablation had a shorter procedural time compared with RF (mean difference -20.76 minutes; p <0.001). In conclusion, considered its efficacy/safety profile and short procedural time, CB ablation represents the preferable option for first AF ablation procedure.
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7
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Mizukami K, Homma T, Natsui H, Kato M, Otsu K, Takenaka T, Sato M. Positioning an ECG electrode to the dorsal side can record higher amplitude of CMAPs during cryoballoon ablation. J Arrhythm 2020; 36:328-334. [PMID: 32256882 PMCID: PMC7132177 DOI: 10.1002/joa3.12314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE Phrenic nerve injury (PNI) is one of the important complications during cryoballoon (CB) ablation. Recording diaphragmatic compound motor action potentials (CMAPs) during CB ablation can predict PNI. CMAP monitoring may be inaccurate when CMAP amplitudes are low. We examined the effect of positioning an electrocardiography (ECG) electrode at the dorsal side. METHODS We retrospectively analyzed the cases of 197 consecutive patients who underwent CB ablation for pulmonary vein isolation (PVI) (April 2016 to December 2018) at our institution. CMAP amplitudes were monitored using two recording methods just before cryoapplication. (a) Conventional method: right-arm ECG electrode positioned 5 cm above the xiphoid on the ventral side; left-arm ECG electrode positioned along the costal margin. (b) Our original method: right-arm electrode positioned 5 cm above the xiphoid on the dorsal side; left-arm electrode positioned along the costal margin. RESULTS The CMAP amplitude during right phrenic nerve pacing was significantly higher at the dorsal side than the ventral side (0.80 ± 0.31 mV vs 0.66 ± 0.29 mV, P < .01). Similarly, the CMAP amplitude during left phrenic nerve pacing was significantly higher at the dorsal side than the ventral side (0.92 ± 0.39 mV, 0.73 ± 0.37 mV, P < .01). PNI occurred in six patients (3.0%); three patients experienced transient PNI, another three patients experienced persistent PNI, and none developed permanent PNI. CONCLUSIONS CMAP amplitudes were significantly high at the dorsal side compared to the ventral side. Monitoring phrenic nerve function using an ECG electrode at the dorsal side is a simple and easy procedure.
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Affiliation(s)
- Kazuya Mizukami
- Department of Cardiovascular MedicineNational Hospital Organization Hokkaido Medical CenterSapporoJapan
| | - Tsuneaki Homma
- Department of Cardiovascular MedicineNational Hospital Organization Hokkaido Medical CenterSapporoJapan
| | - Hiroyuki Natsui
- Department of Cardiovascular MedicineNational Hospital Organization Hokkaido Medical CenterSapporoJapan
| | - Mizuki Kato
- Department of Cardiovascular MedicineNational Hospital Organization Hokkaido Medical CenterSapporoJapan
| | - Keisuke Otsu
- Department of Cardiovascular MedicineNational Hospital Organization Hokkaido Medical CenterSapporoJapan
| | - Takashi Takenaka
- Department of Cardiovascular MedicineNational Hospital Organization Hokkaido Medical CenterSapporoJapan
| | - Minoru Sato
- Department of Cardiovascular MedicineNational Hospital Organization Hokkaido Medical CenterSapporoJapan
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8
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Inaba O, Metzner A, Rottner L, Mathew S, Lemes C, Maurer T, Heeger C, John A, Hashiguchi N, Wohlmuth P, Ouyang F, Kuck K, Rillig A, Reissmann B. Radiofrequency or cryoballoon ablation for index pulmonary vein isolation: What is the impact on long‐term clinical outcomes after repeat ablation? J Cardiovasc Electrophysiol 2020; 31:1068-1074. [DOI: 10.1111/jce.14432] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/20/2020] [Accepted: 02/17/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Osamu Inaba
- Department of CardiologySaitama Red Cross Hospital Saitama Japan
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Andreas Metzner
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
| | - Laura Rottner
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
| | - Shibu Mathew
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Christine Lemes
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Tilman Maurer
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Christian Heeger
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- University Heart Centre Lübeck Germany
| | - Alexander John
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | | | | | - Feifan Ouyang
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Karl‐Heinz Kuck
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
| | - Andreas Rillig
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
| | - Bruno Reissmann
- Department of CardiologyAsklepios Klinik St. Georg Hamburg Germany
- Department of CardiologyUniversity Heart Center Hamburg Hamburg Germany
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9
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Patel N, Patel K, Shenoy A, Baker WL, Makaryus AN, El-Sherif N. Cryoballoon Ablation for the Treatment of Atrial Fibrillation: A Meta-analysis. Curr Cardiol Rev 2019; 15:230-238. [PMID: 30539701 PMCID: PMC6719384 DOI: 10.2174/1573403x15666181212102419] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/25/2018] [Accepted: 12/06/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Ablation therapy is the treatment of choice in antiarrhythmic drugrefractory atrial fibrillation (AF). It is performed by either cryoballoon ablation (CBA) or radiofrequency ablation. CBA is gaining popularity due to simplicity with similar efficacy and complication rate compared with RFA. In this meta-analysis, we compare the recurrence rate of AF and the complications from CBA versus RFA for the treatment of AF. METHODS We systematically searched PubMed for the articles that compared the outcome of interest. The primary outcome was to compare the recurrence rate of AF between CBA and RFA. We also included subgroup analysis with complications of pericardial effusion, phrenic nerve palsy and cerebral microemboli following ablation therapy. RESULTS A total of 24 studies with 3527 patients met our predefined inclusion criteria. Recurrence of AF after CBA or RFA was similar in both groups (RR: 0.84; 95% CI: 0.65, 1.07; I2=48%, Cochrane p=0.16). In subgroup analysis, heterogeneity was less in paroxysmal AF (I2=0%, Cochrane p=0.46) compared to mixed AF (I2=72%, Cochrane p=0.003). Procedure and fluoroscopy time was less by 26.37 and 5.94 minutes respectively in CBA compared to RFA. Complications, pericardial effusion, and silent cerebral microemboli, were not different between the two groups, however, phrenic nerve palsy was exclusively present only in CBA group. CONCLUSION This study confirms that the effectiveness of CBA is similar to RFA in the treatment of AF with the added advantages of shorter procedure and fluoroscopy times.
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Affiliation(s)
- Nirav Patel
- Division of Cardiology, Hartford Hospital, Hartford, CT, United States
| | - Krunalkumar Patel
- Division of Cardiology, North Shore University Hospital, Manhasset, NY, United States
| | - Abhishek Shenoy
- Division of Medicine, University of Virginia, Charlottesville, VA, United States
| | - William L Baker
- Division of Cardiology, Hartford Hospital, Hartford, CT, United States.,Department of Pharmacy Practice, University of Connecticut School of Pharmacy, Storrs, CT, United States
| | - Amgad N Makaryus
- Department of Cardiology, Nassau University Medical Center, East Meadow, NY, United States.,Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
| | - Nabil El-Sherif
- Division of Cardiology, Brooklyn VA Center, Brooklyn, NY, United States
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10
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Murray MI, Bonet MJ, Naci H, Zeiher AM. A Cost-Utility Analysis of Cryoballoon Ablation versus Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. J Atr Fibrillation 2019; 11:2069. [PMID: 31139282 DOI: 10.4022/jafib.2069] [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: 07/25/2017] [Revised: 08/19/2017] [Accepted: 10/14/2018] [Indexed: 11/10/2022]
Abstract
Introduction The objective of this study was to evaluate the cost-effectiveness of the treatment with cryoballoon (CB) compared to the standard treatment with traditional irrigated radiofrequency (RF) ablation for pulmonary vein isolation in patients with paroxysmal atrial fibrillation (pAF) refractory to antiarrhythmic drug therapy. Methods A decision tree model was developed to graphically depict the probabilities, utilities and costs of CB compared to RF therapy. Data from a conducted systematic literature review and meta-analysis of only RCTs were used to evaluate clinical outcomes of CB and RF treatments, including success rates after one year, complications and recurrence of atrial fibrillation. Results The cost-utility analysis estimated that, CB therapy had £1,747 higher cost, and 0.0114 more quality-adjusted life years (QALYs) compared to standard RF treatment over a one-year time horizon. The incremental cost per QALY of CB ablation compared to RF ablation was estimated to be £152,836/QALY. Conclusions Based on current evidence, CB ablation for pulmonary vein isolation in patients with pAF is costeffective compared to RF if decision makers are willing to pay £152,836 or higher for a QALY.
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Affiliation(s)
- Marie-Isabel Murray
- Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany.,Department of Health Policy, London School of Economics and Political Science, London, UK.,Department of Health Policy, London School of Economics and Political Science, London, UK
| | | | - Huseyin Naci
- Department of Health Policy, London School of Economics and Political Science, London, UK
| | - Andreas M Zeiher
- Department of Cardiology, University Hospital Frankfurt, Frankfurt am Main, Germany
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11
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Hunuk B, de Asmundis C, Mugnai G, Velagic V, Ströker E, Moran D, Ruggiero D, Hacioglu E, Umbrain V, Verborgh C, Beckers S, Poelaert J, Brugada P, Chierchia GB. Early repolarization pattern as a predictor of atrial fibrillation recurrence following radiofrequency pulmonary vein isolation. Ann Noninvasive Electrocardiol 2019; 24:e12627. [PMID: 30659704 DOI: 10.1111/anec.12627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/17/2018] [Accepted: 11/30/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Early repolarization patterns (ERP) have been found to be associated with poor cardiovascular end points. We aimed to evaluate the ERP prevalence among patients with structurally normal hearts undergoing radiofrequency (RF) pulmonary vein isolation (PVI) for paroxysmal atrial fibrillation (AF) ablation and its association with the AF recurrence. METHODS All consecutive patients who underwent RF-PVI as index procedure for paroxysmal AF in our center were evaluated. EXCLUSION CRITERIA structural heart disease, ongoing use of Class I/III antiarrhythmics, complete-bundle-branch-block. Lateral (I, aVL, V5 -V6 ), inferior (II, III, aVF), or infero-lateral (both) ERP were defined in baseline ECG as horizontal/downsloping J-point elevation ≥1 mm in two consecutive leads with QRS slurring/notching. Documented episodes of AF lasting ≥30 s were considered recurrence. RESULTS Of 701 cases, 434 patients (305 males, 58 ± 11 years) were included for analysis. ERP observed in 67 patients (15.4%) (Infero-lateral n = 26, inferior n = 23, lateral n = 18) which were significantly younger, demonstrating longer PR-interval and lower heart rates. At a mean follow-up of 22.1 ± 9.7 months, AF recurrences were found in 107 patients (24.6%). In middle-aged patients (≥40-<60 years; n = 206, 79% male), those with an infero-lateral ERP had higher recurrence compared with the ones without (56.3% vs. 19%; p = 0.002). Infero-lateral ERP was significantly predicting recurrence (HR 2.42, 95% CI 1.21-4.82; p = 0.01). CONCLUSION Early repolarization patterns was more prevalent in our AF population than in the general population. Infero-lateral ERP in baseline ECG might predict AF recurrence in the follow-up after RF-PVI in middle-aged patients.
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Affiliation(s)
- Burak Hunuk
- Department of Cardiology, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Vedran Velagic
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Darragh Moran
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Diego Ruggiero
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Ebru Hacioglu
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincent Umbrain
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Christian Verborgh
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Stefan Beckers
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Poelaert
- Department of Anesthesiology, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Brussels, Belgium
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12
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Bode K, Ueberham L, Gawlik S, Hindricks G, Bollmann A. Inguinal vascular complications after ablation of atrial fibrillation: an economic impact assessment. Europace 2019; 21:91-98. [PMID: 29901719 DOI: 10.1093/europace/euy132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
Aims Ablation of atrial fibrillation (AF) is recommended in the guidelines as a Class Ia/IIa indication. However, associated complications should not be dismissed; specifically, inguinal vascular complications (IVC). Although IVCs are generally considered trivial, they represent an economic burden for the procedure-performing hospital and the patient. Therefore, the ability to monitor and ultimately minimize potential complications is of considerable interest. Methods and results An economic model was developed to calculate the economic impact for certain IVC-types from a large German single-centre perspective in 2015 and 2016. Twenty-nine of 1040 (2.79%) and 48 of 1152 (4.17%) AF-ablation patients had documented IVC in 2015 and 2016 (P = 0.08), respectively. Inguinal vascular complications that required invasive treatment (thrombin, intervention, surgery) occurred in 0.58% of the 2015 and in 0.87% of the 2016 AF-ablation cases. The expected excess costs (incorporating direct costs, benefit lost adjusted for reimbursement) per patient treated with AF-ablation were 139.54€ and 153.31€ in 2015 and 2016, respectively. This was mostly driven by opportunity costs, which could reach 15 544.71€ for certain IVC. Sensitivity analysis revealed the probability of occurrence, length of stay of certain IVC types, and the revenue per day influenced the expected costs per AF-ablation patient. Conclusion Even relatively benign complications such as IVC can result in considerable cost increases. Therefore, measures to reduce them should be established and implemented.
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Affiliation(s)
- Kerstin Bode
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Laura Ueberham
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Susan Gawlik
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig, University of Leipzig, Struempellstrasse 39, Leipzig, Germany
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13
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Maltoni S, Negro A, Camerlingo MD, Pecoraro V, Sassone B, Biffi M, Boriani G. Comparison of cryoballoon and radiofrequency ablation techniques for atrial fibrillation. J Cardiovasc Med (Hagerstown) 2018; 19:725-738. [DOI: 10.2459/jcm.0000000000000725] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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14
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Hirao T, Nitta J, Adachi A, Takahashi Y, Goya M, Hirao K. First confirmation of histologic changes in the human heart after cryoballoon ablation. HeartRhythm Case Rep 2018; 5:93-96. [PMID: 30820405 PMCID: PMC6379571 DOI: 10.1016/j.hrcr.2018.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tatsuhiko Hirao
- Department of Cardiovascular Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Junichi Nitta
- Department of Cardiovascular Medicine, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Akiko Adachi
- Department of Pathology, Japanese Red Cross Saitama Hospital, Saitama, Japan
| | - Yoshihide Takahashi
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
| | - Masahiko Goya
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
| | - Kenzo Hirao
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
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15
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Hemoptysis as a side effect of cryoballoon pulmonary vein isolation in atrial fibrillation: a retrospective case-control study. J Interv Card Electrophysiol 2018; 54:231-236. [DOI: 10.1007/s10840-018-0468-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
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16
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Rubesch-Kütemeyer V, Molatta S, Vogt J, Gutleben KJ, Horstkotte D, Nölker G. Reduction of radiation exposure in cryoballoon ablation procedures: a single-centre study applying intracardiac echocardiography and other radioprotective measures. Europace 2018; 19:947-953. [PMID: 27256413 DOI: 10.1093/europace/euw139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 04/23/2016] [Indexed: 11/13/2022] Open
Abstract
Aims The population treated with cryoballoon (CB) ablation is relatively young, and radiation protection is of major importance. We aimed to demonstrate that radiation exposure can be markedly reduced by intracardiac echocardiography (ICE) and optimized settings of the X-ray system. Methods and results We analysed 100 patients undergoing CB pulmonary vein isolation (PVI) for treatment of paroxysmal atrial fibrillation. In 50 consecutive patients (25 male, 59 ± 13 years; Group 1), we used ICE, skipped PV angiography prior to CB inflation, and avoided fluoroscopy whenever possible. Furthermore, we reduced the frame rate, minimized distance between patient and detector, and consequently applied collimation. These patients were compared with 50 similar preceding patients in Group 2 (29 male, 61 ± 12 years). Total fluoroscopy time was reduced from 18 ± 6 min in Group 2 to 12 ± 5 min in Group 1 (P < 0.001). Moreover, the dose area product was significantly lower (1555 ± 1219 vs. 4935 ± 2094 cGycm2, P < 0.001), total freezing time was significantly shortened (1855 ± 399 vs. 2121 ± 756 s, P = 0.031), and contrast media use was significantly reduced (66 ± 25 vs. 109 ± 27 mL, P < 0.001). At the same time, total procedure duration and complication rates did not differ significantly between both groups. After a 12 months follow-up, a similar percentage of patients was free from recurrences (74% in Group 1 vs. 78% in Group 2, P = 0.640). Conclusion Radiation exposure in CB PVI can be markedly reduced without prolonging procedure times, affecting the outcome or complication rates. Moreover, ICE seems to shorten total freezing time.
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Affiliation(s)
- Vanessa Rubesch-Kütemeyer
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Stephan Molatta
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Jürgen Vogt
- Red Cross Hospital, Frankfurt am Main, Germany
| | - Klaus-Jürgen Gutleben
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
| | - Georg Nölker
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstr. 11, 32545 Bad Oeynhausen, Germany
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17
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Cone AK. The Role of Echocardiography in Determining the Method of Ablation for the Treatment of Paroxysmal Atrial Fibrillation: A Literature Review. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2018. [DOI: 10.1177/8756479318755672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Atrial fibrillation is the most common cardiac arrhythmia, affecting approximately 1 out of every 250 people. It is associated with thrombus formation in the left atrium, decreased cardiac output, and deterioration of the myocardium. There are multiple treatments available for paroxysmal atrial fibrillation. This literature review will assess the benefits, risks, and complications associated with radiofrequency ablation and cryoablation, which utilize heat and freezing mechanisms, respectively. The review will also assess the role of echocardiography in determining which treatment, if any, is appropriate for atrial fibrillation.
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18
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Murray MI, Arnold A, Younis M, Varghese S, Zeiher AM. Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials. Clin Res Cardiol 2018; 107:658-669. [DOI: 10.1007/s00392-018-1232-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/08/2018] [Indexed: 12/30/2022]
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19
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Lehrmann H, Jadidi AS, Minners J, Keyl C, Hochholzer W, Carrapatoso F, Trenk D, Weber R, Arentz T. Important reduction of the radiation dose for pulmonary vein isolation using a multimodal approach. Europace 2018; 20:279-287. [PMID: 28011800 DOI: 10.1093/europace/euw334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/29/2016] [Indexed: 11/14/2022] Open
Abstract
Aims The number of pulmonary vein isolation (PVI) ablation procedures is steadily increasing worldwide resulting in a substantial radiation exposure to patients and operators. The aim of our study was to reduce radiation exposure during these procedures to a critical amount without compromising patient safety. Methods and results First, we assessed radiation exposure for primary PVI procedures over time (2005-2015) at the University Heart Center Freiburg-Bad Krozingen. Second, we prospectively evaluated in 52 patients, the efficacy and safety of a novel radiation reduction program (particularly applying an enhanced fluoroscopy pulse dose-reduction and optimized 3D-mapping system use). In 2035 primary PVI procedures, radiation exposure, assessed as estimated effective dose (eED in mSv, dose area product * 0.002 * conversion factor for females), fluoroscopy-time, and procedure-time decreased significantly from 2005 to 2015 (e.g. eED decreased from 9.3 (interquartile range (IQR) 6.4-13.4) mSv to 0.9 (IQR 0.5-1.6) mSv, p for trend <0.001). Importantly, application of the enhanced radiation reduction program further reduced eED to 0.4 mSv (IQR 0.3-0.6, P < 0.001 vs. control), a value not significantly different from slow-pathway ablation procedures (P = 0.41). Multiple linear regression analysis identified the radiation reduction program as the only independent variable associated with a decrease in radiation exposure. Conclusion Radiation exposure during PVI decreased over the last decade and can further be reduced significantly by the implementation of an enhanced radiation reduction program.
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Affiliation(s)
- Heiko Lehrmann
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Amir S Jadidi
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Jan Minners
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Cornelius Keyl
- Department of Anesthesiology, University Heart Center Freiburg/Bad Krozingen, Südring 15, 79189, Bad Krozingen, Germany
| | - Willibald Hochholzer
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Filipe Carrapatoso
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Dietmar Trenk
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Reinhold Weber
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
| | - Thomas Arentz
- Department of Cardiology and Angiology II, University Heart Center Freiburg/Bad Krozingen, Bad Krozingen, Südring 15, 79189, Germany
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20
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Keçe F, Zeppenfeld K, Trines SA. The Impact of Advances in Atrial Fibrillation Ablation Devices on the Incidence and Prevention of Complications. Arrhythm Electrophysiol Rev 2018; 7:169-180. [PMID: 30416730 DOI: 10.15420/aer.2018.7.3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The number of patients with atrial fibrillation currently referred for catheter ablation is increasing. However, the number of trained operators and the capacity of many electrophysiology labs are limited. Accordingly, a steeper learning curve and technical advances for efficient and safe ablation are desirable. During the last decades several catheter-based ablation devices have been developed and adapted to improve not only lesion durability, but also safety profiles, to shorten procedure time and to reduce radiation exposure. The goal of this review is to summarise the reported incidence of complications, considering device-related specific aspects for point-by-point, multi-electrode and balloon-based devices for pulmonary vein isolation. Recent technical and procedural developments aimed at reducing procedural risks and complications rates will be reviewed. In addition, the impact of technical advances on procedural outcome, procedural length and radiation exposure will be discussed.
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Affiliation(s)
- Fehmi Keçe
- Department of Cardiology, Leiden University Medical Centre, University of Leiden Leiden, the Netherlands
| | - Katja Zeppenfeld
- Department of Cardiology, Leiden University Medical Centre, University of Leiden Leiden, the Netherlands
| | - Serge A Trines
- Department of Cardiology, Leiden University Medical Centre, University of Leiden Leiden, the Netherlands
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21
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Cosedis Nielsen J, Curtis AB, Davies DW, Day JD, d’Avila A, (Natasja) de Groot NMS, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 2018; 20:e1-e160. [PMID: 29016840 PMCID: PMC5834122 DOI: 10.1093/europace/eux274] [Citation(s) in RCA: 681] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Affiliation(s)
- Hugh Calkins
- From the Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George's University of London, London, United Kingdom
| | | | | | | | | | | | - D Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David's Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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22
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Boveda S. Cryoballoon ablation in atrial fibrillation: Advantages and drawbacks. Rev Port Cardiol 2017; 36 Suppl 1:19-24. [PMID: 29108897 DOI: 10.1016/j.repc.2017.09.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 08/18/2017] [Accepted: 09/11/2017] [Indexed: 11/15/2022] Open
Abstract
Pulmonary vein isolation is the cornerstone of atrial fibrillation ablation and is effective for preventing arrhythmias recurrences, especially in patients with paroxysmal atrial fibrillation. During the last years, cryoballoon ablation has emerged as an unquestionable alternative approach to radiofrequency ablation. Many non-randomized and randomized trials have proven undoubtedly that cryoballoon ablation displays similar efficacy and overall safety profile, when compared to radiofrequency ablation for the treatment of patients with drug-refractory paroxysmal atrial fibrillation. These results have been obtained in all types of pulmonary veins anatomical subsets, which confirms that there is no need to select patients according to the latter. The value of cryoablation in the setting of short persistent atrial fibrillation still needs more evidence. Importantly, cryoballoon ablation seems to be less operator-dependent and more reproducible than radiofrequency for the isolation of pulmonary veins.
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Affiliation(s)
- Serge Boveda
- Département de Rythmologie, Clinique Pasteur, Toulouse, France.
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23
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Cryoballoon ablation in atrial fibrillation: Advantages and drawbacks. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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24
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Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot N(N, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Heart Rhythm 2017; 14:e275-e444. [PMID: 28506916 PMCID: PMC6019327 DOI: 10.1016/j.hrthm.2017.05.012] [Citation(s) in RCA: 1339] [Impact Index Per Article: 191.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Hugh Calkins
- Johns Hopkins Medical Institutions, Baltimore, MD
| | | | - Riccardo Cappato
- Humanitas Research Hospital, Arrhythmias and Electrophysiology Research Center, Milan, Italy (Dr. Cappato is now with the Department of Biomedical Sciences, Humanitas University, Milan, Italy, and IRCCS, Humanitas Clinical and Research Center, Milan, Italy)
| | | | - Eduardo B. Saad
- Hospital Pro-Cardiaco and Hospital Samaritano, Botafogo, Rio de Janeiro, Brazil
| | | | | | - Vinay Badhwar
- West Virginia University School of Medicine, Morgantown, WV
| | - Josep Brugada
- Cardiovascular Institute, Hospital Clínic, University of Barcelona, Catalonia, Spain
| | - John Camm
- St. George’s University of London, London, United Kingdom
| | | | | | | | | | | | - D. Wyn Davies
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - John D. Day
- Intermountain Medical Center Heart Institute, Salt Lake City, UT
| | | | | | - Luigi Di Biase
- Albert Einstein College of Medicine, Montefiore-Einstein Center for Heart & Vascular Care, Bronx, NY
| | | | | | | | | | - Sabine Ernst
- Royal Brompton and Harefield NHS Foundation Trust, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Guilherme Fenelon
- Albert Einstein Jewish Hospital, Federal University of São Paulo, São Paulo, Brazil
| | | | | | | | | | - Elaine Hylek
- Boston University School of Medicine, Boston, MA
| | - Warren M. Jackman
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Jose Jalife
- University of Michigan, Ann Arbor, MI, the National Center for Cardiovascular Research Carlos III (CNIC) and CIBERCV, Madrid, Spain
| | - Jonathan M. Kalman
- Royal Melbourne Hospital and University of Melbourne, Melbourne, Australia
| | - Josef Kautzner
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Hans Kottkamp
- Hirslanden Hospital, Department of Electrophysiology, Zurich, Switzerland
| | | | | | - Richard Lee
- Saint Louis University Medical School, St. Louis, MO
| | - Thorsten Lewalter
- Department of Cardiology and Intensive Care, Hospital Munich-Thalkirchen, Munich, Germany
| | | | - Laurent Macle
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montréal, Canada
| | | | - Francis E. Marchlinski
- Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | - Hiroshi Nakagawa
- Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute, St. David’s Medical Center, Austin, TX
| | - Stanley Nattel
- Montreal Heart Institute and Université de Montréal, Montreal, Canada, McGill University, Montreal, Canada, and University Duisburg-Essen, Essen, Germany
| | - Ken Okumura
- Division of Cardiology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | | | - Evgeny Pokushalov
- State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | | | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | | | | | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino, IRCCS, Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | | | - Atul Verma
- Southlake Regional Health Centre, University of Toronto, Toronto, Canada
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25
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Efficacy and safety of cryoballoon ablation versus radiofrequency catheter ablation in atrial fibrillation: an updated meta-analysis. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2017; 13:240-249. [PMID: 29056997 PMCID: PMC5644043 DOI: 10.5114/aic.2017.70196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 04/19/2017] [Indexed: 11/17/2022] Open
Abstract
Introduction Cryoballoon ablation (CBA) and irrigated radiofrequency catheter ablation (RFCA) are the main treatments for drug-refractory symptomatic atrial fibrillation (AF). Aim To compare the efficacy and safety between CBA and RFCA for the treatment of AF. Material and methods We searched the Embase and Medline databases for clinical studies published up to December 2016. Studies that satisfied our predefined inclusion criteria were included. Results After searching through the literature in the two major databases, 20 studies with a total of 9,141 patients were included in our study. The CBA had a significantly shorter procedure time (weighted mean difference (WMD) –30.38 min; 95% CI: –46.43 to –14.33, p = 0.0002) and non-significantly shorter fluoroscopy time (WMD –3.18 min; 95% CI: –6.43 to 0.07, p = 0.06) compared with RFCA. There was no difference in freedom from AF between CBA and RFCA (CBA 78.55% vs. RFCA 83.13%, OR = 1.15, 95% CI: 0.95–1.39, p = 0.14). The CBA was associated with a high risk of procedure-related complications (CBA 9.02% vs. RFCA 6.56%, OR = 1.56, 95% CI: 1.05–2.31, p = 0.03), especially phrenic nerve paralysis (PNP, OR = 10.72, 95% CI: 5.59–20.55, p < 0.00001). The risk of pericardial effusions/cardiac tamponade was low in the CBA group (CBA 1.05% vs. RFCA 1.86%, OR = 0.62, 95% CI: 0.41–0.93, p = 0.02). Conclusions For AF, CBA was as effective as RFCA. However, CBA had a shorter procedure time and a non-significantly shorter fluoroscopy time, a significantly high risk of PNP and a low incidence of pericardial effusions/cardiac tamponade compared with RFCA.
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26
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WITHDRAWN: 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. J Arrhythm 2017. [DOI: 10.1016/j.joa.2017.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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27
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Zhou X, Lv W, Zhang W, Ye Y, Li Y, Zhou Q, Zhang J, Xing Q, Lu Y, Zhang L, Wang H, Qin W, Tang B. Comparative efficacy and safety of contact force-sensing catheter and second-generation cryoballoon ablation for atrial fibrillation: a meta-analysis. ACTA ACUST UNITED AC 2017; 50:e6409. [PMID: 28793059 PMCID: PMC5572854 DOI: 10.1590/1414-431x20176409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 05/23/2017] [Indexed: 11/21/2022]
Abstract
This meta-analysis compared the efficacy and safety of the contact force (CF)-sensing catheter and second-generation cryoballoon (CB) ablation for treating atrial fibrillation (AF). Six controlled clinical trials comparing ablation for AF using a CF-sensing catheter or second-generation CB were identified from PubMed, EMBASE, Cochrane Library, Wanfang Data, and China National Knowledge Infrastructure. The procedure duration was significantly lower in the CB group compared with that in the CF group [mean difference (MD)=29.4; 95%CI=17.84–40.96; P=0.01], whereas there was no difference between the groups for fluoroscopy duration (MD=0.59; 95%CI=–4.48–5.66; P=0.82). Moreover, there was no difference in the incidence of non-lethal complications (embolic event, tamponade, femoral/subclavian hematoma, arteriovenous fistula, pulmonary vein stenosis, phrenic nerve palsy, and esophageal injury) between the CB and the CF groups (8.38 vs 5.35%; RR=0.66; 95%CI=0.37–1.17; P=0.15). Transient phrenic nerve palsy occurred in 17 of 326 patients (5.2%) of the CB group vs none in the CF group (RR=0.12; 95%CI=0.03–0.43; P=0.001). A comparable proportion of patients in CF and CB groups suffered from AF recurrence during the 12-month follow-up after a single ablation procedure [risk ratio (RR)=1.03; 95%CI=0.78–1.35; P=0.84]. AF ablation using CF-sensing catheters and second-generation CB showed comparable fluoroscopy duration and efficacy (during a 12-month follow-up), with shorter procedure duration and different complications in the CB group.
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Affiliation(s)
- X Zhou
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - W Lv
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - W Zhang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Y Ye
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Y Li
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Q Zhou
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - J Zhang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Q Xing
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - Y Lu
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - L Zhang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - H Wang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
| | - W Qin
- Xinjiang Medical University, Urumqi, Xinjiang, China
| | - B Tang
- Pacing and Electrophysiological Department, the First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang, China
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Maurer T, Kuck KH. The quest for durable lesions in catheter ablation of atrial fibrillation - technological advances in radiofrequency catheters and balloon devices. Expert Rev Med Devices 2017; 14:621-631. [PMID: 28723304 DOI: 10.1080/17434440.2017.1358086] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Atrial fibrillation is the most common cardiac arrhythmia and represents a growing clinical, social and economic challenge. Catheter ablation for symptomatic atrial fibrillation has evolved from an experimental procedure into a widespread therapy and offers a safe and effective treatment option. A prerequisite for durable PVI are transmural and contiguous circumferential lesions around the pulmonary veins. However, electrical reconnection of initially isolated pulmonary veins remains a primary concern and is a dominant factor for arrhythmia recurrence during long-term follow up. Areas covered: This article discusses the physiology of lesion formation using radiofrequency-, cryo- or laser- energy for pulmonary vein isolation and provides a detailed review of recent technological advancements in the field of radiofrequency catheters and balloon devices. Finally, future directions and upcoming developments for the interventional treatment of atrial fibrillation are discussed. Expert commentary: Durable conduction block across deployed myocardial lesions is mandatory not only for PVI but for any other cardiac ablation strategy as well. A major improvement urgently expected is the intraprocedural real-time distinction of durable lesions from interposed gaps with only transiently impaired electrical conduction. Furthermore, a simplification of ablation tools used for PVI is required to reduce the high technical complexity of the procedure.
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Affiliation(s)
- Tilman Maurer
- a Department of Cardiology , Asklepios Klinik St. Georg , Hamburg , Germany
| | - Karl-Heinz Kuck
- a Department of Cardiology , Asklepios Klinik St. Georg , Hamburg , Germany
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Using anatomical landmark to avoid phrenic nerve injury during balloon-based procedures in atrial fibrillation patients. Surg Radiol Anat 2017; 39:1369-1375. [DOI: 10.1007/s00276-017-1895-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 11/07/2016] [Indexed: 11/26/2022]
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Velagić V, de Asmundis C, Mugnai G, Hünük B, Hacioğlu E, Ströker E, Moran D, Ruggiero D, Poelaert J, Verborgh C, Umbrain V, Paparella G, Beckers S, Brugada P, Chierchia GB. Learning curve using the second-generation cryoballoon ablation. J Cardiovasc Med (Hagerstown) 2017; 18:518-527. [DOI: 10.2459/jcm.0000000000000493] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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31
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Luik A, Kunzmann K, Hörmann P, Schmidt K, Radzewitz A, Bramlage P, Schenk T, Schymik G, Merkel M, Kieser M, Schmitt C. Cryoballoon vs. open irrigated radiofrequency ablation for paroxysmal atrial fibrillation: long-term FreezeAF outcomes. BMC Cardiovasc Disord 2017; 17:135. [PMID: 28545407 PMCID: PMC5445510 DOI: 10.1186/s12872-017-0566-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 05/11/2017] [Indexed: 11/10/2022] Open
Abstract
Background Effective treatment of paroxysmal atrial fibrillation (AF) is essential for reducing the risk of stroke and heart failure. Cryoballoon (CB) ablation has been developed as an alternative to the use of radiofrequency (RF) energy for electrical isolation of the pulmonary veins. Herein, we provide long-term data regarding the efficacy of CB ablation in comparison to RF. Methods FreezeAF was a randomised non-inferiority study comparing CB ablation with RF ablation for the treatment of patients with drug-refractory paroxysmal AF. Procedural success for the long-term follow-up (30 months) was defined as freedom from AF with an absence of persistent complications. Results Of the 315 patients that were randomised and received catheter ablation, 292 (92.7%) completed the 30-month follow-up (147 in the RF group and 145 in the CB group). The baseline characteristics of the RF and CB groups were similar. Single-procedure success was achieved by 40% of patients in the RF group and 42% of the CB group (p < 0.001 for non-inferiority). When including re-do procedures in the analysis, the multiple procedure success rate was 72% in the RF group and 76% in the CB group. Conclusion The data provide long-term evidence that CB ablation is non-inferior to RF ablation, with high proportions of patients reporting freedom from AF 30 months after the index procedure. Trial registration ClinicalTrials.gov Identifier: NCT00774566; first registered October 16, 2008; first patient included October 20, 2008.
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Affiliation(s)
- Armin Luik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany.
| | - Kevin Kunzmann
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Patrick Hörmann
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Kerstin Schmidt
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Andrea Radzewitz
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Mahlow, Germany
| | - Thomas Schenk
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Gerhard Schymik
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Matthias Merkel
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Claus Schmitt
- Medizinische Klinik IV, Städtisches Klinikum Karlsruhe, Academic Teaching Hospital of the University of Freiburg, Karlsruhe, Germany
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Garg J, Chaudhary R, Palaniswamy C, Shah N, Krishnamoorthy P, Bozorgnia B, Natale A. Cryoballoon versus Radiofrequency Ablation for Atrial Fibrillation: A Meta-analysis of 16 Clinical Trials. J Atr Fibrillation 2017; 9:1429. [PMID: 28496925 DOI: 10.4022/jafib.1429] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/10/2016] [Accepted: 08/24/2016] [Indexed: 11/10/2022]
Abstract
Introduction: We aimed to study the procedural characteristics, efficacy and safety of cryoballoon ablation (CBA) versus radiofrequency ablation (RFA) for catheter ablation of paroxysmal atrial fibrillation (AF). Methods: A systematic literature search was performed using PubMed, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials to clinical trials comparing CBA and RFA for AF. Outcomes were evaluated for efficacy, procedure characteristics and safety. For each study, odd ratio (OR) and 95% confidence intervals (CIs) were calculated for endpoints for both approaches. Results: We analyzed a total of 9,957 participants (3,369 in the CBA and 6,588 in RFA group) enrolled in 16 clinical trials. No significant difference was observed between CBA and RFA with regards to freedom from atrial arrhythmia at 12-months, recurrent atrial arrhythmias or repeat catheter ablation. CBA group had a significantly higher transient phrenic nerve injury (OR 14.19, 95% CI: 6.92-29.10; p<0.001) and persistent phrenic nerve injury (OR 4.62, 95% CI: 1.97-10.81; p<0.001); and a significantly lower pericardial effusion/cardiac tamponade (OR 0.43, 95% CI: 0.26-0.72; p=0.001), and groin site complications (OR 0.60, 95% CI: 0.38-0.93; p=0.02). No significant difference was observed in overall complications, stroke/thromboembolic events, major bleeding, and minor bleeding. Conclusion: CBA was non-inferior to RFA for catheter ablation of paroxysmal AF. RF ablation was associated with a higher groin complications and pericardial effusion/cardiac tamponade, whereas CBA was associated with higher rates of transient and persistent phrenic nerve injury.
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Affiliation(s)
- Jalaj Garg
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Rahul Chaudhary
- Department of Medicine, Sinai Hospital of Baltimore, Johns Hopkins University, Baltimore, MD
| | | | - Neeraj Shah
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | | | - Babak Bozorgnia
- Division of Cardiology, Lehigh Valley Health Network, Allentown, PA
| | - Andrea Natale
- Texas Cardiac Arrhythmia Institute at St. David's Medical Center, Austin, TX
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Reissmann B, Metzner A, Kuck KH. Cryoballoon ablation versus radiofrequency ablation for atrial fibrillation. Trends Cardiovasc Med 2017; 27:271-277. [DOI: 10.1016/j.tcm.2016.12.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/13/2016] [Accepted: 12/13/2016] [Indexed: 12/17/2022]
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Miyamoto K, Doi A, Amaya N, Morita Y, Noda T, Asakura M, Hamasaki T, Tada H, Takagi M, Yasuda S, Kusano K. A multicenter study of the need of additional freezing for cryoballoon ablation in patients with atrial fibrillation: The AD-Balloon study. J Arrhythm 2017; 33:81-85. [PMID: 28416971 PMCID: PMC5388036 DOI: 10.1016/j.joa.2016.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 06/14/2016] [Accepted: 06/27/2016] [Indexed: 11/14/2022] Open
Abstract
Background Pulmonary vein isolation (PVI) is a cornerstone of catheter ablation in patients with paroxysmal atrial fibrillation (PAF), and balloon-based ablation has been recently performed worldwide. Ablation using the second-generation cryoballoon (CB2) (Arctic Front AdvanceTM, Medtronic, MN, USA) is useful for PVI; however, there is some debate concerning the optimal freezing time and number of cycles after PVI is achieved. Methods The AD-Balloon study was designed as a prospective, multicenter, randomized clinical trial to evaluate the optimal strategy (freezing cycles) of CB2 ablation (UMIN Clinical Trials Registry UMIN000020130). The main objective of this study is to investigate the need for an additional freezing cycle after PVI in patients treated with CB2 ablation. Patients will be randomly assigned in a 1:1 ratio to treatment with additional freezing (AD group) or without additional freezing (non-AD group). In the AD group, 3 min of additional freezing time will be applied in all pulmonary veins after PVI is confirmed at the previous freezing cycle. In the non-AD group, no additional freezing will be applied in all pulmonary veins after PVI is confirmed. The primary endpoint of this study is the occurrence of atrial tachyarrhythmias within a 1-year follow-up period. We will enroll 110 consecutive patients with PAF. We will also investigate the usefulness of delayed-enhancement magnetic resonance imaging to assess the ablation lesions caused by CB2 ablation. Results The results of this study are currently under investigation. Conclusion The AD-Balloon study would assess the need for an additional freezing cycle after PVI is achieved. Our findings may contribute to further improvement of the CB2 ablation procedure.
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Affiliation(s)
- Koji Miyamoto
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Atsushi Doi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-5-7, Asahi-machi, Abeno-ku, Osaka 545-8586, Japan
| | - Naoki Amaya
- Department of Cardiovascular Medicine, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Takashi Noda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Masanori Asakura
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Toshimitsu Hamasaki
- Department of Data Science, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, University of Fukui, 23-3, Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui 910-1193, Japan
| | - Masahiko Takagi
- Department of Cardiovascular Medicine, Osaka City University Graduate School of Medicine, 1-5-7, Asahi-machi, Abeno-ku, Osaka 545-8586, Japan
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
| | - Kengo Kusano
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1, Fujishiro-dai, Suita, Osaka 565-8565, Japan
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East C, Phan T, Filardo G, Franklin J, Donsky A, Wheelan KR, Kowal RC. Repeat ablation and hospitalization following cryoballoon ablation of atrial fibrillation at a single tertiary medical center. Proc (Bayl Univ Med Cent) 2017; 30:3-6. [PMID: 28127119 DOI: 10.1080/08998280.2017.11929511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Cryoablation for atrial fibrillation (AF) has rapidly become a mainstream treatment for AF. In this report, 163 patients who had undergone a cryoablation procedure at one clinical center were contacted by telephone 33.1 ± 3.3 months after the procedure. All patients had received cryoablation of the pulmonary vein ostia, although concomitant procedures were performed at the same time in over 50% of the patients, including radiofrequency and/or cryoablation of other areas of the left atrium. Freedom from a repeat ablation procedure was 87%, while freedom from recurrent hospitalization for AF was 89%, as compared to previous reports of 65%. Of the 13 patients who had a repeat ablation procedure, only one was found to have a reconnection of pulmonary veins, while 4 were found to have atrial flutter. Cryoablation for AF produces a durable result in most patients out to 3 years with better outcomes than previously reported.
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Affiliation(s)
- Cara East
- Baylor Soltero Cardiovascular Research Center (East), Baylor Jack and Jane Hamilton Heart and Vascular Hospital (East, Franklin, Donsky, Wheelan, Kowal), and Baylor Scott & White Health Care System (East, Phan, Filardo, Franklin, Donsky, Wheelan, Kowal), Dallas, Texas
| | - Teresa Phan
- Baylor Soltero Cardiovascular Research Center (East), Baylor Jack and Jane Hamilton Heart and Vascular Hospital (East, Franklin, Donsky, Wheelan, Kowal), and Baylor Scott & White Health Care System (East, Phan, Filardo, Franklin, Donsky, Wheelan, Kowal), Dallas, Texas
| | - Giovanni Filardo
- Baylor Soltero Cardiovascular Research Center (East), Baylor Jack and Jane Hamilton Heart and Vascular Hospital (East, Franklin, Donsky, Wheelan, Kowal), and Baylor Scott & White Health Care System (East, Phan, Filardo, Franklin, Donsky, Wheelan, Kowal), Dallas, Texas
| | - Jay Franklin
- Baylor Soltero Cardiovascular Research Center (East), Baylor Jack and Jane Hamilton Heart and Vascular Hospital (East, Franklin, Donsky, Wheelan, Kowal), and Baylor Scott & White Health Care System (East, Phan, Filardo, Franklin, Donsky, Wheelan, Kowal), Dallas, Texas
| | - Alan Donsky
- Baylor Soltero Cardiovascular Research Center (East), Baylor Jack and Jane Hamilton Heart and Vascular Hospital (East, Franklin, Donsky, Wheelan, Kowal), and Baylor Scott & White Health Care System (East, Phan, Filardo, Franklin, Donsky, Wheelan, Kowal), Dallas, Texas
| | - Kevin R Wheelan
- Baylor Soltero Cardiovascular Research Center (East), Baylor Jack and Jane Hamilton Heart and Vascular Hospital (East, Franklin, Donsky, Wheelan, Kowal), and Baylor Scott & White Health Care System (East, Phan, Filardo, Franklin, Donsky, Wheelan, Kowal), Dallas, Texas
| | - Robert C Kowal
- Baylor Soltero Cardiovascular Research Center (East), Baylor Jack and Jane Hamilton Heart and Vascular Hospital (East, Franklin, Donsky, Wheelan, Kowal), and Baylor Scott & White Health Care System (East, Phan, Filardo, Franklin, Donsky, Wheelan, Kowal), Dallas, Texas
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Chen YH, Lu ZY, Xiang Y, Hou JW, Wang Q, Lin H, Li YG. Cryoablation vs. radiofrequency ablation for treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis. Europace 2017; 19:784-794. [DOI: 10.1093/europace/euw330] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 09/19/2016] [Indexed: 12/31/2022] Open
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Chen CF, Gao XF, Duan X, Chen B, Liu XH, Xu YZ. Comparison of catheter ablation for paroxysmal atrial fibrillation between cryoballoon and radiofrequency: a meta-analysis. J Interv Card Electrophysiol 2017; 48:351-366. [DOI: 10.1007/s10840-016-0220-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/19/2016] [Indexed: 12/13/2022]
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Kocyigit D, Canpolat U, Aytemir K. Who Needs Catheter Ablation And Which Approach? J Atr Fibrillation 2016; 8:1335. [PMID: 27957233 DOI: 10.4022/jafib.1335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 09/29/2015] [Accepted: 09/29/2015] [Indexed: 12/29/2022]
Abstract
Catheter ablation therapy for atrial fibrillation (AF) has gained a significant role during maintenance of sinus rhythm compared to anti-arrhythmic medication. Catheter ablation techniques are also improved and progressed over years in parallel to better understanding of disease mechanisms and technological advancements. However, due to invasive nature of the therapy with its pertinent procedural risks, both appropriate patient selection and use of relevant approach should be considered by all electrophysiologists before decide to perform catheter ablation.
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Affiliation(s)
- Duygu Kocyigit
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ugur Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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WASSERLAUF JEREMIAH, KNIGHT BRADLEYP, LI ZHI, ANDREI ADINCRISTIAN, ARORA RISHI, CHICOS ALEXANDRUB, GOLDBERGER JEFFREYJ, KIM SUSANS, LIN ALBERTC, VERMA NISHANT, BOHN MARTHAM, PASSMAN RODS. Moderate Sedation Reduces Lab Time Compared to General Anesthesia during Cryoballoon Ablation for AF Without Compromising Safety or Long-Term Efficacy. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:1359-1365. [DOI: 10.1111/pace.12961] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 08/10/2016] [Accepted: 08/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- JEREMIAH WASSERLAUF
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - BRADLEY P. KNIGHT
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - ZHI LI
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - ADIN-CRISTIAN ANDREI
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - RISHI ARORA
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - ALEXANDRU B. CHICOS
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - JEFFREY J. GOLDBERGER
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - SUSAN S. KIM
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - ALBERT C. LIN
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - NISHANT VERMA
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - MARTHA M. BOHN
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - ROD S. PASSMAN
- Division of Cardiology, Feinberg School of Medicine; Northwestern University; Chicago Illinois
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Jiang J, Li J, Zhong G, Jiang J. Efficacy and safety of the second-generation cryoballoons versus radiofrequency ablation for the treatment of paroxysmal atrial fibrillation: a systematic review and meta-analysis. J Interv Card Electrophysiol 2016; 48:69-79. [DOI: 10.1007/s10840-016-0191-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/16/2016] [Indexed: 12/29/2022]
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CARDOSO RHANDERSON, MENDIRICHAGA RODRIGO, FERNANDES GILSON, HEALY CHRIS, LAMBRAKOS LITSAK, VILES-GONZALEZ JUANF, GOLDBERGER JEFFREYJ, MITRANI RAULD. Cryoballoon versus Radiofrequency Catheter Ablation in Atrial Fibrillation: A Meta-Analysis. J Cardiovasc Electrophysiol 2016; 27:1151-1159. [DOI: 10.1111/jce.13047] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 06/17/2016] [Accepted: 07/05/2016] [Indexed: 01/15/2023]
Affiliation(s)
- RHANDERSON CARDOSO
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - RODRIGO MENDIRICHAGA
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - GILSON FERNANDES
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - CHRIS HEALY
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - LITSA K. LAMBRAKOS
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - JUAN F. VILES-GONZALEZ
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - JEFFREY J. GOLDBERGER
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
| | - RAUL D. MITRANI
- Division of Cardiology, Department of Medicine; University of Miami, Jackson Memorial Hospital; Miami Florida USA
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Kurzendorfer T, Mewes PW, Maier A, Strobel N, Brost A. Cryo-Balloon Catheter Localization Based on a Support-Vector-Machine Approach. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:1892-1902. [PMID: 26978663 DOI: 10.1109/tmi.2016.2537052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Cryo-balloon catheters have attracted an increasing amount of interest in the medical community as they can reduce patient risk during left atrial pulmonary vein ablation procedures. As cryo-balloon catheters are not equipped with electrodes, they cannot be localized automatically by electro-anatomical mapping systems. As a consequence, X-ray fluoroscopy has remained an important means for guidance during the procedure. Most recently, image guidance methods for fluoroscopy-based procedures have been proposed, but they provide only limited support for cryo-balloon catheters and require significant user interaction. To improve this situation, we propose a novel method for automatic cryo-balloon catheter detection in fluoroscopic images by detecting the cryo-balloon catheter's built-in X-ray marker. Our approach is based on a blob detection algorithm to find possible X-ray marker candidates. Several of these candidates are then excluded using prior knowledge. For the remaining candidates, several catheter specific features are introduced. They are processed using a machine learning approach to arrive at the final X-ray marker position. Our method was evaluated on 75 biplane fluoroscopy images from 40 patients, from two sites, acquired with a biplane angiography system. The method yielded a success rate of 99.0% in plane A and 90.6% in plane B, respectively. The detection achieved an accuracy of 1.00 mm±0.82 mm in plane A and 1.13 mm±0.24 mm in plane B. The localization in 3-D was associated with an average error of 0.36 mm±0.86 mm.
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LIU XIAOHUA, CHEN CHAOFENG, GAO XIAOFEI, XU YIZHOU. Safety and Efficacy of Different Catheter Ablations for Atrial Fibrillation: A Systematic Review and Meta-Analysis. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2016; 39:883-99. [PMID: 27197002 DOI: 10.1111/pace.12889] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 04/25/2016] [Accepted: 04/30/2016] [Indexed: 12/30/2022]
Affiliation(s)
- XIAO-HUA LIU
- Hangzhou Hospital of Zhejiang Chinese Medical University; Shangcheng District Hangzhou City Zhejiang Province China
| | - CHAO-FENG CHEN
- Department of Cardiology; Hangzhou Hospital of Nanjing Medical University; Shangcheng District Hangzhou City Zhejiang Province China
| | - XIAO-FEI GAO
- Hangzhou Hospital of Zhejiang Chinese Medical University; Shangcheng District Hangzhou City Zhejiang Province China
| | - YI-ZHOU XU
- Department of Cardiology; Hangzhou Hospital of Nanjing Medical University; Shangcheng District Hangzhou City Zhejiang Province China
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Antolič B, Pernat A, Cvijić M, Žižek D, Jan M, Šinkovec M. Radiofrequency catheter ablation versus balloon cryoablation of atrial fibrillation: markers of myocardial damage, inflammation, and thrombogenesis. Wien Klin Wochenschr 2016; 128:480-7. [DOI: 10.1007/s00508-016-1002-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 03/21/2016] [Indexed: 11/30/2022]
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Providencia R, Defaye P, Lambiase PD, Pavin D, Cebron JP, Halimi F, Anselme F, Srinivasan N, Albenque JP, Boveda S. Results from a multicentre comparison of cryoballoon vs. radiofrequency ablation for paroxysmal atrial fibrillation: is cryoablation more reproducible? Europace 2016; 19:48-57. [PMID: 27267554 DOI: 10.1093/europace/euw080] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 02/24/2016] [Indexed: 11/13/2022] Open
Abstract
AIM Cryoballoon ablation (Cryoballoon) has emerged as a new alternative for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Whether the results of Cryoballoon are more reproducible than those of radiofrequency (RF) ablation remains to be proved. METHODS AND RESULTS A total of 860 consecutive patients undergoing a first ablation procedure for paroxysmal AF (467 treated with RF and 393 treated with Cryoballoon) were selected from a prospective multicentre survey of AF ablation (FrenchAF). Radiofrequency and Cryoballoon were compared regarding mid-term efficacy and safety. During a median follow-up of 14 months (interquartile range 8-23), patients treated with Cryoballoon displayed similar rates of freedom from atrial arrhythmia relapse in centres performing this technique (68-80% at 18 months). However, in centres performing RF, a greater heterogeneity in procedural results was observed (46-79% were free from atrial arrhythmia relapse at 18 months). On multivariate analysis, Cryoballoon (HR = 0.47, 95% CI 0.35-0.65, P < 0.001) and annual AF ablation caseload (HR = 0.87 per every 100 AF ablation procedures per year; 95% CI 0.80-0.96, P = 0.003) were independent predictors of procedural success. However, on sensitivity analysis, according to the ablation method, annual AF ablation caseload predicted only sinus rhythm maintenance in the subgroup of patients treated with RF. Analysis of interoperator results with Cryoballoon and RF confirmed lower reproducibility of RF, but suggested that besides caseload, other operator-related factors may play a role. CONCLUSION Cryoballoon seems to be less operator-dependent and more reproducible than RF in the setting of paroxysmal AF ablation.
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Affiliation(s)
- Rui Providencia
- Département de Rythmologie, Clinic Pasteur of Toulouse, 45 avenue de Lombez, BP 27617, Toulouse Cedex 3 31076, France .,Barts Health NHS Trust, London, UK
| | | | | | | | | | | | | | | | - Jean-Paul Albenque
- Département de Rythmologie, Clinic Pasteur of Toulouse, 45 avenue de Lombez, BP 27617, Toulouse Cedex 3 31076, France
| | - Serge Boveda
- Département de Rythmologie, Clinic Pasteur of Toulouse, 45 avenue de Lombez, BP 27617, Toulouse Cedex 3 31076, France
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Kabunga P, Phan K, Ha H, Sy RW. Meta-Analysis of Contemporary Atrial Fibrillation Ablation Strategies. JACC Clin Electrophysiol 2016; 2:377-390. [DOI: 10.1016/j.jacep.2015.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/01/2015] [Accepted: 12/27/2015] [Indexed: 12/21/2022]
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Two-Year Follow-Up after Contact Force Sensing Radiofrequency Catheter and Second-Generation Cryoballoon Ablation for Paroxysmal Atrial Fibrillation: A Comparative Single Centre Study. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6495753. [PMID: 27314032 PMCID: PMC4893449 DOI: 10.1155/2016/6495753] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 04/19/2016] [Accepted: 05/03/2016] [Indexed: 12/15/2022]
Abstract
Background. There are little comparative data on catheter ablation of paroxysmal atrial fibrillation (AF) using the contact force radiofrequency (CF-RF) catheter versus the second-generation cryoballoon (CB2). Methods and results. This is a single center, retrospective, nonrandomized study of 98 patients with symptomatic, drug-refractory paroxysmal AF who underwent their first PVI ablation using either the CB2 (n = 40) or CF-RF (n = 58). The mean age was 60 years with 63% men, a mean LA size of 42 mm. The procedure duration (74 ± 17 versus 120 ± 49 minutes p < 0.05) was shorter for CB2 group; the fluoroscopy time (14 ± 17 versus 16 ± 5 minutes, p = 0.45) was similar. Complete PVI was achieved in 96% of patients with RF-CF and 98% with CB2. Phrenic nerve palsies (2 transient and 1 persistent) occurred exclusively in the CB2 group and 1 severe, nonlethal complication (pericardial tamponade) occurred in the CF-RF group. At 24-month follow-up, the success rate, defined as freedom from AF/atrial tachycardia (AT) after a single procedure without antiarrhythmic drug, was comparable in CF-RF group and CB2 group (65.5% versus 67%, resp., log rank p = 0.54). Conclusion. Both the CB2 and the RF-CF ablation appeared safe; the success rate at 2 years was comparable between both technologies.
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48
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Outcomes after cryoballoon or radiofrequency ablation for persistent atrial fibrillation: a multicentric propensity-score matched study. J Interv Card Electrophysiol 2016; 47:133-142. [DOI: 10.1007/s10840-016-0138-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 04/20/2016] [Indexed: 11/27/2022]
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Chan NY. Catheter ablation of peri-nodal and pulmonary veno-atrial substrates: should it be cool? Europace 2016; 17 Suppl 2:ii19-30. [DOI: 10.1093/europace/euv230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Ströker E, de Asmundis C, Saitoh Y, Velagić V, Mugnai G, Irfan G, Hünük B, Tanaka K, Belsack D, Buyl R, Brugada P, Chierchia GB. Anatomic predictors of phrenic nerve injury in the setting of pulmonary vein isolation using the 28-mm second-generation cryoballoon. Heart Rhythm 2016; 13:342-51. [DOI: 10.1016/j.hrthm.2015.10.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Indexed: 10/22/2022]
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