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Babak A, Kauffman CB, Lynady C, McClellan R, Venkatachalam K, Kusumoto F. Pulmonary vein capture is a predictor for long-term success of stand-alone pulmonary vein isolation with cryoballoon ablation in patients with persistent atrial fibrillation. Front Cardiovasc Med 2024; 10:1150378. [PMID: 38410505 PMCID: PMC10895012 DOI: 10.3389/fcvm.2023.1150378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 11/29/2023] [Indexed: 02/28/2024] Open
Abstract
Background The mechanisms of AF development and progression are still not completely understood. Despite the relative efficacy of ablation, the risk of AF recurrence is substantial, particularly in patients with persistent AF (perAF). At present we do not have any reliable intra-procedural electrophysiologic predictors of long-term success of AF ablation other than pulmonary vein isolation. We evaluated selected intraprocedural pulmonary vein characteristics that may be helpful in future guidance of persistent AF ablation. Methods 390 consecutive procedures using cryoballoon for initial AF ablation were divided by clinical presentation (paroxysmal or persistent AF), and by pulmonary vein (PV) response to pacing after completion of ablation (discrete electrogram elicited with pacing-"PV capture" or not-"Control"). Patients were followed (median 20 months) for recurrent atrial arrhythmias as the primary end point of the study. Results PV capture was identified in 20.3% and 17.1% and patients with paroxysmal and persistent AF respectively (ns). In patients with persistent AF presence of PV capture was associated with significantly better outcomes compared to patients without PV capture (p < 0.001). In the group "persistent AF and PV capture", an initial strategy of PV isolation and reisolation of the PVs (without additional lesions) for patients with recurrent atrial arrhythmias resulted in 20/23 (87%) patients in sinus rhythm off antiarrhythmic medications at study completion. In patients with paroxysmal AF, PV capture was not associated with outcome benefits. Specific electrophysiologic characteristics of PV (PV capture cycle length: PVCCL) did not have an impact on AF recurrence, although 25% shortening of PVCCL was observed after 60 s periods of pacing at short cycle lengths. No background demographic patient characteristic differences were identified between patients with vs. without PV capture. Conclusion The presence of PV capture was associated with better outcomes in patients with persistent AF. PV capture may identify those patients with persistent AF in whom cryoballoon PV isolation alone is sufficient as an initial ablation procedure and as the primary ablation strategy for recurrent AF.
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Affiliation(s)
- Alexey Babak
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL, United States
- School of Medicine, Emory University, Atlanta, GA, United States
| | | | - Cynthia Lynady
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Reginald McClellan
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Kalpathi Venkatachalam
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL, United States
| | - Fred Kusumoto
- Department of Cardiovascular Medicine, Mayo Clinic Florida, Jacksonville, FL, United States
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Tijskens M, Abugattas JP, Thoen H, Strazdas A, Schwagten B, Wolf M, De Greef Y. Adding Electroanatomical Mapping to Cryoballoon Pulmonary Vein Isolation Improves 1-Year Clinical Outcome and Durability of Pulmonary Vein Isolation: A Propensity Score-Matched Analysis. J Cardiovasc Dev Dis 2024; 11:57. [PMID: 38392271 PMCID: PMC10889252 DOI: 10.3390/jcdd11020057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/28/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
Background: Adding electroanatomical left atrial (LA) voltage mapping to cryoballoon ablation (CBA) improves validation of acute pulmonary vein isolation (PVI). Aims: To determine whether the addition of mapping can improve outcome and PVI durability. Methods: One-year outcome and PV reconnection (PVR) rate at first repeat ablation were studied in 400 AF patients in a propensity-matched analysis (age, AF type, CHA2DS2-VASc score) between Achieve catheter-guided CBA with additional EnSite LA voltage maps performed pre- and post-CBA (mapping group; N = 200) and CT- and Achieve catheter-guided CBA (control group; N = 200). Clinical success was defined as freedom of documented AF or atrial tachycardia (AT) > 30 s. PV reconnection patterns were characterized in repeat ablations. Results: At 1 year, 77 (19.25%) patients had recurrence of AF/AT, significantly lower than in the mapping group: 21 (10.5%) vs. 56 (28%), p < 0.001. Procedure time was shorter (72.2 ± 25.4 vs. 78.2 ± 29.3 min, p = 0.034) and radiation exposure lower (4465.0 ± 3454.6 Gy.cm2 vs. 5940.5 ± 4290.5 Gy.cm2, p = 0.037). Use of mapping was protective towards AF/AT recurrence (HR = 0.348; 95% CI 0.210-0.579; p < 0.001), independent of persistent AF type (HR = 1.723; 95% CI 1.034-2.872; p = 0.037), and LA diameter (HR = 1.055; 95% CI 1.015-1.096; p = 0.006). At repeat ablation (N = 90), persistent complete PVI was seen in 14/20 (70.0%) versus 23/70 (32.9%) in the mapping and conventional group, respectively (p = 0.03). Reconnection rate of the right inferior PV was lower with mapping (10.0% vs. 34,3%, p = 0.035). Conclusions: Adding electroanatomical LA voltage mapping to CBA improves 1-year clinical outcome and lowers both procedure time and radiation exposure. At repeat, use of mapping increases complete persistent PVI mainly by improving PVI durability of the RIPV.
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Affiliation(s)
- Maxime Tijskens
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- AZ Rivierenland Hospital, 2840 Bornem, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | | | - Hendrik Thoen
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | - Antanas Strazdas
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | - Bruno Schwagten
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
| | - Michael Wolf
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
| | - Yves De Greef
- Department of Cardiology, ZNA Heart Centre Middelheim, 2020 Antwerp, Belgium
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, European Reference Networks Guard-Heart, 1050 Brussels, Belgium
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3
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De Greef Y, Sofianos D, Tijskens M, Schwagten B, Wolf M, Buysschaert I, Abugattas JP. The absence of real-time pulmonary vein isolation during cryoballoon ablation is associated with atrial fibrillation recurrence and pulmonary vein reconnection : Insights from the Middelheim-PVI Registry 2. J Interv Card Electrophysiol 2023; 66:2091-2101. [PMID: 37067765 DOI: 10.1007/s10840-023-01538-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 03/24/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Absence of real-time pulmonary vein (PV) isolation (PVI) occurring in 15-40% of PVs during cryoballoon ablation (CBA) of atrial fibrillation (AF) raises doubt about adequate PVI. Aim of the present study is to determine whether real-time PVI during CBA is predictive of long-term clinical outcome and durability of PVI. METHODS Eight hundred three AF patients (64 ± 10 years, 68% males) undergoing CBA were studied. The cohort was divided in 4 groups according to the number of PVs without real-time PVI: none (N = 252 [31.4%]), 1 (N = 255 [31.8%]), 2 (N = 159 [19.8%]), and 3-4 (N = 137 [17.1]). RESULTS At 3 years, 279 (34.7%) patients had recurrence of AF of which 188 underwent repeat ablation. A vein without real-time PVI was associated with AF recurrence (HR = 1.275; 95% CI 1.134-1.433; p < 0.01), independent of persistent AF type (HR = 2.075; 95% CI 1.584-2.738; p < 0.01), left atrial diameter (HR = 1.050; 95% CI 1.028-1.072; p < 0.01), and diagnosis-to-ablation time (HR = 1.002; 95% CI 1.000-1.005; p = 0.04). Highest success was achieved with present real-time PVI in all veins (77.4%), gradually decreasing per increasing number of absent real-time PVI: 66.3% for 1 vein, 58.5% for 2, and 48.9% for 3-4 veins (p < 0.001). At repeat ablation (N = 188), PV reconnection was seen in 99/430 (23.0%) versus 83/288 (28.8%) veins with and without real-time PVI, respectively (p = 0.08). Right inferior PVs (RIPVs) with real-time PVI were less reconnected than RIPVs without real-time PVI: 29.7% versus 43.7% (p = 0.047). CONCLUSION The absence of real-time PVI during CBA independently predicts AF recurrence with a 30% gradual decrease in outcome per increase in veins without real-time PVI. Real-time PVI is particularly important for the RIPV to achieve durable PVI.
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Affiliation(s)
- Y De Greef
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium.
- Heart Rhythm Management Centre, University Hospital Brussels, Brussels, Belgium.
| | - D Sofianos
- Cardiology Department, European Interbalkan Medical Center, Thessaloniki, Greece
| | - M Tijskens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | - B Schwagten
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | - M Wolf
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | - I Buysschaert
- Department of Cardiology, Heart Centre AZ Sint Jan, Brugge, Belgium
| | - J P Abugattas
- Department of Cardiology, ULB Erasmus Hospital, Brussels, Belgium
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4
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De Greef Y, Tijskens M, De Torres JPA, Sofianos D, Cecchini F, De Schouwer K, De Cocker J, Buysschaert I, Varnavas V, Wolf M. Electroanatomical mapping improves procedural outcomes of cryoballoon pulmonary vein isolation (the Achieve Plus study). J Interv Card Electrophysiol 2023; 66:923-930. [PMID: 36210397 DOI: 10.1007/s10840-022-01384-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Validation of pulmonary vein (PV) isolation (PVI) using only the Achieve catheter following cryoballoon ablation (CBA) is imperfect since pulmonary vein potentials (PVP) can be recorded in only 50-85% of the veins and residual PVP are found in up to 4.3-7.6% of the isolated veins in remapping studies. OBJECTIVE To study if addition of electroanatomical mapping to Achieve catheter-guided CBA is superior for PVI. METHODS One hundred patients were randomized between Achieve catheter-guided CBA (control group; N = 50) and Achieve catheter-guided CBA with additional EnSite voltage maps performed pre- and post-CBA (Achieve Plus group; N = 50). Confirmation of PVI was done by circular mapping catheter (CMC) and EnSite mapping by a second blinded operator. RESULTS Despite apparent PVI in all PVs after CBA, incomplete PVI was present in 0 out of 50 patients (0%) and 0 out of 204 PVs in the Achieve Plus group versus 6 patients out of 50 (12%; P = 0.012) and 6 out of 203 PVs (3%; P = 0.013) in the control group. All 6 non-isolated PVs could be successfully isolated by additional cryoapplications. Procedure time was longer in the Achieve Plus group (75.76 ± 21.65 vs 66.06 ± 16.83 min; P = 0.014) with equal fluoroscopy times (14.85 ± 6.41 vs 14.33 ± 8.55; P = 0.732). CONCLUSION The addition of electroanatomical EnSite mapping to the Achieve catheter improves the PVI rate of CBA and could be considered for future use. Design and Results of the Achieve Plus study. The Achieve Plus study shows that the addition of electro-anatomical EnSite mapping to the Achieve catheter improves PVI rate of CBA and could be considered for future use. See text for further explanation. ABBREVIATIONS CBA: cryoballoon ablation; PVI: pulmonary vein isolation.
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Affiliation(s)
- Yves De Greef
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium.
- Heart Rhythm Management Centre, University Hospital Brussels, Brussels, Belgium.
| | - M Tijskens
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | | | - D Sofianos
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
- Heart Rhythm Management Centre, University Hospital Brussels, Brussels, Belgium
| | - F Cecchini
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
- Heart Rhythm Management Centre, University Hospital Brussels, Brussels, Belgium
| | - K De Schouwer
- Department of Cardiology, OLV Hospital Alost, Aalst, Belgium
| | - J De Cocker
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
| | - I Buysschaert
- Department of Cardiology, Heart Centre AZ Sint Jan, Brugge, Belgium
| | - V Varnavas
- Department of Cardiology, University Hospital Saint-Luc UCL, Brussels, Belgium
| | - M Wolf
- Department of Cardiology, ZNA Heart Centre, Lindendreef 1, 2020, Antwerp, Belgium
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Bordignon S, Chen S, Bologna F, Thohoku S, Urbanek L, Willems F, Zanchi S, Bianchini L, Trolese L, Konstantinou A, Fuernkranz A, Schmidt B, Chun JKR. Optimizing cryoballoon pulmonary vein isolation: lessons from >1000 procedures- the Frankfurt approach. Europace 2021; 23:868-877. [PMID: 33458770 DOI: 10.1093/europace/euaa406] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022] Open
Abstract
AIMS Cryoballoon (CB) pulmonary vein isolation (PVI) is an accepted ablation strategy for rhythm control in atrial fibrillation (AF). We describe efficacy and safety in a high volume centre with a long experience in the use of the second-generation CB (CB2). METHODS AND RESULTS Consecutive paroxysmal AF (PAF) or persistent AF (persAF) patients undergoing CB2-PVI were enrolled. Procedural data, efficacy, and safety issues were systematically collected. The 28 mm CB2 was used in combination with an inner lumen spiral catheter, a luminal oesophageal temperature (LET) probe was used with a cut-off of 15°C, the phrenic nerve (PN) monitored during septal PVs ablation. Freeze duration was mainly set at 240 s with a bonus application in case of delayed time-to-isolation (TTI > 75 s). A total of 1017 CB2 procedures were analysed (58% male, 66 ± 12 years old, 70% with PAF). 3964 PVs were identified, 99.8% PVs isolated using solely the 28 mm CB. Mean procedure time was 69 ± 25 min, TTI during the first application was recorded in 77% of PVs after a mean of 48 ± 31 s. We recorded 0.2% cardiac tamponade, 4.8% PN injury (1.6% of PN palsy), and 19% of LET < 15°C. Among 725 patients with follow-up data, 84% with PAF and 75% with persAF were in stable SR at 1 year. Shorter freezing duration and longer TTI were procedural predictors for recurrence. CONCLUSION Cryoballoon procedures are fast and associated with a benign safety profile. Shorter TTI and longer freeze durations are associated with sinus rhythm during follow-up.
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Affiliation(s)
- Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Shota Thohoku
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Franziska Willems
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | | | | | - Luca Trolese
- Herzzentrum Uniklinik Freiburg, Freiburg, Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | | | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Agaplesion Markus-Krankenhaus, Wilhelm-Epstein Street 4, 60431 Frankfurt/M., Germany
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Methods to Optimize Cryoballoon Ablation for Atrial Fibrillation to Minimize Risk of Adverse Outcomes and Arrhythmia Recurrences. CURRENT CARDIOVASCULAR RISK REPORTS 2021. [DOI: 10.1007/s12170-021-00668-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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7
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Rzaev FH, Rachkova II, Nikolaeva OA, Gorev MV, Nardaia SG, Makarycheva OV, Vasilieva EY, Shpektor AV. Duration of Applications Affects the Long-Term Efficacy of Cryoballoon Ablation Pulmonary Veins. ACTA ACUST UNITED AC 2021; 61:28-35. [PMID: 33734053 DOI: 10.18087/cardio.2021.1.n1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 12/18/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the effect of cryo-exposure duration and the use of the Achieve circular mapping catheter on efficacy of cryoballoon ablation (CBA).Material and methods CBA of pulmonary vein ostia (PVO) is a major method for heart rhythm control in patients with atrial fibrillation (AF). Since the inception, the PVO CBA method has evolved; the recommended application time was changed, and the Achieve circular catheter appeared. We performed a retrospective analysis of PVO CBA administered to patients with AF in the I.V. Davydovsky Municipal Clinical Hospital from 2017 through 2019. The study included 100 patients with available clinical and demographic characteristics and remote results of the intervention. Three patient groups were analyzed based on differences in surgical techniques: group 1, Guidewire / 240 (n=31) with the cryoballoon placing on a guidewire and PVO exposure duration of 240 s; group 2, Guidewire / 180 (n=26) with the cryoballoon placing on a guidewire and PVO exposure duration of 180 s; and group 3, Achieve / 180 (n=43) with the cryoballoon placing on the mapping catheter Achieve and PVO exposure duration of 180 с. The follow-up period was 33.2±4.5, 15.2±6.1, and 12.2±4.1 months in the Guidewire / 240, Guidewire / 180, and Achieve / 180 groups, respectively. The intervention was considered effective when there was no relapse at the time of interview. A relapse of AF was determined as one or more paroxysms recorded on electrocardiogram (ECG) or during 24-h ECG monitoring; the "blind period" (first 3 months after the procedure) was excluded from the follow-up. Safety evaluation included clinically significant complications, such as phrenic nerve damage, hemopericardium, gastroparesis, hemoptysis, acute cerebrovascular disease, and formation of atrio-esophageal fistula. Effects of independent factors were determined with binary logistic regression.Results In the Guidewire / 240 group, efficacy of PVO CBA for the maximum follow-up period was 74.4%, which was significantly different from the value for the Guidewire / 180 group (57.7 %, р=0.015). At the same time, the difference between the Guidewire / 240 and Achieve / 180 groups was statistically non-significant for a comparable follow-up period (р=0.144). Clinically significant complications were absent in all 3 groups. The independent factors that significantly increased the PVO CBA efficacy were the cryo-exposure duration of 240 s compared to 180 s (р= 0.018) and the use of the Achieve catheter (р=0.014).Conclusion Decreasing the cryo-exposure duration to less than 240 s is impractical (in absence of Achieve mapping catheter) since it impairs the long-term efficacy of PVO CBA and does not influence the risk of complications.
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Affiliation(s)
- F H Rzaev
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow
| | - Iu I Rachkova
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow
| | - O A Nikolaeva
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow
| | - M V Gorev
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow
| | - Sh G Nardaia
- Clinical City Hospital named after I.V. Davydovsky, Moscow Department of Healthcare, Moscow
| | - O V Makarycheva
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow
| | - E Yu Vasilieva
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow
| | - A V Shpektor
- Moscow State University of Medicine and Dentistry named after A.I. Evdokimov, Moscow
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Conte G, Soejima K, de Asmundis C, Bruno J, Cattaneo F, Chierchia GB, Miwa Y, Caputo ML, Sieira J, Regoli F, Moccetti T, Brugada P, Auricchio A. High-density mapping in patients undergoing ablation of atrial fibrillation with the fourth-generation cryoballoon and the new spiral mapping catheter. Europace 2020; 22:1653-1658. [PMID: 32830231 DOI: 10.1093/europace/euaa160] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/22/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS To assess the value of high-density mapping (HDM) in revealing undetected incomplete pulmonary vein isolation (PVI) after the fourth-generation cryoballoon (CB4G) ablation compared to the previous cryoballoon's versions. METHODS AND RESULTS Consecutive patients with paroxysmal or early-persistent atrial fibrillation (AF) undergoing CB ablation as the index procedure, assisted by HDM, were retrospectively included in this study. A total of 68 patients (52 males; mean age: 60 ± 12 years, 58 paroxysmal AF) were included, and a total of 272 veins were mapped. Fourth-generation cryoballoon with the new spiral mapping catheter (SMC) was used in 35 patients (51%). Time to PVI was determined in 102/132 (77%) and in 112/140 (80%) veins during second-generation cryoballoon/third-generation cryoballoon (CB2G/CB3G) and CB4G ablation, respectively (P = 0.66). There was a statistically significant difference in terms of discrepancy rate between the SMC and the mini-basket catheter in PV detection after CB4G and CB2G/CB3G ablation(1.4% vs. 7.6%; P = 0.01). A total of 57 patients (84%) remained free of symptomatic AF during a mean follow-up of 9.8 ± 4.6 months. CONCLUSION High-density mapping after cryoballoon ablation using CB4G and the new SMC identifies incomplete PVI, not detected by the new SMC, in a significantly lower proportion of veins compared to HDM performed after the other generation CB ablation.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.,Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland
| | - Kyoko Soejima
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jolie Bruno
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Fabio Cattaneo
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yosuke Miwa
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - François Regoli
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Tiziano Moccetti
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Angelo Auricchio
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland.,Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland.,Faculty of Biomedical Sciences, USI, Lugano, Switzerland
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9
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Abstract
Cryoballoon ablation for the treatment of atrial fibrillation has established itself as an effective and efficient modality for achieving pulmonary vein isolation. Over the past 13 years more than 100,000 Cryoballoon ablation procedures have been performed with the first to fourth generation cryoballoons. Over that time there have been significant advances in our understanding regarding the optimal procedural techniques. The purpose of this "topic in review" is to focus on the practical aspects of performing a Cryoballoon ablation procedure, within the context of the contemporary literature. Specifically there is a focus on how contemporary studies can inform clinical decision making and ensure operators are able to perform a safe and effective procedure.
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Affiliation(s)
- Jason G Andrade
- Montreal Heart Institute, Department of Medicine, Université de Montréal, Montreal, Canada.,Heart Rhythm Services, Department of Medicine, University of British Columbia, Vancouver, Canada.,Center for Cardiovascular Innovation, Vancouver, Canada
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10
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Primo J, Barra S. Standardizing atrial fibrillation ablation with the cryoballoon: A song of ice versus fire? Rev Port Cardiol 2020; 38:845-846. [PMID: 32061433 DOI: 10.1016/j.repc.2020.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- João Primo
- Cardiology Department, V. N. Gaia Hospital Center, Vila Nova de Gaia, Portugal; Cardiology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal.
| | - Sérgio Barra
- Cardiology Department, V. N. Gaia Hospital Center, Vila Nova de Gaia, Portugal; Cardiology Department, Hospital da Luz Arrábida, Vila Nova de Gaia, Portugal; Cardiology Department, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Chikata A, Kato T, Usuda K, Fujita S, Takaoka M, Tsuda T, Hayashi K, Furusho H, Takamura M. Optimization of the hot balloon ablation strategy using real‐time pulmonary vein potential monitoring. J Cardiovasc Electrophysiol 2019; 31:163-173. [DOI: 10.1111/jce.14313] [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: 09/07/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Akio Chikata
- Division of Cardiology, Department of Internal MedicineToyama Prefectural Central Hospital Toyama Japan
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Takeshi Kato
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kazuo Usuda
- Division of Cardiology, Department of Internal MedicineToyama Prefectural Central Hospital Toyama Japan
| | - Shuhei Fujita
- Department of PediatricsToyama Prefectural Central Hospital Toyama Japan
| | - Motoki Takaoka
- Product Development Group, Hot Balloon Catheter Business DepartmentToray Industries, Inc Tokyo Japan
| | - Toyonobu Tsuda
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Kenshi Hayashi
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Hiroshi Furusho
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical Science Kanazawa Japan
| | - Masayuki Takamura
- Department of Cardiovascular MedicineKanazawa University Graduate School of Medical Science Kanazawa Japan
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Ding J, Xu J, Ma W, Chen B, Yang P, Qi Y, Sun S, Cheng A. A novel individualized strategy for cryoballoon catheter ablation in patients with paroxysmal atrial fibrillation. BMC Cardiovasc Disord 2019; 19:299. [PMID: 31847803 PMCID: PMC6918665 DOI: 10.1186/s12872-019-01295-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 12/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background The optimal dosage for cryoablation of atrial fibrillation (Cryo-AF) is still unknown. To evaluate the efficacy of an individualized freeze duration, we compared the clinical outcome of patients treated with a time-to-pulmonary vein isolation (TT-PVI) or temperature-guided ablation protocol to the outcome of patients treated with a conventional ablation protocol. Methods A total of 164 consecutive patients were included in the study. One method employed was a conventional dosing protocol (at least 2 applications of 180 s each) (the Cryo-AFConventional group n = 84), and the second method had a shorter protocol that was based on the TT-PVI or achievement of − 40 °C within 60 s (the Cryo-AFDosing group n = 80) Results We treated 656 pulmonary veins (PVs) with 1420 cryotherapy applications. The mean number of applications per patient was 8.7 ± 0.8, with no difference between groups (Cryo-AFConventional, 8.7 ± 0.8 versus Cryo-AFDosing,8.6 ± 0.8; P = 0.359). The Cryo-AFDosing group required significantly less total cryotherapy application time (990.60 ± 137.77versus 1501.58 ± 89.60 s; P < 0.001) and left atrial dwell time (69.91 ± 6.91 versus 86.48 ± 7.03 min; P < 0.001) than the Cryo-AFConventional group. Additionally, the Cryo-AFDosing group required significantly less total procedure time (95.03 ± 6.50 versus 112.43 ± 7.11 min; P < 0.001). We observed acute ATP-induced or spontaneous vein electric reconnections in 13 veins (1.98%) after 20 min. The reconnection rates between the Cryo-AFConventional and Cryo-AFDosing groups were similar in that 2.98 and 0.94% of the initially isolated veins were reconnected, respectively, (P = 0.061). There was no difference in the recurrence rate of free atrial arrhythmia after a 1-year follow-up, which were 78.75% in the Cryo-AFDosing group versus 78.57% in the Cryo-AFConventional group (P = 0.978). Conclusion A novel Cryo-AF dosing protocol guided by temperature or the TT-PVI can be used to individualize an ablation strategy. This new protocol can lead to a significant reduction in duration of the procedure, the cryoenergy dosage and the left atrial dwell time. The procedure had equal safety and similar acute and 1-year follow-up outcomes compared to the conventional approach.
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Affiliation(s)
- Jun Ding
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China, 261 South Taierzhuang Road, Jinnan District, Tianjin, 300200, China
| | - Jing Xu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China, 261 South Taierzhuang Road, Jinnan District, Tianjin, 300200, China
| | - Wei Ma
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China, 261 South Taierzhuang Road, Jinnan District, Tianjin, 300200, China
| | - Bingwei Chen
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China, 261 South Taierzhuang Road, Jinnan District, Tianjin, 300200, China
| | - Peigen Yang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China, 261 South Taierzhuang Road, Jinnan District, Tianjin, 300200, China
| | - Yu Qi
- Tianjin medical university, Tianjin, People's Republic of China
| | - Shan Sun
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China, 261 South Taierzhuang Road, Jinnan District, Tianjin, 300200, China.
| | - Aijuan Cheng
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, People's Republic of China, 261 South Taierzhuang Road, Jinnan District, Tianjin, 300200, China.
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13
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Primo J, Barra S. Standardizing atrial fibrillation ablation with the cryoballoon: A song of ice versus fire? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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14
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Mugnai G, Manfrin M, de Asmundis C, Ströker E, Longobardi M, Rauhe W, Storti C, Brugada P, Chierchia GB. The assessment of pulmonary vein potentials using the new achieve advance during cryoballoon ablation of atrial fibrillation. Indian Pacing Electrophysiol J 2019; 19:211-215. [PMID: 31238123 PMCID: PMC6904823 DOI: 10.1016/j.ipej.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The new version of inner lumen mapping catheter (Achieve Advance™; Medtronic, Minnesota, USA) includes a new solid core which provides improved rotational response, as compared to the current Achieve Mapping Catheter. In the present study, we sought to analyze the rate of visualisation of real-time recordings using this new device comparing it with a large cohort of patients having undergone second generation cryoballoon (CB) ablation using the previous Achieve mapping catheter. METHODS All patients having undergone CB ablation using the Achieve Advance and the last 150 consecutive patients having undergone CB ablation using the previous Achieve were analysed. Exclusion criteria were presence of an intracavitary thrombus, uncontrolled heart failure, moderate or severe valvular disease and contraindications to general anesthesia. RESULTS A total of 200 consecutive patients (60.1 ± 9.5 years, 75% males) were evaluated (50 Achieve Advance and 150 old Achieve). Real-time recordings were significantly more prevalent in the "new Achieve Advance" population compared with the "old Achieve" group (73.5% vs 56.8%; p = 0.0001). Real-time recordings could be more frequently visualized in the "Achieve Advance" group in all veins except RIPV (LSPV: 86% vs 71.3%, p = 0.04; LIPV: 84% vs 62.7%, p = 0.005; RSPV: 78% vs 52%, p < 0.0001; RIPV: 46% vs 41.3%, p = 0.3). CONCLUSIONS The rate of visualisation of real-time recordings is significantly higher using the new Achieve Advance if compared to the previous Achieve mapping catheter in the setting of CB ablation. Real-time recordings can be visualized in approximately 73.5% of veins with this new device.
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Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium; Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy.
| | - Massimiliano Manfrin
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | | | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | - Massimo Longobardi
- Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Werner Rauhe
- Electrophysiology and Cardiac Pacing Unit, San Maurizio Regional Hospital, Bolzano, Italy
| | - Cesare Storti
- Electrophysiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
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15
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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: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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16
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Vallès E, Benito B, Jiménez J, Cabrera S, Alcalde O, Altaba C, Guijo MA, Fan R, Martí-Almor J. Double factor single shot to diminish complications in cryoballoon ablation procedures for atrial fibrillation. J Interv Card Electrophysiol 2018; 55:17-26. [PMID: 30411175 DOI: 10.1007/s10840-018-0483-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/30/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Cryoballoon ablation (CBA) has become a standard treatment for recurrent atrial fibrillation (AF). There is need for improved CBA protocols. We aimed to demonstrate that a new protocol including minimum temperature (minT) reached could reduce procedure times and complications. METHODS A new double factor protocol (DFP), based on the performance of one single shot per vein with variable duration, and conditional bonus shot, determined by time-to-effect (TTE) and minT, was compared with the conventional protocol (CP), with at least two shots per vein. Procedure parameters, complications, and efficacy were compared. RESULTS We prospectively included 88 consecutive patients treated with the DFP. These were compared to the previous consecutive 69 patients treated with CP. All procedures were performed with 28-mm second-generation balloon. Acute pulmonary vein (PV) isolation was similar (98.6% vs. 98.9% in CP vs. DFP, p = 0.687). Procedure and ablation times favored DFP over CP (120 vs. 134 min, p = 0.003; and 1051 vs. 1475 s, p < 0.001; respectively). A composite of major and minor complications was significantly reduced in the DFP compared to the CP (18.8% vs. 6.8%, p = 0.02; respectively). Within a follow-up of 18 months, freedom from AF was 79.7% in CP and 78.4% in DFP (Log-rank 0.501). Paroxysmal AF and absence of PV potentials predicted better arrhythmia outcomes (HR 2.14 for paroxysmal vs. persistent, p = 0.031; and HR 1.61 for absence vs. presence of PV potentials, p = 0.01). CONCLUSIONS The novel DFP results in reduced complication rates and procedure times, with similar success rates compared with a conventional strategy.
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Affiliation(s)
- Ermengol Vallès
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain. .,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
| | - Begoña Benito
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Jesús Jiménez
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Sandra Cabrera
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Oscar Alcalde
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Carmen Altaba
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Miguel Angel Guijo
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain
| | - Roger Fan
- Stony Brook University School of Medicine Health Science Center, T16-80, Stony Brook, NY, 11794, USA
| | - Julio Martí-Almor
- Electrophysiology Unit, Department of Cardiology, Hospital del Mar, Universitat Autònoma de Barcelona, 25-29 Passeig Marítim, 08003, Barcelona, Spain.,Group of Biomedical Research in Heart Diseases, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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17
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Boveda S, Metzner A, Nguyen DQ, Chun KRJ, Goehl K, Noelker G, Deharo JC, Andrikopoulos G, Dahme T, Lellouche N, Defaye P. Single-Procedure Outcomes and Quality-of-Life Improvement 12 Months Post-Cryoballoon Ablation in Persistent Atrial Fibrillation: Results From the Multicenter CRYO4PERSISTENT AF Trial. JACC Clin Electrophysiol 2018; 4:1440-1447. [PMID: 30466850 DOI: 10.1016/j.jacep.2018.07.007] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/05/2018] [Accepted: 07/19/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVES The CRYO4PERSISTENT AF (Cryoballoon Ablation for Early Persistent Atrial Fibrillation) trial aims to report long-term outcomes after a single pulmonary vein isolation (PVI)-only ablation procedure using the second-generation cryoballoon in persistent atrial fibrillation (PerAF) patients. BACKGROUND Pulmonary vein isolation is recognized as the cornerstone of atrial fibrillation (AF) ablation, including ablation of PerAF. METHODS The CRYO4PERSISTENT AF trial (NCT02213731) is a prospective, multicenter, single-arm trial designed to assess single-procedure outcomes of PVI using the cryoballoon. The primary endpoint was freedom from AF, atrial flutter, or atrial tachycardia ≥30 s after a 90-day blanking period. After enrollment, but before ablation, patients without 100% AF burden (18-h Holter monitoring or 3 consecutive electrocardiograms in a time frame ≥14 days) were excluded. Patients were followed at 3, 6, and 12 months, with 48-h Holter monitoring at 6 and 12 months. Quality of life and symptoms were evaluated at baseline and 12 months. Arrhythmia recurrence and adverse events were adjudicated by an independent committee. RESULTS A total of 101 patients (62 ± 11 years of age, 74% men, left ventricular ejection fraction 56 ± 8%, left atrial diameter 43 ± 5 mm) meeting criteria, undergoing cryoballoon-based PVI, with follow-up data, were included. Kaplan-Meier estimate of freedom from AF, atrial flutter, or atrial tachycardia recurrence was 60.7% at 12 months. Compared with baseline, there were significantly fewer patients with arrhythmia-related symptoms at 12 months (16% vs. 92%; p < 0.0001). The symptom reduction was supported by significant improvement in 36-Item Short Form Health Survey composite scores and European Heart Rhythm Association score at 12 months. The only device related event was transient phrenic nerve injury in 2 (2%) patients, with resolution pre-discharge. CONCLUSIONS Cryoballoon ablation for treatment of PerAF demonstrated 61% single-procedure success at 12 months post-ablation in addition to significant reduction in arrhythmia-related symptoms and improved quality of life. (Cryoballoon Ablation for Early Persistent Atrial Fibrillation [Cryo4 Persistent AF]; NCT02213731).
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Affiliation(s)
| | | | | | - K R Julian Chun
- Markuskrankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | | | - Georg Noelker
- Clinic for Cardiology Herz- und Diabeteszentrum North Rhine-Westphalia Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | | | | | | | | | - Pascal Defaye
- Centre Hospitalier Universitaire de Grenoble-Alpes, Grenoble, France
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18
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Chen S, Schmidt B, Bordignon S, Bologna F, Perrotta L, Nagase T, Chun KRJ. Atrial fibrillation ablation using cryoballoon technology: Recent advances and practical techniques. J Cardiovasc Electrophysiol 2018; 29:932-943. [PMID: 29663562 DOI: 10.1111/jce.13607] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 02/12/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022]
Abstract
Atrial fibrillation (AF) affects 1-2% of the population, and its prevalence is estimated to double in the next 50 years as the population ages. AF results in impaired patients' life quality, deteriorated cardiac function, and even increased mortality. Antiarrhythmic drugs frequently fail to restore sinus rhythm. Catheter ablation is a valuable treatment approach for AF, even as a first-line therapy strategy in selected patients. Effective electrical pulmonary vein isolation (PVI) is the cornerstone of all AF ablation strategies. Use of radiofrequency (RF) catheter in combination of a three-dimensional electroanatomical mapping system is the most established ablation approach. However, catheter ablation of AF is challenging even sometimes for experienced operators. To facilitate catheter ablation of AF without compromising the durability of the pulmonary vein isolation, "single shot" ablation devices have been developed; of them, cryoballoon ablation, is by far the most widely investigated. In this report, we review the current knowledge of AF and discuss the recent evidence in catheter ablation of AF, particularly cryoballoon ablation. Moreover, we review relevant data from the literature as well as our own experience and summarize the key procedural practical techniques in PVI using cryoballoon technology, aiming to shorten the learning curve of the ablation technique and to contribute further to reduction of the disease burden.
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Affiliation(s)
- Shaojie Chen
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Laura Perrotta
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Takahiko Nagase
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - K R Julian Chun
- CCB, Cardioangiologisches Centrum Bethanien Frankfurt am Main, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Salghetti F, Abugattas JP, Regibus VD, Iacopino S, Takarada K, Ströker E, Coutiño HE, Lusoc I, Sieira J, Capulzini L, Mugnai G, Umbrain V, Beckers S, Brugada P, de Asmundis C, Chierchia GB. Real-Time Recordings in Cryoballoon Pulmonary Veins Isolation: Comparison Between the 25mm and the 20mm Achieve Catheters. J Atr Fibrillation 2018; 10:1855. [PMID: 29988256 PMCID: PMC6009793 DOI: 10.4022/jafib.1855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 02/19/2018] [Accepted: 03/22/2018] [Indexed: 11/10/2022]
Abstract
AIMS Real Time Recordings (RTR) of pulmonary vein (PV) activity provide important information in the setting of the 2nd generation Cryoballoon (CB-A), as a funcion of time to isolation. Visualization of RTR with the standard inner lumen mapping catheter (ILMC) 20mm Achieve (AC) is possible in roughly 50% of PVs. A novel 25mm-Achieve Advance (AC-A) has been developed with the aim of increasing the detection of RTR. The purpose of this study is to compare the AC-A with the AC, to feasibility and improvement of RTR. METHODS We assigned 50 patients with paroxysmal or persistent atrial fibrillation to CB-A PVI, using the AC-A as ILMC. We compared this group with 50 patients, matched for age and left atrial volume, who previously underwent the CB-A PVI using the AC. RESULTS RTR were more frequently observed with the AC-A than with the AC (74% vs 49%; p= 0.02). RTR in the left superior PVs was similar in both groups (74% vs 72%, p= 0.8). RTR with the AC-A were equally appreciated in left or right sided, superior or inferior PVs. No significant differences were found in terms of feasibility, procedure fluoroscopy and freezing times, nadir temperatures, and acute PVI. CONCLUSIONS CB-A PVI with the AC-A is feasible and safe in all PVs. The AC-A has proven significantly superior in visualising RTR if compared to the AC, affording RTR in 74% of PVs.
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Affiliation(s)
- Francesca Salghetti
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
- Division of Cardiology, Spedali Civili Hospital, Brescia, Italy
| | - Juan-Pablo Abugattas
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Valentina De Regibus
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Saverio Iacopino
- Electrophysiology Unit, Maria Cecilia Hospital, Gruppo Villa Maria - Via Corriera 1, 48033 Cotignola, Italy
| | - Ken Takarada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Hugo-Enrique Coutiño
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ian Lusoc
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Lucio Capulzini
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Vincent Umbrain
- Anaesthesiology Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Stefan Beckers
- Anaesthesiology Department, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel- Laarbeeklaan 101, 1090 Brussels, Belgium
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Wei HQ, Guo XG, Zhou GB, Sun Q, Liu X, Yang JD, Luo B, Ma J. Pulmonary vein isolation with real-time pulmonary vein potential recording using second-generation cryoballoon: Procedural and biophysical predictors of acute pulmonary vein reconnection. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2017; 41:14-21. [PMID: 29087000 DOI: 10.1111/pace.13230] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/09/2017] [Accepted: 10/22/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The study sought to evaluate the procedural and biophysical factors related to acute pulmonary vein isolation (PVI) guided by real-time pulmonary vein (PV) potential recordings. METHODS A total of 180 consecutive patients with drug-resistant atrial fibrillation (AF) undergoing CB2 (second-generation version of cryoballoon) ablation were enrolled. Real-time monitoring of PV potentials was obtained using an inner lumen spiral mapping catheter. RESULTS Acute isolation was achieved in all PVs without touch-up ablation. Real-time assessment of PV disconnection was possible in 611 of 711 (85.9%) PVs. A total of 617 (86.8%) PVs were isolated during the initial freeze. Longer time cycle integration (TCI) (TTI * freeze cycle, TCI) (254.6 ± 112.8 seconds vs 74.1 ± 59.7 seconds, P < 0.001), time to isolation (TTI) (94.3 ± 34.0 seconds vs 46.3 ± 26.2 seconds, P < 0.001), higher nadir temperature (-45.5 ± 5.3°C vs -50.4 ± 5.5°C, P < 0.001), longer time to -40°C (77.3 ± 22.7 seconds vs 55.7 ± 23.2 seconds, P < 0.001), faster interval rewarming time at 0°C (9.4 ± 4.3 seconds vs 12.4 ± 4.9 seconds, P = 0.008), and total balloon rewarming time (38.1 ± 11.6 seconds vs 47.7 ± 14.0 seconds, P = 0.003) were observed in PVs with acute reconduction. TTI ≤ 65 seconds predicted absence of acute reconnection with 84.2% sensitivity and 75.7% specificity, whereas TCI ≤ 119 seconds presented 94.7% sensitivity and 80.2% specificity. At a mean follow-up of 4.7 ± 1.4 months, 82.2% of patients were free of AF. None of those with PV reconnections suffered from AF recurrences. CONCLUSIONS The ablation using CB2 is effective in achieving acute PVI. Real-time assessment of PVI could be achieved during CB application in 86% of PVs. The incidence of spontaneous PV reconnection is very low, observed in just 3% of isolated PVs. TTI ≤ 65 seconds and TCI ≤ 119 seconds predicted absence of acute PV reconnection. Although they may identify effective cryoapplications in the acute phase, their performance still needs to be verified in the long term.
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Affiliation(s)
- Hui-Qiang Wei
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-Gang Guo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Gong-Bu Zhou
- Department of Cardiology, Peking University Third Hospital, Beijing, China
| | - Qi Sun
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu Liu
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Du Yang
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Luo
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Ma
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Ferrero-de-Loma-Osorio Á, García-Fernández A, Castillo-Castillo J, Izquierdo-de-Francisco M, Ibáñez-Críado A, Moreno-Arribas J, Martínez A, Bertomeu-González V, López-Mases P, Ajo-Ferrer M, Núñez C, Bondanza-Saavedra L, Sánchez-Gómez JM, Martínez-Martínez JG, Chorro-Gascó FJ, Ruiz-Granell R. Time-to-Effect–Based Dosing Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2017; 10:CIRCEP.117.005318. [DOI: 10.1161/circep.117.005318] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Ángel Ferrero-de-Loma-Osorio
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Amaya García-Fernández
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Jesús Castillo-Castillo
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Maite Izquierdo-de-Francisco
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Alicia Ibáñez-Críado
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Jose Moreno-Arribas
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Angel Martínez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Vicente Bertomeu-González
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Patricia López-Mases
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - María Ajo-Ferrer
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Carlos Núñez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Lourdes Bondanza-Saavedra
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Juan Miguel Sánchez-Gómez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Juan Gabriel Martínez-Martínez
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Francisco Javier Chorro-Gascó
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
| | - Ricardo Ruiz-Granell
- From the Department of Cardiology, Arrhythmia Unit, INCLIVA Foundation, Hospital Clínico Universitario, Valencia, Spain (A.F.-d.-L.-O., M.I.-d.-F, A.M., P.L.-M., C.N., L.B.-S., J.M.S.-G., F.J.C.-G., R.R.-G.); Department of Cardiology, Arrhythmia Unit, Hospital General Universitario, Valencia, Spain (A.G.-F., A.I.-C., M.A.-F., J.G.M.-M.); and Department of Cardiology, Arrhythmia Unit, Hospital Universitario de San Juan, Alicante, Spain (J.C.-C., J.M.-A., V.B.-G.)
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Adragão P. Commemorating twenty years since the first catheter-based pulmonary vein isolation to treat atrial fibrillation by ablation. Rev Port Cardiol 2017; 36 Suppl 1:3-5. [PMID: 29126893 DOI: 10.1016/j.repc.2017.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 09/29/2017] [Indexed: 11/30/2022] Open
Affiliation(s)
- Pedro Adragão
- Serviço de Cardiologia, CHLC, Hospital de Santa Cruz, Carnaxide, Portugal.
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23
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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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Adragão P. Commemorating twenty years since the first catheter‐based pulmonary vein isolation to treat atrial fibrillation by ablation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.repce.2017.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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25
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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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26
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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: 5.1] [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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Fürnkranz A, Bologna F, Bordignon S, Perrotta L, Dugo D, Schmidt B, Chun JKR. Procedural characteristics of pulmonary vein isolation using the novel third-generation cryoballoon. Europace 2016; 18:1795-1800. [PMID: 26935947 DOI: 10.1093/europace/euw012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 12/20/2015] [Indexed: 11/14/2022] Open
Abstract
AIM A novel third-generation cryoballoon (CB3) to perform pulmonary vein isolation (PVI) has recently been released, featuring a shortened distal balloon tip when compared with the second-generation (CB2), possibly allowing for enhanced intra-ablation pulmonary vein (PV) signal mapping. We aimed to investigate procedural efficacy and safety of the CB3 as compared to the CB2. METHODS AND RESULTS We studied 472 consecutive patients who underwent CB-PVI for paroxysmal or persistent atrial fibrillation (CB3: 49 patients; CB2: 423 patients). Detailed procedural data and in-hospital complications were registered in a prospective database. Complete PVI using the CB only was achieved in 98% of patients in each group. Single-freeze PVI was observed in 84/88% (CB2/CB3, P = n.s.) of the PVs. Time-to-PVI (TPVI) was 49 ± 32 (CB2) and 45 ± 27 s (CB3) (P = n.s.). Time-to-PVI determination rate was higher in the CB3 group (89.5 vs. 82.6%, P = 0.016). Signal noise due to ice formation on mapping electrodes occurred after 70 ± 46 s using CB3 and did not interfere with TPVI determination. Exchange of the spiral mapping catheter with a guide wire was more frequently required in the CB3 group (8.2 vs. 0.7% patients, P < 0.001). Balloon dislodgement during hockey stick manoeuvres occurred in 6.1% patients of the CB3 group only (P = 0.001). Complication rates were not different between the groups. CONCLUSION The CB3 offers a higher TPVI determination rate, facilitating dosing schemes based on TPVI, with equally high single-freeze efficacy compared with the CB2. The shortened distal tip of the CB3 requires adaptation of standard catheter manoeuvers to avoid balloon dislodgement.
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Affiliation(s)
- Alexander Fürnkranz
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | - Daniela Dugo
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien, Medizinische Klinik III, Markus Krankenhaus, Wilhelm-Epstein-Street 4, D-60431 Frankfurt am Main, Germany
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Mugnai G, de Asmundis C, Hünük B, Ströker E, Moran D, Hacioglu E, Ruggiero D, Poelaert J, Verborgh C, Umbrain V, Beckers S, Coutino-Moreno HE, Takarada K, de Regibus V, Brugada P, Chierchia GB. Improved visualisation of real-time recordings during third generation cryoballoon ablation: a comparison between the novel short-tip and the second generation device. J Interv Card Electrophysiol 2016; 46:307-14. [DOI: 10.1007/s10840-016-0114-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/04/2016] [Indexed: 12/16/2022]
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Chierchia GB, Mugnai G, Ströker E, Velagic V, Hünük B, Moran D, Hacioglu E, Poelaert J, Verborgh C, Umbrain V, Beckers S, Ruggiero D, Brugada P, de Asmundis C. Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon. Europace 2016; 18:1158-63. [PMID: 26857185 DOI: 10.1093/europace/euv452] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 12/23/2015] [Indexed: 11/13/2022] Open
Abstract
AIMS The third-generation Cryoballoon Advance Short-tip (CB-ST) has been designed with a 40% shortened tip length compared with the former second-generation CB Advance device. Ideally, a shorter tip should permit an improved visualization of real-time (RT) recordings in the pulmonary vein (PV) due to a more proximal positioning of the inner lumen mapping catheter. In the present study, we sought to analyse the rate of visualization of RT recordings in our first series of patients with the CB-ST device. METHODS AND RESULTS All consecutive patients having undergone CB ablation using CB-ST technology were analysed. Exclusion criteria were the presence of an intracavitary thrombus, uncontrolled heart failure, moderate or severe valvular disease, and contraindications to general anaesthesia. A total of 60 consecutive patients (60.5 ± 11.2 years, 62% males) were evaluated. Real-time recordings were detected in 209 of 240 PVs (87.1%). Specifically, RT recordings could be visualized in 55 left superior PVs (91.7%), 51 left inferior PVs (85.0%), 53 right superior PVs (88.3%), and 50 right inferior PVs (83.3). CONCLUSION The rate of visualization of RT recordings is significantly high during third-generation CB-ST ablation. Real-time recordings can be visualized in ∼87.1% of veins with this novel cryoballoon.
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Affiliation(s)
| | - Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Vedran Velagic
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Burak Hünük
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Darragh Moran
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ebru Hacioglu
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jan Poelaert
- Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium
| | | | - Vincent Umbrain
- Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium
| | - Stefan Beckers
- Department of Anaesthesiology, UZ Brussel-VUB, Brussels, Belgium
| | - Diego Ruggiero
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Center, UZ Brussel-VUB, Laarbeeklaan 101, 1090 Brussels, Belgium
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Khoueiry Z, Albenque JP, Providencia R, Combes S, Combes N, Jourda F, Sousa P, Cardin C, Pasquie JL, Cung T, Massin F, Marijon E, Boveda S. Outcomes after cryoablation vs. radiofrequency in patients with paroxysmal atrial fibrillation: impact of pulmonary veins anatomy. Europace 2016; 18:1343-51. [DOI: 10.1093/europace/euv419] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 11/10/2015] [Indexed: 11/12/2022] Open
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Aryana A, Bowers MR, O'Neill PG. Outcomes Of Cryoballoon Ablation Of Atrial Fibrillation: A Comprehensive Review. J Atr Fibrillation 2015; 8:1231. [PMID: 27957187 DOI: 10.4022/jafib.1231] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 07/03/2015] [Accepted: 07/03/2015] [Indexed: 11/10/2022]
Abstract
Over the last decade, cryoballoon ablation has emerged as an effective alternate strategy to point-by-point radiofrequency ablation for treatment of symptomatic atrial fibrillation. There are several reasons for this. First, the acute and long-term safety and efficacy associated with cryoablation appear comparable to that of radiofrequency ablation in patients with both paroxysmal and also persistent atrial fibrillation. Second, cryoablation offers certain advantages over conventional radiofrequency ablation including a gentler learning curve, shorter ablation and procedure times as well as lack of need for costly electroanatomical mapping technologies commonly utilized with radiofrequency ablation. Lastly, with the recent advent of the second-generation cryoballoon, the effectiveness of cryoablation has further improved dramatically. This comprehensive review examines the gradual evolution of the cryoablation tools as well as the rationale and data in support of the currently-available cryoballoon technologies for catheter ablation of atrial fibrillation.
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Affiliation(s)
- Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Mark R Bowers
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
| | - Padraig Gearoid O'Neill
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, California
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ZHOU GONGBU, GUO XIAOGANG, LIU XU, YANG JIANDU, SUN QI, MA JIAN, ZHANG SHU. Pulmonary Vein Isolation Using the First-Generation Cryoballoon Technique in Chinese Patients. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2015; 38:1073-81. [PMID: 26096255 DOI: 10.1111/pace.12675] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 05/05/2015] [Accepted: 05/26/2015] [Indexed: 11/30/2022]
Affiliation(s)
- GONG-BU ZHOU
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - XIAO-GANG GUO
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - XU LIU
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - JIAN-DU YANG
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - QI SUN
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - JIAN MA
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
| | - SHU ZHANG
- State Key Laboratory of Cardiovascular Disease, Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases; Chinese Academy of Medical Sciences and Peking Union Medical College; Beijing People's Republic of China
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Sousa PA, Boveda S, Combes N, Combes S, Albenque JP. Ablation of paroxysmal atrial fibrillation in 2015: radiofrequency or cryoenergy? Interv Cardiol 2015. [DOI: 10.2217/ica.15.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Pulmonary vein signal interpretation during cryoballoon ablation for atrial fibrillation. Heart Rhythm 2015; 12:1387-94. [PMID: 25724834 DOI: 10.1016/j.hrthm.2015.02.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Indexed: 11/24/2022]
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Pavlovic N, Knecht S, Reichlin T, Kühne M, Sticherling C. Cryoballoon ablation for atrial fibrillation. Interv Cardiol 2014. [DOI: 10.2217/ica.14.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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