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Miki K, Fukuda K, Hirano M, Sato K, Ikeda S, Shinozaki M, Takeda M. Localization and Spread of Challenging Conduction Gaps of Pulmonary Veins for Atrial Fibrillation Cryoablation. Pacing Clin Electrophysiol 2025; 48:21-29. [PMID: 39731637 DOI: 10.1111/pace.15133] [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: 03/11/2024] [Revised: 11/10/2024] [Accepted: 12/08/2024] [Indexed: 12/30/2024]
Abstract
BACKGROUND Cryoballoon ablation has been widely performed in patients with paroxysmal atrial fibrillation (AF). In some challenging pulmonary veins (PVs), the procedure requires additional touch-up applications against the residual conduction gaps. It implies that there could exist difficult sites to cover with standard cryoballoon applications (CBAs), resulting in resistant conduction gaps (RCGs). This study aims to characterize the RCGs after initial CBAs. METHODS We retrospectively enrolled 90 consecutive paroxysmal AF patients in our institute from January 2018 to December 2021 (66.5 ± 8.9 [SD] year-old, male/female 58/32). The RCGs after initial CBAs were mapped and analyzed with a high-resolution mapping (HRM) catheter. The PVs isolated using HRM were classified as HRM group. The PVs isolated without HRM, if isolated with a total of one or two CBAs, were classified as Control group. RESULTS Whereas 325 PVs were isolated without HRM, 29 PVs had RCGs which were mapped and identified with HRM (HRM group): 15 right inferior pulmonary veins (RIPVs), 11 left superior PVs (LSPVs), and 3 left inferior PVs (LIPVs). In HRM group, the rate of broad RCGs in each PV extending over 2 or 3 segments of PV was almost double that of one-segment RCGs. The width of RCGs significantly correlated with nadir balloon temperature (R = 0.42; p = 0.021) and iTT15 (R = -0.44; p = 0.015). CONCLUSIONS After standard CBAs, most RCGs were demonstrated to spread from the bottom to the posterior wall of RIPV and from the roof to the anterior wall of LSPV. The width of the RCGs was found to be correlated with parameters of balloon temperature, such as Tnadir and iTT15.
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Affiliation(s)
- Keita Miki
- Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Koji Fukuda
- Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Michinori Hirano
- Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Koichi Sato
- Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Shohei Ikeda
- Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Mariko Shinozaki
- Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan
| | - Morihiko Takeda
- Department of Cardiology, International University of Health and Welfare Hospital, Tochigi, Japan
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2
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Zhang ML, Zhang C, Peng JY, Xing SQ, Guo J, Wei CL, Zhang NF, Ma E, Chen WS. The safety and efficacy of third- and fourth-generation cryoballoons for atrial fibrillation: a systematic review and meta-analysis. Front Cardiovasc Med 2024; 11:1364893. [PMID: 39188322 PMCID: PMC11345166 DOI: 10.3389/fcvm.2024.1364893] [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: 01/03/2024] [Accepted: 07/22/2024] [Indexed: 08/28/2024] Open
Abstract
Objectives An increasing number of studies have shown that third (CB3)- and fourth-generation cryoballoons (CB4) have been used to treat various types of atrial fibrillation (AF), but previous research regarding the safety and efficacy of CB3 or CB4 ablation remains controversial. Therefore, a meta-analysis was performed to further evaluate the safety and efficacy of pulmonary vein isolation (PVI) using the CB3 and CB4 in the treatment of AF. Methods We searched PubMed, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, China Science and Technology Journal Database, and Clinicaltrials.gov up to December 2023 for qualified trials and data extraction according to inclusion and exclusion criteria. All analyses were carried out using Review Manager 5.3 software. Results The meta-analysis included 13 observational studies consisting of 3,281 subjects and did not include a randomized controlled trial. Overall analyses indicated that the CB3 significantly reduced total procedure time [weighted mean difference (WMD) = -8.69 min, 95% confidence interval (CI) = -15.45 to -1.94 min, I2 = 93%], increased the PVI recording [relative risk (RR) = 1.24, 95% CI = 1.03-1.49, I2 = 90%], and increased the mean nadir temperature of overall PVs (WMD = 2.80°C, 95% CI = 1.08-4.51°C, I2 = 89%) compared with the CB2. Moreover, the CB4 significantly reduced the total procedure time (WMD = -14.50 min, 95% CI = -20.89 to -8.11 min, I2 = 95%), reduced the fluoroscopy time (WMD = -2.37 min, 95% CI = -4.28 to -0.46 min, I2 = 95%), increased the PVI recording (RR = 1.40, 95% CI = 1.15-1.71, I2 = 90%) compared with the CB2. Time-to-isolation, the success rate of PVI, AF recurrence, and complications in the CB3 and CB4 were not significantly different compared with the CB2. Conclusion These findings demonstrated that the CB3 and CB4 tended to be more effective than the CB2 in the treatment of AF, with shorter procedure times, more PVI recording, and similar safety endpoints.
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Affiliation(s)
- Man-Li Zhang
- Department of Cardiovascular Surgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Chao Zhang
- Department of Cardiovascular Surgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Jian-Yong Peng
- Department of Ultrasound, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Shu-Qiao Xing
- Department of Pharmacy, Hangzhou Normal University, Zhejiang, Hangzhou, China
| | - Jian Guo
- Department of Cardiovascular Surgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Chen-Long Wei
- Department of Cardiovascular Surgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Neng-Fang Zhang
- Department of Cardiovascular Surgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - En Ma
- Department of Cardiovascular Surgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
| | - Wen-Sheng Chen
- Department of Cardiovascular Surgery, Xi’an Gaoxin Hospital, Xi’an, Shaanxi, China
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Liu G, Wang Y, Xu X, Tian J, Lv T. Comparison for the efficacy and safety of time-to-isolation protocol and conventional protocol of cryoballoon in the treatment of atrial fibrillation: a meta-analysis and systematic review. J Interv Card Electrophysiol 2021; 62:259-268. [PMID: 33033904 DOI: 10.1007/s10840-020-00890-z] [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: 08/16/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cryoballoon (CB) has been widely utilized in the treatment of drug-refractory atrial fibrillation (AF), but the balance point between efficacy and safety has been unclear. The protocol based on the time-to-isolation (TTI) was expected to provide patients with individualized ablation strategies. METHODS All studies up to June 2020 comparing the CB of TTI-based protocol (TTIP) and conventional protocol (ConP) in PubMed, Embase, and Cochrane Library databases were searched. The pooled OR or SMD with 95% CIs for each outcome were calculated with inverse-variance random effect model. The Egger method was used to evaluate the publication bias and the subgroup analysis was conducted according to the type of atrial fibrillation. RESULTS Six studies enrolling a total of 1770 patients with drug-refractory AF were included. The pool real-time recording of pulmonary veins potential was 71% (95% CI: 61 ~ 81%, I2 = 97.9%) and a similar incidence of freedom from ATs after 1 year (OR: 1.12; 95% CI: 0.86 ~ 1.46, I2 = 0.0%, P = 0.481) was observed between two protocols. No difference was observed in complications (OR: 0.67; 95% CI: 0.43 ~ 1.04, I2 = 0.0%, P = 0.717) and phrenic nerve palsy (OR: 0.70; 95% CI: 0.37 ~ 1.35, I2 = 0.0%, P = 0.807). TTIP could significantly decrease the CB freezes per patient (SMD: - 2.44; 95% CI: - 4.46 to approximately - 0.41; I2 = 99.5%, P = 0.00) and shorten the cryotherapy application time (SMD: - 3.04; 95% CI: - 4.18 to approximately - 1.89; I2 = 97.4%, P = 0.00), procedure time (SMD: - 1.51; 95% CI: - 2.08 to approximately - 0.94; I2 = 95.4%, P = 0.00), and fluorescence time (SMD: - 0.70; 95% CI: - 1.25 to approximately - 0.15; I2 = 95.7%, P = 0.00). CONCLUSION TTIP is safe and effective and it opens a new chapter in the field of individualized protocol of CB for patients with AF.
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Affiliation(s)
- Guolin Liu
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - YuanLi Wang
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Xin Xu
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Jie Tian
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China
| | - Tiewei Lv
- Department of Cardiology; Ministry of Education Key Laboratory of Child Development and Disorders; National Clinical Research Center for Child Health and Disorders; China International Science and Technology Cooperation base of Child development and Critical Disorders, Children's Hospital of Chongqing Medical University, Chongqing, 400014, China.
- Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
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Heeger CH, Bohnen JE, Popescu S, Meyer-Saraei R, Fink T, Sciacca V, Kirstein B, Hatahet S, Traub A, Lopez LD, Schlüter M, Kuck KH, Eitel C, Vogler J, Richard Tilz R. Experience and procedural efficacy of pulmonary vein isolation using the fourth and second generation cryoballoon: The shorter, the better? J Cardiovasc Electrophysiol 2021; 32:1553-1560. [PMID: 33760304 DOI: 10.1111/jce.15009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 02/16/2021] [Accepted: 03/05/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome. The novel fourth-generation cryoballoon (CB4) incorporates a 40% shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE). METHODS AND RESULTS Three hundred consecutive patients with paroxysmal or persistent atrial fibrillation were prospectively enrolled. The first 150 consecutive patients underwent CB2 based PVI (CB2 group) and the last 150 consecutive patients were treated with the CB4 (CB4 group). A total of 594/594 (100%, CB4) and 589/594 (99.2%, CB2) pulmonary veins (PVs) were successfully isolated utilizing the CB4 and CB2, respectively (p = .283). The real-time PVI visualization rate was 47% (CB4) and 39% (CB2; p = .005) and the mean freeze cycle duration 200 ± 90 s (CB4) and 228 ± 110 s (CB2; p < .001), respectively. The total procedure time did not differ between the groups (CB4: 64 ± 32 min) and (CB2: 62 ± 29 min, p = .370). No differences in periprocedural complications were detected. CONCLUSIONS A higher rate of real-time electrical PV recordings are seen using the CB4 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.
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Affiliation(s)
- Christian-Hendrik Heeger
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Jan-Eric Bohnen
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sorin Popescu
- Carol Davila, University of Medicine and Pharmacy, Bucharest, Romania
| | - Roza Meyer-Saraei
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Thomas Fink
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Vanessa Sciacca
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Bettina Kirstein
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Sascha Hatahet
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Anna Traub
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Lisbeth D Lopez
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - Karl-Heinz Kuck
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.,LANS Cardio, Hamburg, Germany
| | - Charlotte Eitel
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Julia Vogler
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Roland Richard Tilz
- Department of Cardiology, Angiology and Intensive Care Medicine, Division of Electrophysiology, Medical Clinic II, University Heart Center Lübeck, University Hospital Schleswig-Holstein, Lübeck, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
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5
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Anic A, Lever N, Martin A, Breskovic T, Sulkin MS, Duffy E, Saliba WI, Niebauer MJ, Wazni OM, Varma N. Acute safety, efficacy, and advantages of a novel cryoballoon ablation system for pulmonary vein isolation in patients with paroxysmal atrial fibrillation: initial clinical experience. Europace 2021; 23:1237-1243. [PMID: 33729470 PMCID: PMC8350865 DOI: 10.1093/europace/euab018] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/09/2021] [Indexed: 11/13/2022] Open
Abstract
AIMS Cryoballoon pulmonary vein isolation (PVI) is a safe and effective treatment for atrial fibrillation (AF). Current limitations include incomplete vein occlusion due to balloon rigidity and inconsistent electrogram recording, which impairs identification of isolation. We aimed to evaluate the acute safety and performance of a novel cryoballoon system. METHODS AND RESULTS The system includes a steerable sheath, mapping catheter, and a balloon that maintains uniform inflation pressure and size following initiation of ablation. Protocol-directed cryoablation was delivered for 180 s for isolation documented in ≤60 s, otherwise freeze duration was 240 s. Primary endpoints were acute safety and vein isolation. Pulmonary vein isolation was confirmed at ≥30 min post-isolation. Data were compared across vein locations. Thirty patients with paroxysmal AF were enrolled at two centres and underwent PVI. Pulmonary vein isolation was achieved with cryoablation only in 100% of veins (120/120). Nadir temperature was -53.1 ± 5.3°C. The number of applications to achieve PVI was 1.4 ± 0.4 per vein. Of the 120 veins, 89 were isolated with a single cryothermal application (10/30 patients required only 4 total cryoablations). There were no procedural- or device-related serious adverse events at 30 days post-procedure. A subset (24/30) of patients was followed for 1-year and 71% (17/24) remained free of atrial arrhythmias. Six patients with arrhythmia recurrence were remapped and three had durable PVI for all four veins. CONCLUSION In this first human experience, the novel cryoballoon platform was safe, efficacious, and demonstrated a high proportion of successful single ablation isolation.
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Affiliation(s)
- Ante Anic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | - Nigel Lever
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Andrew Martin
- Cardiovascular Diseases, Green Lane Cardiovascular Services, Auckland City Hospital, Auckland, New Zealand
| | - Toni Breskovic
- Cardiovascular Diseases, University Hospital Center Split, Spinciceva 1, 21000 Split, Croatia
| | | | - Elizabeth Duffy
- Electrophysiology, Boston Scientific Corp., St. Paul, MN, USA
| | - Walid I Saliba
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Mark J Niebauer
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Oussama M Wazni
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
| | - Niraj Varma
- Department for Cardiovascular Diseases, Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, OH, USA
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Miyazaki S, Hasegawa K, Mukai M, Aoyama D, Nodera M, Shiomi Y, Tama N, Ikeda H, Ishida K, Uzui H, Tada H. The advantages and disadvantages of the novel fourth-generation cryoballoon as compared to the second-generation cryoballoon in the current short freeze strategy. J Interv Card Electrophysiol 2021; 63:143-152. [PMID: 33575920 DOI: 10.1007/s10840-021-00957-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/04/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The novel fourth-generation cryoballoon (4th-CB) is characterized by a shorter-tip that potentially facilitates better time-to-isolation (TTI) monitoring. We sought to clarify the advantages and disadvantages of the 4th-CB compared to the second-generation cryoballoon (2nd-CB) in pulmonary vein isolation (PVI). METHODS Forty-one and 49 consecutive atrial fibrillation patients underwent 2nd-CB and 4th-CB PVIs using 28-mm balloons and short freeze strategies. When effective freezing was not obtained, the CB was switched to the other CB. RESULTS The rate of successful PVIs was significantly higher for 2nd-CBs than 4th-CBs (162/162[100%] vs. 178/193[92.2%] PVs, p < 0.0001). The difference was significant for lower PVs, especially right inferior PVs (RIPVs)(p = 0.005). In a total of 15 PVs in 11 patients, 4th-CBs were switched to 2nd-CBs, and 14/15(93.3%) PVs were successfully isolated. The balloon temperature tended to reach -55℃ more frequently with 2nd-CBs than 4th-CBs during RIPV ablations (15/41[36.6%] vs. 12/49[24.5%], p = 0.21). The TTI monitoring capability was significantly higher with 4th-CBs than 2nd-CBs (131/188[69.7%] vs. 83/160[51.9%] PVs, p = 0.0007). The difference was significant for right superior and left inferior PVs, but not for left superior PVs. Even if PVs requiring crossover were excluded, the total freeze duration (715±152 vs. 755±215 seconds, p = 0.31) tended to be shorter for 2nd-CBs than 4th-CBs. The incidence of phrenic nerve injury was similar for 2nd-CB and 4th-CB ablation (0/41 vs. 2/49, p = 0.12) CONCLUSIONS: The 4th-CB's shorter balloon tip enabled a significantly higher capability of TTI monitoring; however, it resulted in significantly lower rates of successful PVIs than the 2nd-CB, especially for the RIPVs.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
| | - Kanae Hasegawa
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Moe Mukai
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Daisetsu Aoyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Minoru Nodera
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Yuichiro Shiomi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Naoto Tama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyuki Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Kentaro Ishida
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroyasu Uzui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Shimo-aiduki, Matsuoka, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan
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7
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Mizutani Y, Inden Y, Yanagisawa S, Kanashiro M, Makino Y, Satake A, Kurobe M, Ichimiya H, Uchida Y, Watanabe J, Ichimiya S, Murohara T. Disappearance pattern and the last remaining earliest pulmonary vein potential during cryoballoon ablation in predicting recurrence and conduction gap site of pulmonary veins. Heart Vessels 2021; 36:1190-1200. [PMID: 33496818 DOI: 10.1007/s00380-021-01785-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
Electrophysiological studies have rarely evaluated the sites prone to pulmonary vein (PV) conduction gap during cryoballoon ablation (CBA) for atrial fibrillation (AF). In addition, no studies have analyzed the sequence of PV potentials just before PV isolation during CBA for AF. Of the 238 patients who underwent first-time CBA for paroxysmal AF, 115 PVs of 29 patients who underwent repeat session due to recurrence after the procedure were retrospectively evaluated in the study. We evaluated the disappearance pattern of PV potential and PV reconnection on intracardiac electrograms and investigated whether the conduction gap site of the PV was related to the last remaining earliest PV potential (EP) and sequence pattern during the first-time CBA. Time to isolation was observed in 81 PVs during the first-time CBA. At the repeat session, PV reconnection was only observed in 22 of 81 PVs. PV potentials disappeared with sequence changes in 36 PVs and without sequence changes in 38 PVs. Multivariate analysis demonstrated that disappearance of PV potentials without change in the EP site but with delay or disappearance of other PV potentials was independently associated with PV reconnection (12/22 PVs [55%] vs. 4/59 PVs [6.8%]; odds ratio 14.4; 95% confidence interval 3.75-55.5; p < 0.001). In 19 of 22 (86%) reconnected PVs, PV conduction gap sites at repeat ablation corresponded with the last remaining EP sites during first-time CBA. In conclusion, disappearance pattern of the PV potential and the last remaining EP during the CBA can predict PV reconnection and gap site.
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Affiliation(s)
- Yoshiaki Mizutani
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan. .,Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan.
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Yuichiro Makino
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Akinori Satake
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Masanari Kurobe
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Hitoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Yasuhiro Uchida
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Junji Watanabe
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Satoshi Ichimiya
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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8
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Mathew S, Rottner L, Warneke L, Maurer T, Lemes C, Hashiguchi N, Reißmann B, Goldmann B, Ouyang F, Kuck KH, Metzner A, Rillig A. Initial experience and procedural efficacy of pulmonary vein isolation using the fourth-generation cryoballoon - a step forward? Acta Cardiol 2020; 75:754-759. [PMID: 31630633 DOI: 10.1080/00015385.2019.1677373] [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] [Indexed: 10/25/2022]
Abstract
Background: Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an established treatment modality for patients suffering from paroxysmal or persistent atrial fibrillation (AF). Recently, the novel fourth-generation cryoballoon (CB4) was introduced which mainly provides a 40% shorter distal tip as compared to the second-generation cryoballoon (CB2). This two-centre analysis sought to assess the primary efficacy of the 28 mm CB4 for PVI and the feasibility of real-time signal recordings from the PVs considering the time-to-isolation (TTI).Methods and results: Eighty-four patients with paroxysmal or short-standing persistent AF underwent CB4-based PVI at two different hospitals. Individual freeze-cycle duration was set at TTI + 120 seconds. No bonus freeze was applied. A total of 331 pulmonary veins (PVs) including five left common PVs were identified and all PVs were successfully isolated. Mean freeze-cycle duration was 165.7 ± 31.5 seconds. The mean minimal CB temperature was -45.6 ± 7.6 °C with a real-time PVI visualisation rate of 78% (67/84 (79.8%) RSPVs, 55/84 (65.5%) RIPVs, 67/79 (84.8%) LSPVs, 66/79 (83.5%) LIPVs and 2/5 (40%) LCPV). Transient phrenic nerve palsy occurred in 2/84 (2.4%) patients during cryo-application along the RSPV.Conclusions: The novel CB4 provides both, a high acute efficacy and a high rate of real time electrical PV-recordings, thus facilitating individual ablation strategies based on TTI.
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Affiliation(s)
- Shibu Mathew
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Laura Rottner
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Laura Warneke
- Department of Cardiology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | | | - Bruno Reißmann
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Britta Goldmann
- Department of Cardiology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinikum Harburg, Hamburg, Germany
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. George, Hamburg, Germany
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9
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Mugnai G, de Asmundis C, Chierchia GB. Signal- or temperature-based approach for cryoballoon ablation of atrial fibrillation: still an unsolved issue. J Interv Card Electrophysiol 2020; 59:479-480. [PMID: 32529313 DOI: 10.1007/s10840-020-00792-0] [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: 05/20/2020] [Accepted: 06/01/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Giacomo Mugnai
- 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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10
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Suenari K, Nakano T, Tomomori S, Shiode N, Higa S, Chen SA. Cryoballoon Ablation for Patients With Paroxysmal Atrial Fibrillation. Circ Rep 2020; 2:75-82. [PMID: 33693211 PMCID: PMC7929758 DOI: 10.1253/circrep.cr-19-0125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 12/24/2019] [Indexed: 11/09/2022] Open
Abstract
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and induces cardiac dysfunction and stroke. The development of AF requires a trigger and also an electroanatomic substrate capable of both initiating and perpetuating AF. In the past decade, ectopic beats originating from the pulmonary veins (PV) have been identified as a source of paroxysmal AF. Thus, strategies that target the PV, including the PV antrum, are the cornerstone of most AF ablation procedures. Recently, alternative technologies to radiofrequency catheter ablation for paroxysmal AF such as balloon ablation modalities have been developed. The purpose of this review is to discuss cryoballoon ablation for paroxysmal AF.
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Affiliation(s)
- Kazuyoshi Suenari
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
| | - Takayuki Nakano
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
| | - Shunsuke Tomomori
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
| | - Nobuo Shiode
- Department of Cardiology, Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan
| | - Satoshi Higa
- Cardiac Electrophysiology and Pacing Laboratory, Division of Cardiovascular Medicine, Makiminato Central Hospital Okinawa Japan
| | - Shih-Ann Chen
- Division of Cardiology and Cardiovascular Research Center, Taipei Veterans General Hospital Taipei Taiwan
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11
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Osório TG, Coutiño HE, Brugada P, Chierchia GB, De Asmundis C. Recent advances in cryoballoon ablation for atrial fibrillation. Expert Rev Med Devices 2019; 16:799-808. [PMID: 31389263 DOI: 10.1080/17434440.2019.1653181] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Pulmonary vein isolation (PVI), by catheter ablation, represents the current treatment for drug-resistant atrial fibrillation (AF). Nowadays cryoballoon (CB) is a recognized ablation method in patients with atrial fibrillation, mainly due to its ease of use, leading to reproducible and fast procedures. This novel single shot technology literally revolutionized the approach to AF ablation. Areas covered: The historical development of the cryoballoon, ablation techniques and new approaches beyond the ordinary PVI and complications are summarized here. Expert opinion: Although cryoballoon ablation has greatly standardized the approach to PVI a few critical points still need to be clarified scientifically in order to further uniform this procedure in cath labs worldwide. Duration and dosage of the cryoapplication is undoubtedly a topic of great interest.
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Affiliation(s)
- Thiago Guimarães Osório
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Hugo-Enrique Coutiño
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
| | - Carlo De Asmundis
- Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel , Brussels , Belgium
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12
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Earliest pulmonary vein potential-guided cryoballoon ablation for atrial fibrillation. Heart Vessels 2019; 35:232-238. [DOI: 10.1007/s00380-019-01471-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/05/2019] [Indexed: 12/13/2022]
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13
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Moltrasio M, Sicuso R, Fassini GM, Riva SI, Tundo F, Dello Russo A, Casella M, Majocchi B, Zucchetti M, Cellucci S, Tondo C. Acute outcome after a single cryoballoon ablation: Comparison between Arctic Front Advance and Arctic Front Advance PRO. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:890-896. [DOI: 10.1111/pace.13718] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/22/2019] [Accepted: 04/29/2019] [Indexed: 12/31/2022]
Affiliation(s)
| | - Rita Sicuso
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | | | - Stefania I. Riva
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | - Fabrizio Tundo
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | | | - Michela Casella
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | | | | | - Selene Cellucci
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
| | - Claudio Tondo
- Heart Rhythm CenterCentro Cardiologico Monzino, IRCCS Milano Italy
- Department of Clinical Science and Community HealthUniversity of Milan Italy
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14
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Moltrasio M, Tundo F, Fassini G, Sicuso R, Cellucci S, Tondo C. Cryoablation of atrial fibrillation with the fourth‐generation balloon: The first reported case. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:553-556. [DOI: 10.1111/pace.13562] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 11/26/2022]
Affiliation(s)
| | - Fabrizio Tundo
- Heart Rhythm CenterCentro Cardiologico Monzino IRCCS Milan Italy
| | - Gaetano Fassini
- Heart Rhythm CenterCentro Cardiologico Monzino IRCCS Milan Italy
| | - Rita Sicuso
- Heart Rhythm CenterCentro Cardiologico Monzino IRCCS Milan Italy
| | - Selene Cellucci
- Heart Rhythm CenterCentro Cardiologico Monzino IRCCS Milan Italy
| | - Claudio Tondo
- Heart Rhythm CenterCentro Cardiologico Monzino IRCCS Milan Italy
- Department of Clinical Science and Community HealthUniversity of Milan Milan Italy
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15
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De Sensi F, Berruezo A. Pulmonary vein potentials during cryoballoon ablation of atrial fibrillation. If you don't see them, look forward…and make a good lesion! Int J Cardiol 2018; 272:223-224. [PMID: 30131227 DOI: 10.1016/j.ijcard.2018.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Francesco De Sensi
- Cardiology Department, Electrophysiology Unit, Misericordia Hospital, Grosseto, Italy.
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16
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Conte G, Soejima K, de Asmundis C, Chierchia GB, Badini M, Miwa Y, Caputo ML, Özkartal T, Maffessanti F, Sieira J, Degreef Y, Stroker E, Regoli F, Moccetti T, Brugada P, Auricchio A. Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation. Int J Cardiol 2018; 270:136-142. [PMID: 29929934 DOI: 10.1016/j.ijcard.2018.05.135] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/29/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND Unrecognized incomplete pulmonary vein isolation (PVI), as opposed to post-PVI pulmonary vein reconnection, may be responsible for clinical recurrences of atrial fibrillation (AF). To date, no data are available on the use of high-resolution mapping (HRM) during cryoballoon (CB) ablation for AF as the index procedure. The aims of this study were: - to assess the value of using a HRM system during CB ablation procedures in terms of ability in acutely detecting incomplete CB lesions; - to compare the 8-pole circular mapping catheter (CMC, Achieve) and the 64-pole mini-basket catheter (Orion) with respect to pulmonary vein (PV) signals detection at baseline and after CB ablation; - to characterize the extension of the lesion produced by CB ablation by means of high-density voltage mapping. METHODS Consecutive patients with drug-resistant paroxysmal or early-persistent AF undergoing CB ablation as the index procedure, assisted by a HRM system, were retrospectively included in this study. RESULTS A total of 33 patients (25 males; mean age: 59 ± 18 years, 28 paroxysmal AF) were included. At baseline, CMC catheter revealed PV activity in 102 PVs (77%), while the Orion documented PV signals in all veins (100%). Failure of complete CB-PVI was more frequently revealed by atrial re-mapping with the Orion as compared to the Achieve catheter (24% vs 0%, p < 0.05). A repeat ablation was performed in 8 patients (24%). In 9% of cases, the Orion catheter detected far-field signals originating from the right atrium. Quantitative assessment of the created lesion revealed a significant reduction of the left atrial area having voltage >0.5 mV. A total of 29 patients (88%) remained free of symptomatic AF during a mean follow-up of 13.2 ± 3.7 months. CONCLUSION Atrial re-mapping after CB ablation by means of a HRM system improves the detection of areas of incomplete ablation, characterizes the extension of the cryo-ablated tissue and can identify abolishment of potential non-PVI related sources of AF.
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Affiliation(s)
- Giulio Conte
- Division of Cardiology, Cardiocentro Ticino, 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
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Matteo Badini
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Yosuke Miwa
- Department of Cardiology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Tardu Özkartal
- Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland
| | - Francesco Maffessanti
- Centre for Computational Medicine in Cardiology, Faculty of Informatics, Università della Svizzera Italiana, Lugano, Switzerland
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yves Degreef
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel - Postgraduate Program Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Stroker
- 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
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17
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Heeger CH, Schuette C, Seitelberger V, Wissner E, Rillig A, Mathew S, Reissmann B, Lemes C, Maurer T, Fink T, Inaba O, Hashiguchi N, Santoro F, Ouyang F, Kuck KH, Metzner A. Time-to-effect guided pulmonary vein isolation utilizing the third-generation versus second generation cryoballoon: One year clinical success. Cardiol J 2018; 26:368-374. [PMID: 29924380 DOI: 10.5603/cj.a2018.0056] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/05/2018] [Accepted: 04/02/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging and reproducible clinical outcome data. The latest- -generation cryoballoon (CB3) incorporates a 40% shorter distal tip, thus allowing for an increased rate of PVI real-time signal recording and facilitating individualized ablation strategies taking the time-to- -effect (TTE) into account. However, whether this characteristic translates into favorable clinical success has not been evaluated yet. Herein was investigated 1-year clinical success after CB3 in comparison to CB2 based-PVI. METHODS One hundred and ten consecutive patients with paroxysmal or short-standing persistent atrial fibrillation (AF) underwent CB2 (n = 55 patients) -or CB3 (n = 55 patients) -based PVI. The freeze-cycle duration was set to TTE + 120 s if TTE could be recorded, otherwise a fixed freeze-cycle duration of 180 s was applied. RESULTS A total of 217/218 (99%, CB3) and 217/217 (100%, CB2) pulmonary veins (PV) were successfully isolated. The real-time PVI visualization rate was 69.2% (CB3) and 54.8% (CB2; p = 0.0392). The mean freeze-cycle duration was 194 ± 77 s (CB3) and 206 ± 85 s (CB2; p = 0.132), respectively. During a median follow-up of 409 days (interquartile range [IQR] 378-421, CB3) and 432 days (IQR 394-455, CB2) 73.6% (CB3) and 73.1% of patients (CB2) remained in stable sinus rhythm after a single procedure (p = 0.806). CONCLUSIONS A higher rate of real-time electrical PV recordings was seen using the CB3 as compared to CB2. There was no difference in 1-year clinical follow-up.
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Affiliation(s)
- Christian-Hendrik Heeger
- University Heart Center Luebeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), Sektion Elektropjysiologie, University Hospital Schleswig-Holstein, Germany. .,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany. .,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany.
| | | | | | - Erik Wissner
- Division of Cardiology, University of Illinois at Chicago, United States
| | - Andreas Rillig
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Bruno Reissmann
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Thomas Fink
- University Heart Center Luebeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), Sektion Elektropjysiologie, University Hospital Schleswig-Holstein, Germany.,Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Berlin, Germany
| | - Osamu Inaba
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Francesco Santoro
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Feifan Ouyang
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Fuwai Hospital / National Center of Cardiovascular Diseases, Beijing, China
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.,Department of Cardiology-Electrophysiology, University Hospital Hamburg, University Heart Center Hamburg, Hamburg, Germany
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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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19
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Chen S, Schmidt B, Bordignon S, Bologna F, Nagase T, Perrotta L, Julian Chun KR. Practical Techniques in Cryoballoon Ablation: How to Isolate Inferior Pulmonary Veins. Arrhythm Electrophysiol Rev 2018; 7:11-17. [PMID: 29686870 DOI: 10.15420/aer.2018;1;2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Catheter ablation is the most effective treatment option for patients suffering from symptomatic atrial fibrillation. Electrical isolation of the pulmonary veins is the procedural cornerstone. Point-by-point radiofrequency current energy ablation in combination with a 3D electro-anatomical mapping system is the established approach to ablation. In contrast, cryoballoon ablation uses a single-shot approach to facilitate pulmonary vein isolation. However, fixed cryoballoon diameters (28 mm or 23 mm) and non-balloon compliance can lead to technical difficulties in isolating variable pulmonary vein anatomies. This review focuses on key procedural aspects and illustrates practical techniques in cryoballoon pulmonary vein isolation to shorten the learning curve without compromising safety and efficacy. It has a special emphasis on inferior pulmonary veins.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CBC) Medical Clinic III, Frankfurt, 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: 1.3] [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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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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22
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Spies F, Kühne M, Reichlin T, Osswald S, Sticherling C, Knecht S. A quantitative comparison of the electrical and anatomical definition of the pulmonary vein ostium. Pacing Clin Electrophysiol 2017; 40:1213-1217. [PMID: 28892174 DOI: 10.1111/pace.13192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/07/2017] [Accepted: 08/28/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anatomically guided pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation. However, the position where to confirm electrical isolation is ill-defined. The aim of the current study was to quantify the relationship between the anatomical and electrical definition of the pulmonary vein ostium. METHODS We analyzed 20 patients with paroxysmal AF undergoing PVI using radiofrequency energy and an electroanatomical mapping system. The anatomical ostium was defined based on the geometry obtained from preprocedural magnetic resonance imaging and computed tomography. The electrical ostium was defined at the position with a far-field atrial signal preceding a sharp pulmonary vein (PV) signal without any isoelectric interval in between. RESULTS The electrically defined ostia were 8.4 ± 4.7 mm more distal in the PV compared to the anatomically defined ostia. The distances varied considerably between the four PVs and were 10.5 ± 6.5 mm, 7.4 ± 4.3 mm, 5.3 ± 4.0 mm, and 8.3 ± 3.4 mm for the left superior, left inferior, right superior, and right inferior PVs, respectively (P = 0.009). CONCLUSIONS The position of the electrical and anatomical ostium differs markedly. The site of the electrical ostium is variable within the PV but always more distal in the PV compared to the site of the anatomical ostium.
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Affiliation(s)
- Florian Spies
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Michael Kühne
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tobias Reichlin
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian Sticherling
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Cardiology/Electrophysiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Cardiovascular Research Institute Basel, University Hospital Basel, University of Basel, Basel, Switzerland
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23
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Yokoyama K, Tokuda M, Matsuo S, Isogai R, Tokutake K, Kato M, Narui R, Tanigawa S, Yamashita S, Inada K, Yoshimura M, Yamane T. Pulmonary vein re-mapping after cryoballoon ablation for atrial fibrillation. Europace 2017; 20:943-948. [DOI: 10.1093/europace/eux129] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 04/18/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kenichi Yokoyama
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Michifumi Tokuda
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Seiichiro Matsuo
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ryota Isogai
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kenichi Tokutake
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Mika Kato
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Ryohsuke Narui
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Shinichi Tanigawa
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Seigo Yamashita
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Keiichi Inada
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Michihiro Yoshimura
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Teiichi Yamane
- Department of Cardiology, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan
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24
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Georgiopoulos G, Tsiachris D, Manolis AS. Cryoballoon ablation of atrial fibrillation: a practical and effective approach. Clin Cardiol 2016; 40:333-342. [PMID: 27991673 DOI: 10.1002/clc.22653] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/02/2016] [Accepted: 11/05/2016] [Indexed: 12/17/2022] Open
Abstract
Medical management of atrial fibrillation (AF), the most common arrhythmia in the general population, has had modest efficacy in controlling symptoms and restoring and maintaining sinus rhythm. Since the seminal observation in 1998 that pulmonary veins host the triggers of AF in the majority of cases, electrical isolation of all pulmonary veins constitutes the cornerstone of ablation in patients with symptomatic AF. However, due to the elaborate and tedious technique of the conventional point-by-point method with radiofrequency ablation guided by electroanatomical mapping, newer, more versatile single-shot techniques, such as cryoballoon ablation, have been sought and developed over recent years and are progressively prevailing. Cryoballoon ablation appears to be the most promising practical and effective approach, and we review it here by presenting all available relevant data from the literature as well as from our own experience in an attempt to apprise colleagues of the significant progress made over the last several years in this important field of electrophysiology.
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Affiliation(s)
- George Georgiopoulos
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Dimitris Tsiachris
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
| | - Antonis S Manolis
- Third Department of Cardiology, Athens University School of Medicine, Athens, Greece
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25
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Aryana A, Kowalski M, O’Neill PG, Koo CH, Lim HW, Khan A, Hokanson RB, Bowers MR, Kenigsberg DN, Ellenbogen KA. Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: Short- and long-term results of a multicenter study. Heart Rhythm 2016; 13:2306-2313. [DOI: 10.1016/j.hrthm.2016.08.011] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Indexed: 11/25/2022]
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