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Oda A, Shigeta T, Sagawa Y, Murata K, Arai H, Yasui Y, Fukami Y, Okishige K, Kurabayashi M, Sasano T, Yamauchi Y. Gastric Hypomotility After Pulmonary Vein Isolation With or Without Left Atrial Roof Ablation Using a Novel Cryoballoon. Pacing Clin Electrophysiol 2025. [PMID: 40391662 DOI: 10.1111/pace.15204] [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: 01/25/2025] [Revised: 04/16/2025] [Accepted: 05/06/2025] [Indexed: 05/22/2025]
Abstract
BACKGROUND The novel POLARx cryoballoon ablation (CBA) system offers enhanced cooling properties for the treatment of atrial fibrillation (AF); however, these capabilities may damage adjacent tissues. This study aimed to assess the prevalence and predictors of gastric hypomotility (GH) in patients undergoing pulmonary vein isolation (PVI) and left atrial (LA) roofline ablation using the POLARx. METHODS Patients who underwent CBA for PVI using the POLARx system were included in this study. Additional LA roofline ablation was performed in patients with non-paroxysmal AF and paroxysmal AF with LA enlargement. GH occurrence was assessed postoperatively by esophagogastroscopy, and the distance between the esophagus and surrounding tissues were measured. RESULTS Among the 61 patients who underwent PVI, 22 underwent additional LA roofline ablation. GH was confirmed in 12 patients (30.8%) who underwent PVI only and 12 patients (54.5%) who underwent additional LA roofline ablation. Symptomatic GH with acute gastric dilation occurred in three patients, all of whom had undergone roofline ablation. Multivariate analysis, a shorter distance between the esophagus and the midpoint of the vertebral body (odds ratio, 0.74; 95% confidence interval, 0.55-0.98; p = 0.04) was identified as the sole predictor of GH, with a cutoff of 20.0 mm (sensitivity, 80.0%; specificity, 81.8%). CONCLUSION Adding LA roofline ablation to PVI using the POLARx may increase the risk of GH, particularly when the esophagus is in close proximity to the midpoint of the vertebral body.
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Affiliation(s)
- Atsuhito Oda
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
| | - Takatoshi Shigeta
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
- Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan
| | - Yuichiro Sagawa
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
| | - Kazuya Murata
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
| | - Hirofumi Arai
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
| | - Yumi Yasui
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
| | - Yuichi Fukami
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
- Gastroenterology, Tokyo Kyosai Hospital, Tokyo, Japan
| | - Kaoru Okishige
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
| | - Manabu Kurabayashi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Institute of Science Tokyo, Tokyo, Japan
| | - Yasuteru Yamauchi
- Heart Center, Japan Red Cross Yokohama City Bay Hospital, Yokohama City, Japan
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Kato H, Yanagisawa S, Suga K, Murakami H, Inden Y, Murohara T. Transmural left atrial roofline block using rescue cryoballoon ablation after unsuccessful radiofrequency ablation. Heart Rhythm O2 2025; 6:546-550. [PMID: 40321735 PMCID: PMC12047457 DOI: 10.1016/j.hroo.2025.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025] Open
Affiliation(s)
- Hiroyuki Kato
- Department of Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazumasa Suga
- Department of Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Hisashi Murakami
- Department of Cardiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kawaji T, Aizawa T, Naka M, Yamano S, Bingyuan B, Hojo S, Tezuka Y, Matsuda S, Kato M, Yokomatsu T, Miki S. Discrimination Between Anterior and Posterior Left Atrial Roof Area Ablation by a Cryoballoon. Circ Arrhythm Electrophysiol 2025; 18:e013093. [PMID: 39660435 DOI: 10.1161/circep.124.013093] [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] [Indexed: 12/12/2024]
Affiliation(s)
- Tetsuma Kawaji
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (T.K., T.A.)
| | - Takanori Aizawa
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Japan (T.K., T.A.)
| | - Misaki Naka
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Saki Yamano
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Bao Bingyuan
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Shun Hojo
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Yuji Tezuka
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Shintaro Matsuda
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Masashi Kato
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Takafumi Yokomatsu
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
| | - Shinji Miki
- Department of Cardiology, Mitsubishi Kyoto Hospital, Japan (T.K., M.N., S.Y., B.B., S.H., Y.T., S. Matsuda, M.K., T.Y., S. Miki)
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Erkapic D, Roussopoulos K, Aleksic M, Sözener K, Kostev K, Rosenbauer J, Sossalla S, Gündüz D, Labenz J, Tanislav C, Weipert KF. Cryoballoon-Assisted Pulmonary Vein Isolation and Left Atrial Roof Ablation Using a Simplified Sedation Strategy without Esophageal Temperature Monitoring: No Notable Thermal Esophageal Lesions and Low Arrhythmia Recurrence Rates after 2 Years. Diagnostics (Basel) 2024; 14:1370. [PMID: 39001260 PMCID: PMC11241260 DOI: 10.3390/diagnostics14131370] [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: 06/02/2024] [Revised: 06/23/2024] [Accepted: 06/25/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Atrial fibrillation (AF) ablation is increasingly effective for managing heart rhythm but poses risks like esophageal fistulas. Minimizing esophageal thermal lesions while simplifying procedures is crucial. METHODS This prospective study involved 100 consecutive AF patients undergoing cryoballoon ablation with simplified sedation, without esophageal temperature monitoring. Patients with paroxysmal AF (Group A) received pulmonary vein isolation only, while those with persistent AF (Group B) also had left atrial roof ablation. Gastroesophageal endoscopy was performed post-procedure to detect lesions, and cardiological follow-ups were conducted at 3, 12, and 24 months. RESULTS The cohort included 69% men, with a median age of 65.5 years. Post-ablation endoscopy was performed in 92 patients; esophageal lesions were found in 1.1% of Group A and none of Group B. GERD was diagnosed in 14% of patients, evenly distributed between groups and not linked to lesion occurrence. Gastric hypomotility was observed in 16% of patients, with no significant difference between groups. At 24 months, arrhythmia-free survival was 88% in Group A and 74% in Group B. CONCLUSION Cryoballoon-assisted pulmonary vein isolation, with or without additional left atrial roof ablation and without esophageal temperature monitoring during a simplified sedation strategy, shows low risk of esophageal thermal injury and effective ablation outcomes.
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Affiliation(s)
- Damir Erkapic
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
| | - Konstantinos Roussopoulos
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Marko Aleksic
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Korkut Sözener
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Karel Kostev
- Department of Epidemiology, Philipps-University Marburg, 35037 Marburg, Germany;
| | - Josef Rosenbauer
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
| | - Samuel Sossalla
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
| | - Dursun Gündüz
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
| | - Joachim Labenz
- Department of Gastroenterology, Medical Clinic I, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany;
| | - Christian Tanislav
- Department of Geriatrics and Neurology, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany;
| | - Kay Felix Weipert
- Department of Cardiology, Rhythmology and Angiology, Medical Clinic II, Diakonie Klinikum Jung Stilling, 57074 Siegen, Germany; (K.R.); (M.A.); (K.S.); (J.R.); (D.G.); (K.F.W.)
- Department of Cardiology and Angiology, Medical Clinic I, University Hospital Giessen, 35392 Giessen, Germany;
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Mizutani Y, Yanagisawa S, Fujiwara G, Kasai Y, Tajima A, Makino Y, Suzuki H, Hiramatsu T, Ichimiya H, Uchida Y, Watanabe J, Kanashiro M, Inden Y, Murohara T. Evaluation of the direction and extent of ice formation during cryoballoon ablation: an experimental study. J Interv Card Electrophysiol 2022; 66:981-989. [PMID: 36336724 DOI: 10.1007/s10840-022-01411-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/31/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND The distal hemisphere of a balloon is generally cooled during cryoapplication. However, a wide ablation area can be acquired after cryoballoon ablation. This study aimed to evaluate the extent of ice formation on two types of balloon surfaces through experimental and simulation studies. METHODS A standard cryoballoon (SCB; Arctic Front Advance Pro, Medtronic) and novel cryoballoon (NCB; POLARx, Boston Scientific) were frozen for 240 s in 36 °C normal saline solution to observe ice formation on the balloon surface. Pieces of porcine tissue were placed between the upper and lower sides of the balloon, and the balloon was frozen in the horizontal direction for 240 s in 20 attempts (10 for SCB and NCB each). The measured areas of ice formation were evaluated and compared between the upper and lower sides of each balloon. RESULTS Ice formation was greater on the lower side of the balloon than on the upper side. A larger area of ice formation in the tissue slab was observed on the lower side than on the upper side in both balloons, and the ice formation extended to the proximal hemisphere on the lower side of the balloon. The ice formation area in the NCB was significantly larger than that in SCB. CONCLUSIONS Ice formation was significantly greater on the lower side of the cryoballoon than on the upper side and extended to the proximal hemisphere of the balloon, which might facilitate the acquisition of a wide ablation area on the left atrial posterior wall after cryoballoon ablation. Different ice formation after cryoballoon ablation Greater ice formation on the lower side of cryoballoon and an extensive ice formation in the proximal hemisphere, especially in novel cryoballoon.
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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.
| | - Satoshi Yanagisawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Gen Fujiwara
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Yosuke Kasai
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Atomu Tajima
- 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
| | - Hitomi Suzuki
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Takatsugu Hiramatsu
- 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
| | - Masaaki Kanashiro
- Department of Cardiology, Yokkaichi Municipal Hospital, 2-2-37, Shibata, Yokkaichi, Mie, Japan
| | - Yasuya Inden
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Chen X, Xia Y, Lin Y, Li X, Wang C, Chen Y, Fang P, Liu J. Cryoballoon Ablation for Treatment of Atrial Fibrillation in a Chinese Population: Five-Year Outcomes and Predictors of Recurrence After a Single Procedure. Front Cardiovasc Med 2022; 9:836392. [PMID: 35571157 PMCID: PMC9091437 DOI: 10.3389/fcvm.2022.836392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe 5-year outcomes and predictors of atrial fibrillation (AF) recurrence following cryoballoon (CB) ablation in Chinese population remain scarce. Our aim was to report 5-year outcomes and predictors of AF recurrence following a single CB ablation procedure in a Chinese population.MethodsFrom December 2013 to August 2016, we included 256 consecutive patients (mean age: 58 ± 10.9 years old; female: 41.0%) with paroxysmal or persistent AF successfully underwent first-generation CB ablation at Fuwai hospital in this prospective study. All patients were followed at least 5 years or when there was recurrent AF. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.ResultsThe 5-year success rate after pulmonary vein isolation (PVI) by a single procedure was 59.4%. The recurrence rate was the highest (14.5%) within the first year after the index procedure, and then stabilized. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than patients with persistent AF (63.2% vs. 36.4%, log-rank P < 0.01). The overall incidence of complications related to CB ablation was 7.8%. Phrenic nerve injury (PNI) was the most common complication, with an incidence of 3.5%, and patients with PNI were recovered within the 1-year follow-up. Only persistent AF (HR 1.72, 95%CI 1.028–2.854, P < 0.05) was significantly and independently associated with an increased risk of AF recurrence after adjusting for other factors.ConclusionPulmonary vein isolation using CB ablation was safe and effective with an acceptable complication and 5-year success rate in a Chinese population with AF, and persistent AF was the independent predictor for 5-year AF recurrence after a single CB ablation procedure.
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Affiliation(s)
- Xiongbiao Chen
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Xia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yu Xia,
| | - Yuan Lin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Xiaofeng Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun Wang
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yanjun Chen
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jun Liu,
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Kobori A, Sasaki Y, Pak M, Ishikura M, Murai R, Okada T, Toyota T, Taniguchi T, Kim K, Ehara N, Kinoshita M, Kihara Y, Furukawa Y. Comparison of Cryoballoon and Contact Force-Sensing Radiofrequency Ablation for Persistent Atrial Fibrillation in Clinical Practice. Circ J 2022; 86:290-298. [PMID: 34565782 DOI: 10.1253/circj.cj-21-0608] [Citation(s) in RCA: 3] [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] [Indexed: 11/09/2022]
Abstract
BACKGROUND Outcomes of cryoballoon ablation for persistent atrial fibrillation (AF) are unclear, especially in Japanese patients, so the effectiveness and safety of cryoballoon ablation in clinical practice were retrospectively compared with those of contact force-sensing radiofrequency (CFRF) ablation including the high-power protocol. METHODS AND RESULTS Consecutive patients with persistent AF were reviewed, and 253 and 265 patients who underwent cryoballoon and CFRF ablation, respectively, were enrolled. The primary endpoint was atrial arrhythmia recurrence. The secondary endpoints were periprocedural complications and repeat ablation. The rate of additional left atrial (LA) ablation after pulmonary vein isolation (PVI) was similar between groups (68.8% cryoballoon vs. 74.0% CFRF, P=0.19). Freedom from atrial arrhythmia recurrence was comparable between groups over a follow-up of 25.5±12.5 months (72.3% cryoballoon vs. 69.8% CFRF; adjusted hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.59-1.21, P=0.36). Outcomes were similar in the subgroups of PVI alone and PVI plus additional LA ablation. LA posterior wall isolation, absence of defragmentation, and low creatine clearance, but not catheter selection, were associated with the primary endpoint. Periprocedural complications (adjusted HR 0.73, 95% CI 0.34-1.54, P=0.41) and repeat ablation (adjusted HR 1.11, 95% CI 0.71-1.74, P=0.64) were similar for both procedures. CONCLUSIONS Cryoballoon ablation for persistent AF in Japanese clinical practice had acceptable outcomes comparable to those of advanced CFRF ablation.
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Affiliation(s)
- Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Yasuhiro Sasaki
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Misun Pak
- Department of Cardiology, Kobe City Medical Center General Hospital
| | | | - Ryosuke Murai
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Taiji Okada
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Toshiaki Toyota
- Department of Cardiology, Kobe City Medical Center General Hospital
| | | | - Kitae Kim
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Natsuhiko Ehara
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Makoto Kinoshita
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Yasuki Kihara
- Department of Cardiology, Kobe City Medical Center General Hospital
| | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital
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Shigeta T, Yamauchi Y, Sagawa Y, Oda A, Tachibana S, Sudo K, Nakamura R, Okishige K, Goya M, Sasano T. Cryoballoon ablation of the left atrial posterior wall reduces recurrence of persistent atrial fibrillation in patients with non-paroxysmal atrial fibrillation. J Arrhythm 2021; 37:1477-1487. [PMID: 34887952 PMCID: PMC8637091 DOI: 10.1002/joa3.12654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/06/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND This study aimed to clarify the clinical outcomes of cryoballoon ablation of the left atrial (LA) posterior wall (LAPW), including the LA roof, in patients with non-paroxysmal atrial fibrillation (AF). METHODS We analyzed the outcomes of 284 patients with non-paroxysmal AF, of whom 210 underwent the cryoballoon ablation of the LAPW, including the LA roof, in addition to pulmonary vein isolation with a cryoballoon. RESULTS Complete conduction block at the LA roof was obtained in 95.7% (201/210) of patients, and LAPW was isolated in 83.3% (130/156) of patients. Over 372 (range, 208-477) days of follow-up, atrial arrhythmia recurrence was observed in 84 (29.6%) patients, and atrial tachycardia (AT) recurrence accounted for 27.4% of cases. The prevalence of LA roof cryoballoon ablation was significantly higher in patients without recurrence than in those with recurrence (78.6% vs. 63.1%, respectively; p = .01), especially those with persistent AF recurrence (77.0% vs. 55.0%, p = .01). No significant difference was found in the prevalence of AT recurrence between patients who had undergone additional LAPW ablation and those who had not. Durable LA roof lesions were confirmed in 29 (72.5%) of 40 patients who underwent redo ablation. CONCLUSIONS Cryoballoon ablation of the LAPW leads to a sufficient acute success rate of complete conduction block and durable lesions of the LA roof without increasing AT recurrence risk. The prevalence of persistent AF recurrence decreases after additional cryoballoon ablation of the LAPW in patients with non-paroxysmal AF.
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Affiliation(s)
- Takatoshi Shigeta
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Yasuteru Yamauchi
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
| | - Yuichiro Sagawa
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
| | - Atsuhito Oda
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
| | - Shinichi Tachibana
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
| | - Koji Sudo
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
| | - Rena Nakamura
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
| | - Kaoru Okishige
- Heart CenterJapan Red Cross Yokohama City Bay HospitalYokohama CityKanagawaJapan
| | - Masahiko Goya
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
| | - Tetsuo Sasano
- Department of Cardiovascular MedicineTokyo Medical and Dental UniversityTokyoJapan
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9
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Chun J, Maurer T, Rillig A, Bordignon S, Iden L, Busch S, Steven D, Tilz RR, Shin DI, Estner H, Bourier F, Duncker D, Sommer P, Ewertsen NC, Jansen H, Johnson V, Bertagnolli L, Althoff T, Metzner A. [Practical guide for safe and efficient cryoballoon ablation for atrial fibrillation : Practical procedure, tips and tricks]. Herzschrittmacherther Elektrophysiol 2021; 32:550-562. [PMID: 34735629 DOI: 10.1007/s00399-021-00820-0] [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: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 11/24/2022]
Abstract
In the current guidelines on treatment of atrial fibrillation, cryoballoon-based catheter ablation of atrial fibrillation is recommended in addition to radiofrequency ablation and has become established as a standard procedure in the clinical routine of many centers for index pulmonary vein isolation. A safe, simplified and often durable pulmonary vein isolation can be achieved by a systematic approach. This review article provides a practical guide for all steps of cryoballoon-based pulmonary vein isolation, including preprocedural preparation and postinterventional follow-up. Both cryoballoon systems currently available on the market are considered.
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Affiliation(s)
- Julian Chun
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland. .,Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland.
| | - Tilman Maurer
- Klinik für Kardiologie, Asklepios Klinik St. Georg, Hamburg, Deutschland
| | - Andreas Rillig
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
| | - Stefano Bordignon
- Med. Klinik III, Markuskrankenhaus, Cardioangiologisches Centrum Bethanien - CCB, Wilhelm-Epstein-Str. 4, 60431, Frankfurt, Deutschland
| | - Leon Iden
- Klinik für Kardiologie, Herz- und Gefäßzentrum Bad Segeberg, Bad Segeberg, Deutschland
| | - Sonia Busch
- Medizinische Klinik II, Klinikum Coburg GmbH, Coburg, Deutschland
| | - Daniel Steven
- Abteilung für Elektrophysiologie, Herzzentrum der Uniklinik Köln, Köln, Deutschland
| | - Roland R Tilz
- Sektion für Elektrophysiologie, Medizinische Klinik II, Universitäres Herzzentrum Lübeck, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Deutschland
| | - Dong-In Shin
- Klinik für Kardiologie, Herzzentrum Niederrhein, HELIOS Klinikum Krefeld, Krefeld, Deutschland.,Center for Clinical Medicine Witten-Herdecke, University Faculty of Health, Wuppertal, Deutschland
| | - Heidi Estner
- Medizinische Klinik und Poliklinik I, LMU Klinikum der Universität München, München, Deutschland
| | - Felix Bourier
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, München, Deutschland
| | - David Duncker
- Hannover Herzrhythmus Centrum, Klinik für Kardiologie und Angiologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Philipp Sommer
- Klinik für Elektrophysiologie/Rhythmologie, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Deutschland
| | - Nils-Christian Ewertsen
- Klinik für Innere Medizin - Kardiologie und konservative Intensivmedizin, Vivantes Klinikum Am Urban, Berliner-Herzrhythmus-Zentrum, Berlin, Deutschland
| | | | - Victoria Johnson
- Klinik für Innere Medizin, Universitätsklinikum Gießen, Gießen, Deutschland
| | - Livio Bertagnolli
- Abteilung für Rhythmologie, Herzzentrum HELIOS Leipzig, Leipzig, Deutschland
| | - Till Althoff
- Med. Klinik m.S. Kardiologie u. Angiologie, Charité - Universitätsmedizin Medizin Berlin, Berlin, Deutschland
| | - Andreas Metzner
- Universitäres Herzzentrum Hamburg, Universitätsklinikum Eppendorf, Hamburg, Deutschland
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10
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Tohoku S, Bordignon S, Bologna F, Chen S, Urbanek L, Operhalski F, Chun KJ, Schmidt B. Laser balloon in pulmonary vein isolation for atrial fibrillation: current status and future prospects. Expert Rev Med Devices 2021; 18:1083-1091. [PMID: 34618626 DOI: 10.1080/17434440.2021.1990754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Visually guided laser balloon (LB) catheter has been an established modality dedicated for pulmonary vein (PV) isolation in patients with atrial fibrillation. The newly updated version of this novel device has technically evolved recent years. AREAS COVERED This review will summarize the contemporary technical evolution of LB catheter. Available efficacy outcomes and the historical change of ablation style will be evaluated. Furthermore, the future perspectives for clinical practice are discussed. EXPERT COMMENTARY The initial LB ablation system provided comparable clinical results in PV isolation with other technologies, but with a unique strategical concept enabling the direct visualization of the tissue to cauterize. With multigenerational development, the LB catheter has been equipped with more compliant balloon for favorable PV occlusion and a robotically motor driven continuous ablation mode (RAPID mode). These technical innovations changed the concept of the ablation strategy using LB catheter as 'point-by-point' into 'single-shot' fashion. The remaining tasks are further improvements such as equipping with real-time recording system of intracardiac electrogram, durable structured balloon and the instrument for visualizing the cauterization area in a 360-degree panoramic view, which includes potential possibilities to develop this novel device to the more optimal device for PV isolation.
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Affiliation(s)
- Shota Tohoku
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Stefano Bordignon
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Fabrizio Bologna
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Shaojie Chen
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Lukas Urbanek
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany
| | - Felix Operhalski
- Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
| | - Kr Julian Chun
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Academy for Arrhythmias (FAFA), Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Cardioangiologisches Centrum Bethanien, Frankfurt, Germany.,Universitätsklinikum Frankfurt, Medizinische Klinik 3- Klinik für Kardiologie, Frankfurt, Germany
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11
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Bisignani A, Pannone L, Bala G, Kazawa S, Calburean P, Overeinder I, Monaco C, Lipartiti F, Miraglia V, Rizzi S, Al Housari M, Mojica J, Strazdas A, Osório TG, Sieira J, Iacopino S, Almorad A, Ströker E, Sorgente A, Brugada P, de Asmundis C, Chierchia GB. Repeat procedures for recurrent persistent atrial fibrillation: A propensity-matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon. J Arrhythm 2021; 37:1287-1294. [PMID: 34621427 PMCID: PMC8485792 DOI: 10.1002/joa3.12614] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/10/2021] [Accepted: 07/28/2021] [Indexed: 11/08/2022] Open
Abstract
AIMS To evaluate the clinical outcome in patients undergoing repeat procedures for recurrent persistent atrial fibrillation following an index cryoballoon (CB-A) pulmonary vein isolation ablation on a mid-term follow-up of 12 months. METHODS In this propensity score-matched comparison, 50 patients undergoing left atrial posterior wall isolation (LAPWI) with the CB-A were matched to 50 patients treated with additional linear ablation using radiofrequency catheter ablation (RFCA). RESULTS Meantime to repeat the procedure was 9.74 ± 4.36 months. At 12 months follow-up freedom from atrial tachyarrhythmias (ATas) was achieved in 82% of patients in the LAPWI group and in 62% of patients in the linear ablation group (P = .03). Regression analysis demonstrated that relapses during the blanking period and LA dimensions were independent predictors of ATas recurrences following the repeat procedure. CONCLUSION LAPWI using CB-A is associated with a significantly higher freedom from atrial arrhythmias when compared with the RFCA mediated left atrial linear lesions on a mid-term follow-up of 12 months in patients with persAF undergoing a redo procedure.
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Affiliation(s)
- Antonio Bisignani
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
- Institute of Cardiology Catholic University of the Sacred Heart Rome Italy
| | - Luigi Pannone
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Shuichiro Kazawa
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Paul Calburean
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Felicia Lipartiti
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Sergio Rizzi
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Maysam Al Housari
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Joerelle Mojica
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Antanas Strazdas
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre Universitair Ziekenhuis Brussel Postgraduate Program in Cardiac Electrophysiology and Pacing European Reference Networks Guard-Heart Vrije Universiteit Brussel Brussels Belgium
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12
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Xu G, Cai J, Liu Z, Liu E, Jing X, Liu T, Zhang Q, Ye L, Li G. Clinical efficacy of "ICE-FIRE" ablation for non-paroxysmal atrial fibrillation. J Interv Card Electrophysiol 2021; 60:205-211. [PMID: 32193775 DOI: 10.1007/s10840-020-00725-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Catheter ablation is less successful for non-paroxysmal atrial fibrillation (NPAF) according to numerous follow-up studies. The choice of ablation strategy for patients with NPAF remains controversial. The objective of the study was to explore the clinical efficacy of the "ICE-FIRE" ablation. METHODS Ninety NPAF patients were enrolled. Patients were randomly divided into RF (treated with circumferential pulmonary vein isolation (CPVI) and additional substrate modification by radiofrequency ablation) group and I-F (treated with CPVI by cryoablation and additional substrate modification by radiofrequency ablation) group. After CPVI and cardioversion to sinus rhythm, high-density mapping was performed. Eight-one of 90 participants restored to sinus rhythm. Seventy-four of 81 NPAF patients showed low-voltage zone. Substrates with low-voltage zone were targeted for further modification. Participants were followed at baseline, 3, 6, 9, and 12 months after the initial ablation. RESULTS The I-F group shared more X-ray exposure (I-F, 264.4 ± 97.4 mGy; RF, 224.9 ± 62.0 mGy; P = 0.039) and less duration of the procedure (I-F, 150.3 ± 27.5 min; RF, 174.2 ± 38.5 min; P = 0.003) compared to RF group. The freedom from atrial arrhythmia recurrence at 12 months post-ablation was similar between the RF and I-F groups (RF, 57.1%; I-F, 71.8%; P = 0.197). However, I-F group experienced lower rehospitalization rate of AF recurrence (RF, 42.9%; I-F, 20.5%; P = 0.038). CONCLUSIONS In NPAF patients requiring substrate mapping and modification, the "ICE-FIRE" ablation demonstrated non-inferior clinical efficacy and lower rehospitalization rate of AF recurrence when compared with pure radiofrequency ablation strategy.
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Affiliation(s)
- Gang Xu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Jiageng Cai
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Zhaohong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Enzhao Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China.
| | - Xiangyang Jing
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Tong Liu
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Qitong Zhang
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Lan Ye
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
| | - Guangping Li
- Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, No. 23 Pingjiang Road, Hexi District, Tianjin, 300211, People's Republic of China
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13
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Bisignani A, Cecchini F, Mugnai G, Overeinder I, Sieira J, Osório TG, Miraglia V, Monaco C, Sofianos D, Boveda S, Bala G, Ströker E, Paparella G, Westra SW, Brouwer MA, Brugada P, de Asmundis C, Chierchia GB. Single procedural outcomes in the setting of percutaneous ablation for persistent atrial fibrillation: a propensity-matched score comparison between different strategies. J Interv Card Electrophysiol 2021; 64:9-16. [PMID: 33629193 DOI: 10.1007/s10840-021-00968-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 02/18/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Catheter ablation for persistent atrial fibrillation (persAF) is associated with less favorable outcomes than for paroxysmal AF. To improve success rates, left atrial (LA) substrate modification is frequently performed in addition to pulmonary vein isolation (PVI). The purpose of the study was to compare 4 different ablation approaches using radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CB-A) for persAF and to evaluate the respective outcomes on a midterm follow-up of 12 months. METHODS We did a propensity score-matched comparison of 30 patients undergoing PVI + LA posterior wall isolation (LAPWI) with CB-A, 30 patients who underwent PVI + linear ablation (roof and mitral lines) using RFCA, 60 patients with PVI alone using CB-A, and 60 patients who had PVI alone using RFCA. The endpoint was recurrence of documented atrial tachyarrhythmias (ATas) > 30 s at 1-year follow-up. RESULTS After 12 months, freedom from ATas after a single procedure was 83.3% in the PVI + LAPWI group, 46.7% in the PVI + linear ablation group, 58.3% in the PVI-alone CB-A group, and 61.6% PVI-alone RFCA (p = 0.03). Moreover, freedom from ATas was significantly higher comparing the PVI + LAPWI group with each of the other groups. CONCLUSIONS In this propensity-matched comparison of strategies for persAF, LAPW ablation in addition to PVI with CB-A seems to improve 1-year outcome in comparison to PVI + linear ablation using RFCA and to PVI alone using RFCA or CB-A. Randomized comparisons are eagerly awaited.
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Affiliation(s)
- Antonio Bisignani
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
- Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Federico Cecchini
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Giacomo Mugnai
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Thiago Guimarães Osório
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Vincenzo Miraglia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dimitrios Sofianos
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Serge Boveda
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Sjoerd W Westra
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marc A Brouwer
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Pedro Brugada
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Vrije Universiteit Brussel, Brussels, Belgium.
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14
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Intracardiac echocardiography guided nonocclusive balloon cryothermal applications to achieve antral isolation during pulmonary vein isolation. J Interv Card Electrophysiol 2020; 62:329-336. [PMID: 33106958 DOI: 10.1007/s10840-020-00905-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/21/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Ablation for atrial fibrillation (AF) requires electrical isolation of the pulmonary veins (PV) by wide-area circumferential PV antral isolation (PVAI). Cryoballoon ablation delivers cryoenergy circumferentially after occlusion of the PV by the cryoballoon; thus, it is likely that the level of isolation, determined by adequate balloon-tissue contact, depends on PV anatomy. We sought to examine the need for nonocclusive segmental cryoballoon ablation in achieving antral isolation, describe methods of accurate visualization of the cryoballoon using intracardiac echocardiography (ICE), and provide data on biophysical characteristics of an effective nonocclusive cryothermal lesion. METHODS Forty consecutive patients undergoing catheter ablation with a second-generation 28-mm cryoballoon and electroanatomic mapping (EAM) were included. Balloon was visualized with ICE, and its location was registered in EAM using available technology (CARTOSOUND, Biosense Webster). Need for delivery of nonocclusive lesions was based on level of isolation post occlusive lesions. RESULTS Nonocclusive lesions to PVAI was required in 26 of 40 patients (65%) or 46 out of 148 veins (31%). Left PVs > 19.4 ± 2.9 mm, right superior PV > 20.2 ± 4.7mm, funnel-shaped PVs, and right PVs not converging to a carina were more likely to require nonocclusive lesions to achieve an antral level of isolation. Projection of balloon contour on EAM using CARTOSOUND successfully predicted level of isolation by voltage mapping. CONCLUSION Nonocclusive cryoballoon applications are commonly required to achieve antral isolation. Use of ICE can be helpful in determining the accurate location of the balloon and in predicting the level of isolation by voltage map.
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Nishimura T, Okishige K, Yamauchi Y, Shigeta T, Nakamura R, Hirao T, Sasano T, Hirao K. Clinical impact of rapid ventricular pacing on the left atrial posterior wall isolation by a cryoballoon application: a randomized controlled trial. J Interv Card Electrophysiol 2020; 59:565-573. [DOI: 10.1007/s10840-019-00641-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Accepted: 10/07/2019] [Indexed: 12/29/2022]
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16
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Kuniss M, Akkaya E, Berkowitsch A, Zaltsberg S, Greiss H, Rechner M, Weipert K, Hain A, Hamm CW, Neumann T. Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon: benefit or wasted time? Clin Res Cardiol 2019; 109:714-724. [DOI: 10.1007/s00392-019-01560-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 10/16/2019] [Indexed: 10/25/2022]
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17
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Chun JKR, Bordignon S, Chen S, Tohoku S, Bologna F, Urbanek L, Schmidt BH. Current Status of Atrial Fibrillation Ablation with Balloon Strategy. Korean Circ J 2019; 49:991-1001. [PMID: 31646768 PMCID: PMC6813157 DOI: 10.4070/kcj.2019.0226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 07/18/2019] [Indexed: 01/09/2023] Open
Abstract
Catheter ablation of atrial fibrillation (AF) has been established worldwide and is recommended for symptomatic paroxysmal AF patients according to international guidelines. Importantly, the cornerstone of any AF ablation represents pulmonary vein isolation (PVI). Traditional radiofrequency (RF) point by point ablation within a 3D electroanatomic left atrial (LA) map requires profound understanding of LA anatomy and electrophysiology. This ablation strategy can be highly efficient and safe if performed in experienced hands and centers. However, procedural complexity causes a long learning curve and has limited its wide spread utilization. In contrast, balloon based PVI ablation strategies are based on an anatomic principle. Currently, two balloon types (cryoballoon and laserballoon) have been adopted to clinical routine. Both balloons are positioned at the target PV and circumferential energy ablation is enabled. This simplified anatomic approach facilitates reaching the procedural endpoint of PVI and demonstrated less operator dependency. Therefore, balloon PVI appears to be associated with improved procedural reproducibility and safety. Importantly, large scale randomized trials proved non-inferiority of balloon guided AF ablation (cryothermal and laser energy) vs. experienced operators using traditional “gold standard” RF ablation in paroxysmal and persistent AF. Ongoing technological refinements of both balloons as well as the introduction of novel energy dosing strategies and ablation targets may potentially impact the current way of ablating AF in future. This review will summarize current clinical experience of contemporary balloon devices and will look into future developments.
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Affiliation(s)
- Julian Kyoung Ryul Chun
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.
| | - Stefano Bordignon
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shaojie Chen
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Lukas Urbanek
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Heinrich Schmidt
- Medizinische Klinik III, CCB Kardiologie, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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Akkaya E, Berkowitsch A, Rieth A, Erkapic D, Hamm CW, Neumann T, Kuniss M. Clinical outcome and left atrial function after left atrial roof ablation using the cryoballoon technique in patients with symptomatic persistent atrial fibrillation. Int J Cardiol 2019; 292:112-118. [DOI: 10.1016/j.ijcard.2019.04.091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/16/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
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Patel K, Romero J, Di Biase L. Persistent atrial fibrillation: should we always ice the back of the left atrium? J Interv Card Electrophysiol 2019; 56:95-97. [PMID: 31342223 DOI: 10.1007/s10840-019-00586-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Kavisha Patel
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, 111 East 210th St, Bronx, NY, USA
| | - Jorge Romero
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, 111 East 210th St, Bronx, NY, USA
| | - Luigi Di Biase
- Division of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, 111 East 210th St, Bronx, NY, USA.
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Canpolat U, Kocyigit D, Aytemir K. Complications of Atrial Fibrillation Cryoablation. J Atr Fibrillation 2017; 10:1620. [PMID: 29487676 PMCID: PMC5821627 DOI: 10.4022/jafib.1620] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 12/18/2022]
Abstract
Catheter ablation either by using radiofrequency or cryo energy in symptomatic patients with atrial fibrillation (AF) has shown to be effective as compared to anti-arrhythmic drugs. However, all the techniques used during AF ablation are not free of complication. There are several well-known peri-procedural complications in which operators should be informed of the possible risks, cautious during the procedure and able to manage them when occurred. Herein, we aimed to review possible complications of AF cryoablation.
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Affiliation(s)
- Ugur Canpolat
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Duygu Kocyigit
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
| | - Kudret Aytemir
- Hacettepe University Faculty of Medicine, Department of Cardiology, Ankara, Turkey
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Omran H, Gutleben KJ, Molatta S, Fischbach T, Wellmann B, Horstkotte D, Körber B, Nölker G. Second generation cryoballoon ablation for persistent atrial fibrillation: an updated meta-analysis. Clin Res Cardiol 2017; 107:182-192. [PMID: 29075979 DOI: 10.1007/s00392-017-1171-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/10/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND Catheter ablation is an established treatment option for patients with symptomatic atrial fibrillation (AF). The cornerstone of AF ablation is pulmonary vein isolation (PVI). The second-generation cryoballoon (2G-CB) has shown non-inferiority to radiofrequency (RF) ablation in paroxysmal AF in several trials. Growing evidence suggests that 2G-CB is also effective in patients with persistent AF (perAF). The aim of this study was to summarize and analyze available data on safety and mid-term (≥ 12 months) efficacy of PVI using 2G-CB in patients with perAF. METHODS We did a search in PubMed, Web of Science, Cochrane Library, and clinicaltrials.gov in December 2016 for studies of 2G-CB ablation for perAF. Studies reporting clinical success rates at a follow-up (FU) of ≥ 12 months were included. Success was defined as freedom from any atrial arrhythmia lasting > 30 s after an initial blanking period of 3 months. Acute success and complication rates were also assessed. Data were analyzed applying random-effects model. RESULTS A total of 917 patients from 11 studies meeting study inclusion criteria were analyzed. After a mean FU of 16.7 ± 3.0 months, 68.9% were free from recurrences [95% confidence interval (CI) 63.4-74.7%]. Overall acute success rate was 99.7% (95% CI 99.2-100%). Complications occurred in 5.5% (95% CI 2.4-9.6%). Vascular access complications were the most frequent 3.3% (95% CI 1.5-5.6%). The rate of phrenic nerve palsy/injury was 2.09% (95% CI 0.8-3.9%). No death, stroke or myocardial infarction was reported. CONCLUSION The 2G-CB seems to be safe and effective in the treatment of perAF in the mid-term.
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Affiliation(s)
- Hazem Omran
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany.
| | - Klaus-Jürgen Gutleben
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Stephan Molatta
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Thomas Fischbach
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Birgit Wellmann
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Britta Körber
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
| | - Georg Nölker
- Clinic for Cardiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Georgstraße 11, 32545, Bad Oeynhausen, Germany
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