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Urbanek L, Schmidt B, Bordignon S, Schaack D, Ebrahimi R, Tohoku S, Hirokami J, Efe TH, Plank K, Schulte-Hahn B, Nowak B, Chun JKR, Chen S. Cryoablation of atrial fibrillation in "very severe" obese patients (BMI ≥ 40): Indications, feasibility, procedural safety and efficacy, and clinical outcome (the ICE-Obese Extreme). J Cardiovasc Electrophysiol 2024; 35:1412-1421. [PMID: 38750671 DOI: 10.1111/jce.16302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/23/2024] [Accepted: 04/28/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Management of atrial fibrillation (AF) in very severe obese patients is challenging. Cryoballoon ablation (CBA) represents an effective rhythm control strategy. However, data in this patient group were limited. METHODS Highly symptomatic AF patients with body mass index (BMI) ≥ 40 kg/m2 who had failed antiarrhythmic drug therapy and electrocardioversion and failure to achieve targeted body-weight-reduction underwent CBA. RESULTS Data of 72 very severe obese AF patients (Group A) and 129 AF patients with normal BMI (Group B, BMI < 25 kg/m2) were consecutively collected. Group A had significantly younger age (60.6 ± 10.4 vs. 69.2 ± 11.2 years), higher BMI (44.3 ± 4.3 vs. 22.5 ± 1.6 kg/m2). Procedural pulmonary vein isolation (PVI) was successful in all patients (2 touch-up ablation in Group A). Compared to Group B, Group A had similar procedural (61.3 ± 22.6 vs. 57.5 ± 19 min), similar fluoroscopy time (10.1 ± 5.5 vs. 9.2 ± 4.8 min) but significantly higher radiation dose (2852 ± 2095 vs. 884 ± 732 µGym2). We observed similar rates of real-time-isolation (78.6% vs. 78.5%), single-shot-isolation (86.5% vs. 88.8%), but significantly longer time-to-sustained-isolation (53.5 ± 33 vs. 43.2 ± 25 s). There was significantly higher rate of puncture-site-complication (6.9% vs. 1.6%) in Group A. One-year clinical success in paroxysmal AF was (Group A: 69.4% vs. Group B: 80.2%; p < .001), in persistent AF was (Group A: 58.1% vs. Group B: 62.8%; p = .889). In Re-Do procedures Group A had a numerically lower PVI durability (75.0% vs. 83.6%, p = .089). CONCLUSION For very severe obese AF patients, CBA appears feasible, leads to relatively good clinical outcome.
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Affiliation(s)
- Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - David Schaack
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Ramin Ebrahimi
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Jun Hirokami
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Tolga Han Efe
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Britta Schulte-Hahn
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Bernd Nowak
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
| | - Julian K R Chun
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
- Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe-Universität, Frankfurt am Main, Germany
- Section of Rhythmology/Electrophysiology, Department of Internal Medicine B (Kardiologie, Angiologie, Pneumologie/Infektiologie und internistische Intensivmedizin), University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, Germany
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Ellenbogen KA, Mittal S, Varma N, Aryana A, Marrouche N, Anić A, Nair D, Champagne J, Iacopino S, de Asmundis C, Weiner S, Makati K, Raybuck JD, Richards E, Su W. One-year outcomes of pulmonary vein isolation with a novel cryoballoon: Primary results of the FROZEN AF trial. J Cardiovasc Electrophysiol 2024; 35:832-842. [PMID: 38448797 DOI: 10.1111/jce.16220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 01/27/2024] [Accepted: 02/05/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Cryoablation therapy for pulmonary vein isolation (PVI) to treat paroxysmal atrial fibrillation (PAF) is well established. A novel 28 mm cryoballoon system designed to operate under low pressure to safely reach a lower nadir temperature and maintain constant balloon size during cooling has not been prospectively studied in a large patient population for safety and efficacy. The FROZEN AF (NCT04133168) trial was an international multicenter, open-label, prospective, single-arm study on the safety and performance of a novel cryoballoon system for treatment of PAF. METHODS AND RESULTS The study enrolled patients at 44 sites in 10 countries across North America, Europe, and Asia. Subjects were indicated for PVI treatment of PAF and had failed or were intolerant of one or more antiarrhythmic drugs. Procedural outcomes were defined based on the 2017 HRS consensus statement. Follow-up was performed at 7 days, 3, 6, and 12 months. Data are reported as mean ± SD or median (IQR). PVI was performed with a 28 mm cryoballoon in 325 drug refractory PAF patients. Complete PVI was achieved in 95.7% of patients. In cryoablation lesions longer than 60 s, 60.1% of PV isolations required only a single cryoballoon application. Procedure related complications included: phrenic nerve palsy [temporary 4 (1.2%), persistent 0 (0.0%)], cardiac tamponade/perforation 2 (0.6%), and air embolism 1 (0.3%). Freedom from documented atrial arrhythmia recurrence at 12 months was 79.9% (AF 82.7%, AFL 96.5%, AT 98.1%), antiarrhythmic drugs (AAD) were continued or re-initiated in 26.8% of patients after the 3-month blanking period. Additionally, an extension arm enrolled 50 pts for treatment with 28/31 mm variable size cryoballoon. A single temporary PNP occurred in this group, which resolved before discharge. Freedom from documented recurrence at 12 months in these pts was 82.0%. CONCLUSIONS This novel cryoballoon may facilitate PVI to treat PAF, providing more options to address the variety of anatomies present in patients with PAF. This cryoballoon system proved to be safe and effective for treatment of patients with drug refractory or drug intolerant PAF.
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Affiliation(s)
- Kenneth A Ellenbogen
- Division of Cardiology, Virginian Commonwealth University, Richmond, Virginia, USA
| | | | | | - Arash Aryana
- Mercy General Hospital, Sacramento, California, USA
| | - Nassir Marrouche
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Ante Anić
- University Hospital Split, Split, Croatia
| | - Devi Nair
- Arrhythmia Research Group, Jonesboro, Arkansas, USA
| | - Jean Champagne
- Institut Universitaire de Cardiologie et de Pneumologie de Quebec, Quebec, Canada
| | | | | | - Stanislav Weiner
- Christus Trinity Mother Frances Health System, Tyler, Texas, USA
| | | | | | | | - Wilber Su
- Banner University Medical Center, Phoenix, Arizona, USA
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Liao Y, Tomaiko-Clark ED, Martinez J, Shinoda Y, Morris MF, Liu Z, Shatz DY, Katrapati P, Sahara N, Weiss JP, Zawaneh MS, Tung R, Bai R, Su W. Incidence of cryoballoon expansion dislodgement during pulmonary vein isolation-An underappreciated frequent cause of incomplete isolation. Pacing Clin Electrophysiol 2024; 47:347-352. [PMID: 38140909 DOI: 10.1111/pace.14910] [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: 06/22/2023] [Revised: 11/08/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Cryoballoon ablation for atrial fibrillation (AF) requires adequate contact between the pulmonary vein (PV) antrum and cryoballoon. The surge of intraballoon pressure during the initial phase of ablation may change the balloon's shape and compliance, resulting in balloon dislodgement and loss of PV occlusion. Without continuous monitoring, this phenomenon is often undetected but can be associated with incomplete PV isolation (PVI). METHODS Primary cryoablation of AF was performed in 15 patients. PV occlusion status pre- and post-freezing were analyzed with intracardiac echocardiography (ICE) and dielectric imaging-based occlusion tool (DIOT) to calculate the incidence of expansion dislodgement of cryoballoon. RESULTS A total of 105 cryoablation applications were performed on 57 veins, including three common ostiums of left pulmonary veins. In the evaluation of PV occlusion, both modalities reported consistent results in 86.7% of the assessments. Despite complete PV occlusion before ablation, peri-balloon leak after initiation of freezing was detected by ICE in 5/22 (22.7%) applications and by DIOT in 8/25 (32%) applications. CONCLUSION Incidence of expansion dislodgement of the cryoballoon was detected in one-fourth to one-third of cryoablation applications depending on the imaging modality used, which was clinically frequent and significant.
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Affiliation(s)
- Yu Liao
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- National Cheng Kung University Hospital, Tainan, Taiwan
| | | | - Jake Martinez
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Yasutoshi Shinoda
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Michael F Morris
- Division of Radiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Zhao Liu
- EPD Solutions, Best, Netherlands
| | - Dalise Yi Shatz
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Praneeth Katrapati
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Naohiko Sahara
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Toho University Ohashi Medical Center, Tokyo, Japan
| | - J Peter Weiss
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Michael S Zawaneh
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Roderick Tung
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Rong Bai
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Wilber Su
- Division of Cardiology, Banner University Medical Center Phoenix, University of Arizona College of Medicine, Phoenix, Arizona, USA
- University of Arizona College of Medicine, Phoenix, Arizona, USA
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Hopman LHGA, van Pouderoijen N, Mulder MJ, van der Laan AM, Bhagirath P, Nazarian S, Niessen HWM, Ferrari VA, Allaart CP, Götte MJW. Atrial Ablation Lesion Evaluation by Cardiac Magnetic Resonance: Review of Imaging Strategies and Histological Correlations. JACC Clin Electrophysiol 2023; 9:2665-2679. [PMID: 37737780 DOI: 10.1016/j.jacep.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023]
Abstract
Cardiac magnetic resonance (CMR) imaging is a valuable noninvasive tool for evaluating tissue response following catheter ablation of atrial tissue. This review provides an overview of the contemporary CMR strategies to visualize atrial ablation lesions in both the acute and chronic postablation stages, focusing on their strengths and limitations. Moreover, the accuracy of CMR imaging in comparison to atrial lesion histology is discussed. T2-weighted CMR imaging is sensitive to edema and tends to overestimate lesion size in the acute stage after ablation. Noncontrast agent-enhanced T1-weighted CMR imaging has the potential to provide more accurate assessment of lesions in the acute stage but may not be as effective in the chronic stage. Late gadolinium enhancement imaging can be used to detect chronic atrial scarring, which may inform repeat ablation strategies. Moreover, novel imaging strategies are being developed, but their efficacy in characterizing atrial lesions is yet to be determined. Overall, CMR imaging has the potential to provide virtual histology that aids in evaluating the efficacy and safety of catheter ablation and monitoring of postprocedural myocardial changes. However, technical factors, scanning during arrhythmia, and transmurality assessment pose challenges. Therefore, further research is needed to develop CMR strategies to visualize the ablation lesion maturation process more effectively.
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Affiliation(s)
| | | | - Mark J Mulder
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | | | - Pranav Bhagirath
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Saman Nazarian
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | - Hans W M Niessen
- Department of Pathology, Amsterdam UMC, Amsterdam, the Netherlands
| | - Victor A Ferrari
- Penn Cardiovascular Institute, Penn Heart and Vascular Center, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania, USA
| | | | - Marco J W Götte
- Department of Cardiology, Amsterdam UMC, Amsterdam, the Netherlands.
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A novel alternating second-generation cryoballoon or contact-force guided radiofrequency catheter ablation strategy for redo-ablation in patients with recurrent atrial fibrillation: a single-center experience. J Interv Card Electrophysiol 2022; 65:739-750. [PMID: 35945311 DOI: 10.1007/s10840-022-01321-x] [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: 04/22/2022] [Accepted: 07/21/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pulmonary vein (PV) reconnection after radiofrequency (RFC) or cryoballoon (CB) pulmonary vein isolation (PVI) is common. METHOD We report a single-center experience of 156 patients who underwent a redo procedure-ablation strategy for recurrent atrial fibrillation (AF) in a reverse sequence after a failed index RFC or CB PVI. RESULTS A total of 60 patients after index CB PVI underwent RFC-redo ablation (CB-RFC redo), and 96 patients after index RFC PVI underwent CB-redo ablation (RFC-CB redo). During the redo procedure, the proportion of patients with PV reconnection was lower after index CB PVI procedure compared with the proportion of patients after index RFC PVI (88.3% versus 98.9%, p = 0.01). Additionally, a mean number of 1.50 ± 0.8 PVs/patient were reconnected after index CB PVI, compared with 3.36 ± 0.9 PVs/patient after index RFC PVI (p = 0.001). Patients after index RFC PVI frequently presented with ≥ 3 reconnected PVs, compared with index CB PVI (70.8% vs 10%, p < 0.001). At a 2-year follow-up, 43 patients (27.6%) developed recurrence after redo ablation, with a similar AF-free outcome (CB-RFC redo:73.3% vs RFC-CB redo: 71.9%, p = 0.873). In the multivariate analysis, persistent AF (HR = 2.107, 95% CI: 1.085-4.091, p = 0.028) and early AF recurrence after the initial ablation (HR = 2.431, 95% CI: 1.279-4.618, p = 0.007) were independent predictors of AF recurrence. CONCLUSIONS The extent and distribution of PV reconnections were different after index RFC and CB PVI procedures. Alternating CB or RFC ablation technique strategy is effective with a similar long-term outcome, and it may be an appropriate option for repeated AF ablation.
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Miyama H, Takatsuki S. Less Invasive Ablation of Atrial Fibrillation Achieved by Contrast-Free Cryoballoon Ablation. Circ J 2022; 86:266-267. [PMID: 34497161 DOI: 10.1253/circj.cj-21-0674] [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] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Miyama
- Department of Cardiology, Keio University School of Medicine
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine
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7
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Suzuki A, Fujiwara R, Asada H, Iwasa K, Miyata T, Song WH, Higuchi K, Seo H, Sakamoto Y, Shimizu M, Soga F, Shibata H, Kozuki A, Nagoshi R, Lehmann HI, Kijima Y, Shite J. Peri-Balloon Leak Flow Velocity Assessed by Intra-Cardiac Echography Predicts Pulmonary Vein Electrical Gap - Intra-Cardiac Echography-Guided Contrast-Free Cryoballoon Ablation. Circ J 2022; 86:256-265. [PMID: 34334554 DOI: 10.1253/circj.cj-21-0423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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 The use of iodine contrast agents is one possible limitation in cryoballoon ablation (CBA) for atrial fibrillation (AF). This study investigated intracardiac echography (ICE)-guided contrast-free CBA. METHODS AND RESULTS The study was divided into 2 phases. First, 25 paroxysmal AF patients (Group 1) underwent CBA, and peri-balloon leak flow velocity (PLFV) was assessed using ICE and electrical pulmonary vein (PV) lesion gaps were assessed by high-density electroanatomical mapping. Then, 24 patients (Group 2) underwent ICE-guided CBA and were compared with 25 patients who underwent conventional CBA (historical controls). In Group 1, there was a significant correlation between PLFV and electrical PV gap diameter (r=-0.715, P<0.001). PLFV was higher without than with an electrical gap (mean [±SD] 127.0±28.6 vs. 66.6±21.0 cm/s; P<0.001) and the cut-off value of PLFV to predict electrical isolation was 105.7 cm/s (sensitivity 0.700, specificity 0.929). In Group 2, ICE-guided CBA was successfully performed with acute electrical isolation of all PVs and without the need for "rescue" contrast injection. Atrial tachyarrhythmia recurrence at 6 months did not differ between ICE-guided and conventional CBA (3/24 [12.5%] vs. 5/25 [20.0%], respectively; P=0.973, log-rank test). CONCLUSIONS PLFV predicted the presence of an electrical PV gap after CBA. ICE-guided CBA was feasible and safe, and could potentially be performed completely contrast-free without a decrease in ablation efficacy.
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Affiliation(s)
- Atsushi Suzuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Ryudo Fujiwara
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Hiroyuki Asada
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Kohei Iwasa
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | - Woo Hyung Song
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Kotaro Higuchi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Hidenobu Seo
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Yuki Sakamoto
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | - Fumitaka Soga
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | | | - Amane Kozuki
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Ryoji Nagoshi
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - H Immo Lehmann
- Department of Cardiology, Massachusetts General Hospital, Corrigan Minehan Heart Center
- Harvard Medical School
| | - Yoichi Kijima
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
| | - Junya Shite
- Department of Cardiology, Osaka Saiseikai Nakatsu Hospital
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Álvarez-Ortega CA, Ruiz MA, Solórzano-Guillén C, Barrera A, Toquero-Ramos J, Martínez-Alday JD, Grande C, Segura JM, García-Alberola A, Moriña-Vázquez P, Ferrero-de-Loma-Osorio Á, Villuendas R, Cózar R, Arcocha MF, Ibañez A, Peinado R. Time to -30°C as a predictor of acute success during cryoablation in patients with atrial fibrillation. Cardiol J 2021; 30:534-542. [PMID: 34708863 PMCID: PMC10508066 DOI: 10.5603/cj.a2021.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 08/29/2021] [Accepted: 09/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Freezing rate of second-generation cryoballoon (CB) is a biophysical parameter that could assist pulmonary vein isolation. The aim of this study is to assess freezing rate (time to reach -30°C ([TT-30C]) as an early predictor of acute pulmonary vein isolation using the CB. METHODS Biophysical data from CB freeze applications within a multicenter, nation-wide CB ablation registry were gathered. Successful application (SA), was defined as achieving durable intraprocedural vein isolation. And SA with time to isolation under 60 s (SA-TTI<60) as achieving durable vein isolation in under 60 s. Logistic regressions were performed and predictive models were built for the data set. RESULTS 12,488 CB applications from 1,733 atrial fibrillation (AF) ablation procedures were included within 27 centers from a Spanish CB AF ablation registry. SA was achieved in 6,349 of 9,178 (69.2%) total freeze applications, and SA-TTI<60 was obtained in 2,673 of 4,784 (55.9%) freezes where electrogram monitoring was present. TT-30C was shorter in the SA group (33.4 ± 9.2 vs 39.3 ± 12.1 s; p < 0.001) and SA-TTI<60 group (31.8 ± 7.6 vs. 38.5 ± 11.5 s; p < 0.001). Also, a 10 s increase in TT-30C was associated with a 41% reduction in the odds for an SA (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.56-0.63) and a 57% reduction in the odds for achieving SA-TTI<60 (OR 0.43; 95% CI 0.39-0.49), when corrected for electrogram visualization, vein position, and application order. CONCLUSIONS Time to reach -30°C is an early predictor of the quality of a CB application and can be used to guide the ablation procedure even in the absence of electrogram monitoring.
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Affiliation(s)
- Carlos Antonio Álvarez-Ortega
- Arrhythmia Unit, Cardiology Department, University Hospital La Paz, Madrid, Spain.
- Cardiology Department, University Hospital Torrejón, Spain.
| | | | | | - Alberto Barrera
- Hospital Clínico Universitario, Virgen de la V ictoria, Málaga, Spain
| | | | | | | | | | | | | | | | | | - Rocío Cózar
- Hospital Universitario Vírgen Macarena, Sevilla, Spain
- Hospital Nisa Aljarafe, Sevilla, Spain
| | | | - Alicia Ibañez
- Alicante University Genaral Hospital, Alicante, Spain
| | - Rafael Peinado
- Arrhythmia Unit, Cardiology Department, University Hospital La Paz, Madrid, Spain
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Kobori A, Sasaki Y, Pak M, Okada T, Toyota T, Kim K, Kitai T, Ehara N, Kinoshita M, Kaji S, Kihara Y, Furukawa Y. Early experiences with three types of balloon-based ablation catheters in patients with paroxysmal atrial fibrillation. Heart Rhythm O2 2021; 2:223-230. [PMID: 34337572 PMCID: PMC8322794 DOI: 10.1016/j.hroo.2021.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Although balloon-based ablation catheters are expected to improve the feasibility and quality of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF), they must be introduced to physicians in the proper setting to ensure their correct usage. Objective To identify the optimal clinical settings for learning the techniques for 3 balloon-based ablation catheters (Cryoballoon, Hotballoon, and Laserballoon). Methods We introduced 3 balloon catheters in 50 consecutive patients with paroxysmal AF each during the introduction periods. Clinical parameters were compared among the groups and between these groups and their steady-state controls. Results The completion rate of PVI by sole balloon procedures was 56% with the Hotballoon catheter, which was lower than those of the Cryoballoon and Laserballoon catheters (each 88%). Radiofrequency touch-up was most frequently required at the bottom aspect of the inferior pulmonary veins (PVs) in the Cryoballoon group and at the anterior aspect of the superior PVs in the Hotballoon and Laserballoon groups. The Laserballoon catheter had the longest average PVI procedural time (89.2 ± 40 vs 58.4 ± 22 minutes for Hotballoon, 65.1 ± 25 minutes for Cryoballoon, P < .001), but the difference was ultimately removed by the learning curve. There was no significant difference in the major complication or recurrence-free survival rates among the catheter types. Conclusions All 3 balloon-based catheter types allowed feasibility and quality for PVI, even during the learning period. To introduce these new catheters without complications, an experiences of 20 cases with specific clinical settings should be met for each catheter type.
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Affiliation(s)
- Atsushi Kobori
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuhiro Sasaki
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Misun Pak
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Taiji Okada
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Toshiaki Toyota
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kitae Kim
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takeshi Kitai
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Natsuhiko Ehara
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Makoto Kinoshita
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Shuichiro Kaji
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yasuki Kihara
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Furukawa
- Department of Cardiology, Kobe City Medical Center General Hospital, Kobe, Japan
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10
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Chen S, Schmidt B, Bordignon S, Tohoku S, Chun KRJ. Pulmonary vein isolation using cryoballoon technique in atrial fibrillation patient after Greenfield vena cava filter implantation. Glob Cardiol Sci Pract 2020; 2020:e202021. [PMID: 33426038 PMCID: PMC7768625 DOI: 10.21542/gcsp.2020.21] [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] [Indexed: 11/05/2022] Open
Abstract
Background: Cryoballoon ablation is an established procedure for atrial fibrillation (AF). Patient with vena cava filter undergoing pulmonary vein isolation (PVI) were seldom reported. Case presentation: We describe an AF ablation technique using the second generation cryoballoon in a patient after vena cava filter implantation. All pulmonary veins were successfully isolated without complication. Conclusions: For AF patient with previously implanted vena cava filter, cryoballoon based PVI appears feasible and safe.
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Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
| | - K R Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA), Kardiologie, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany.,Die Sektion Medizin, Universität zu Lübeck, Lübeck, Germany
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11
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Le Bloa M, Abadir S, Nair K, Mondésert B, Khairy P. New developments in catheter ablation for patients with congenital heart disease. Expert Rev Cardiovasc Ther 2020; 19:15-26. [PMID: 33153326 DOI: 10.1080/14779072.2021.1847082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Introduction: There are numerous challenges to catheter ablation in patients with congenital heart disease (CHD), including access to cardiac chambers, distorted anatomies, displaced conduction systems, multiple and/or complex arrhythmia substrates, and excessively thickened walls, or interposed material. Areas covered: Herein, we review recent developments in catheter ablation strategies for patients with CHD that are helpful in addressing these challenges. Expert opinion: Remote magnetic navigation overcomes many challenges associated with vascular obstructions, chamber access, and catheter contact. Patients with CHD may benefit from a range of ablation catheter technologies, including irrigated-tip and contact-force radiofrequency ablation and focal and balloon cryoablation. High-density mapping, along with advances in multipolar catheters and interpolation algorithms, is contributing to new mechanistic insights into complex arrhythmias. Ripple mapping allows the activation wave front to be tracked visually without prior assignment of local activation times or window of interest, and without interpolations of unmapped regions. There is growing interest in measuring conduction velocities to identify arrhythmogenic substrates. Noninvasive mapping with a multielectrode-embedded vest allows prolonged bedside monitoring, which is of particular interest in those with non-sustained or multiple arrhythmias. Further studies are required to assess the role of radiofrequency needle catheters and stereotactic radiotherapy in patients with CHD.
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Affiliation(s)
- Mathieu Le Bloa
- Montreal Heart Institute, Université De Montréal , Montreal, Canada.,Electrophysiology Service, Centre Hospitalier Universitaire Vaudois , Lausanne, Switzerland
| | - Sylvia Abadir
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
| | - Krishnakumar Nair
- University Health Network, Toronto General Hospital , Toronto, Canada
| | | | - Paul Khairy
- Montreal Heart Institute, Université De Montréal , Montreal, Canada
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12
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Tohoku S, Chen S, Last J, Bordignon S, Bologna F, Trolese L, Zanchi S, Bianchini L, Schmidt B, Chun KRJ. Phrenic nerve injury in atrial fibrillation ablation using balloon catheters: Incidence, characteristics, and clinical recovery course. J Cardiovasc Electrophysiol 2020; 31:1932-1941. [DOI: 10.1111/jce.14567] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/12/2020] [Indexed: 08/29/2023]
Affiliation(s)
- Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Luca Trolese
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Abteilung für Kardiologie, Medizinische Klinik III, Agaplesion Markus KrankenhausAkademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
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13
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Is the time of atrial fibrillation recurrence after cryoballoon ablation of paroxysmal atrial fibrillation influenced by the pattern of PV reconnections? J Interv Card Electrophysiol 2020; 60:321-327. [PMID: 32621212 DOI: 10.1007/s10840-020-00804-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 06/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) with 2nd-generation cryoballoon (CB) has been shown to be effective in the treatment of paroxysmal atrial fibrillation (AF). We describe pulmonary vein (PV) reconnection at repeat ablation in patients with AF recurrence after CB PVI and analyze the correlation between the time of AF recurrence and the observed PV reconnection patterns. METHODS Sixty-six patients undergoing a redo PVI for recurrent AF were enrolled 9.1 ± 2.6 months after the initial CB PVI procedure. RESULTS Ninety-two percent had PV reconnections with a mean of 1.97 ± 0.8 reconnected PVs/patient, and 52% of formerly isolated PVs were found reconnected. The highest reconnected rates were observed for left superior PVs (67%). Fifty-three percent of the patients had 2 reconnected PVs, no patient had all PVs reconnected, and 8% were without PV reconnection. There was a significant negative correlation between the time of AF recurrences and the extent of PV reconnections at redo PVI for patients with proven PV reconnection in more than one PV (R = 0.52, p < 0.001), while all patients without PV reconnection had AF recurrences within the first 9 months after PVI. CONCLUSIONS At redo ablation, most patients with recurrence of AF after CB PVI had PV reconnection(s). Patients with PV reconnection(s) showed a negative correlation between the number of reconnected PVs and the time of AF recurrence with more extensive PV reconnections resulting in earlier PV recurrences after the blanking period. Patients without PV reconnection experienced early AF recurrences, indicating non-PV triggers contributing for paroxysmal AF recurrences in these patients.
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14
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Chen S, Schmidt B, Bordignon S, Tohoku S, Urbanek L, Plank K, Willems F, Throm C, Konstantinou A, Hilbert M, Zanchi S, Bianchini L, Bologna F, Tsianakas N, Kreuzer C, Nagase T, Perrotta L, Last J, Chun KRJ. Cryoballoon pulmonary vein isolation in treating atrial fibrillation using different freeze protocols: The “ICE‐T 4 minutes vs 3 minutes” propensity‐matched study (Frankfurt ICE‐T 4 vs. 3). J Cardiovasc Electrophysiol 2020; 31:1923-1931. [DOI: 10.1111/jce.14602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Shaojie Chen
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Die Sektion MedizinUniversität zu Lübeck Lübeck Germany
| | - Boris Schmidt
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Stefano Bordignon
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Shota Tohoku
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lukas Urbanek
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Karin Plank
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Franziska Willems
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Christina Throm
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Athanasios Konstantinou
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Max Hilbert
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Simone Zanchi
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Lorenzo Bianchini
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Fabrizio Bologna
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Nikolaos Tsianakas
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Claudia Kreuzer
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Takahiko Nagase
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Laura Perrotta
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - Jana Last
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
| | - K. R. Julian Chun
- Cardioangiologisches Centrum Bethanien (CCB), Frankfurt Academy For Arrhythmias (FAFA); Kardiologie, Medizinische Klinik IIIAgaplesion Markus Krankenhaus, Akademisches Lehrkrankenhaus der Goethe‐Universität Frankfurt am Main Frankfurt am Main Germany
- Medizinische Klinik II, Kardiologie/Angiologie/IntensivmedizinUniversitätsklinikum Schleswig‐Holstein, Universität zu Lübeck Lübeck Germany
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15
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Kumar N, Ranganathan MK, Mustafa S, Saraf K, Timmermans C, Gupta D. Hemoptysis After Cryoablation for Atrial Fibrillation. J Atr Fibrillation 2020; 12:2237. [PMID: 32435347 DOI: 10.4022/jafib.2237] [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] [Received: 07/20/2019] [Revised: 08/18/2019] [Accepted: 09/26/2019] [Indexed: 12/11/2022]
Abstract
Aim Cryoballoon is a widely used tool for ablation for atrial fibrillation (AF). There are several complications after cryoablation. This paper assesses the incidence rate and severity of hemoptysis after cryo ablation for AF. Methods For current systemic review and meta-analysis, literature has been reviewed from 2008 to 2019 focusing on the incidence of hemoptysis after cryoballoon ablation for atrial fibrillation catheter ablation in PubMed, Cochrane library and EMBASE databases. Results This meta-analysis included 3534 patients from 20 studies; of mean age 54.0 ± 10.9 years. All patients had cryoballoon ablation for paroxysmal or persistent AF refractory to treatment and follow up duration for 8.2 ± 5.9 months with mean procedure duration of 153.4± 65.4 minutes. The mean cryoablation duration was 869.4 ± 148 sec with mean temperature of -59.7 ± 5.1 °C and a total of 109 patients (3.08%) had hemoptysis which was mild in the majority of cases (76.1%), mild to moderate in 20.2% and severe in only 3.7%. Hemoptysis onset was at 29.0 ± 56.5 day with median of 7 days, range (2 hours to 210 days). In 11 studies hemoptysis occurred early in 51 patients (95% CI for I2 was 0.0% to 0.0, P =0.95, I2 was 0.0%), but in 9 studies, hemoptysis occurred late in 58 patients (95% CI for I2 was 0.0% to 0.0, P =0.96, I2 was 0.0%). Conclusions Mild hemoptysis is experienced by significant number of cryoballoon AF ablation patients and severe type in 3.5 % attributed to significantly lower temperature in inferior pulmonary veins and is more often associated with bigger cryoballoon.
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Affiliation(s)
- Narendra Kumar
- Dept. Of Cardiology, Manchester University NHS Foundation Trust. Oxford Road, Manchester, M13 9WL, UK
| | | | - Shaimaa Mustafa
- Assistant professor of cardiovascular medicine, Benha University, faculty of Medicine, Egypt
| | - Karan Saraf
- Dept. Of Cardiology, Manchester University NHS Foundation Trust. Oxford Road, Manchester, M13 9WL, UK
| | - Carl Timmermans
- Department of Cardiology, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht (CARIM), the Netherlands
| | - Dhiraj Gupta
- Dept of Cardiology, Liverpool Heart and Chest Hospital, Liverpool, UK
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16
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Wieczorek M, Sassani K, Hoeltgen R. Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation. BMC Cardiovasc Disord 2020; 20:197. [PMID: 32326885 PMCID: PMC7181531 DOI: 10.1186/s12872-020-01459-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022] Open
Abstract
Background Pulmonary vein isolation (PVI) using phased radiofrequency (RF) energy has been shown to be effective in the treatment of atrial fibrillation (AF). Methods We characterize and compare pulmonary vein (PV) reconnection at repeat ablation in patients with AF after initially successful PVI using phased RF technology (PVAC) or 2nd generation cryoballoon (CB). Eighty five patients undergoing redo PVI using multielectrode PVAC phased RF catheter and 66 patients after CB PVI were enrolled 9.7 ± 3.4 months after the initial ablation procedure. Results The percentage of patients with PV reconnection(s) was comparably high between both groups (93% PVAC and 92% CB). However, 75% of all PVs and left common trunks (CTs) isolated with PVAC were reconnected, compared with 52% reconnections after CB PVI (p < 0.001). A mean of 2.79 ± 1.2 PVs and CTs/patient were reconnected after PVAC PVI compared with 1.97 ± 0.8 in CB patients, p < 0.0001. No patients in the CB group had 4 reconnected PVs, while this pattern of reconnection was observed in 33% in the PVAC group (p < 0.0001). The percentage of patients in the PVAC group with ≥3 reconnected PVs was significantly higher compared with CB patients (56 patients (66%) vs. 17 patients (26%), p < 0.0001), while the percentage of patients with no PV reconnection was comparably low in PVAC and CB patients (7 and 8%, respectively). CTs were most frequently reconnected after PVAC PVI (94%) and left superior PVs after CB ablation (67%), respectively. Conclusions The number of patients with recurrent AF and PV reconnection(s) at redo PVI was comparably high between both groups. However, the extent and distribution of PV reconnections was different in many aspects, indicating more stable atrial lesions after CB PVI compared with PVAC technology.
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Affiliation(s)
- Marcus Wieczorek
- School of Medicine; Department of Cardiology and Electrophysiology, Witten/Herdecke University, St. Agnes-Hospital Bocholt, Barloer Weg 125, 46397, Bocholt, Germany.
| | - Kiarash Sassani
- St. Agnes-Hospital Bocholt, Barloer Weg 125, 46397, Bocholt, Germany
| | - Reinhard Hoeltgen
- St. Agnes-Hospital Bocholt, Barloer Weg 125, 46397, Bocholt, Germany
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17
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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: 0.5] [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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18
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Chen S, Schmidt B, Bordignon S, Bologna F, Chun KRJ. Short tip–more function? Atrial fibrillation ablation using the novel third-generation cryoballoon in resected pulmonary vein. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2019. [DOI: 10.1186/s42444-019-0006-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cryoballoon ablation is an established procedure for atrial fibrillation (AF). Patients who had previous pulmonary surgery undergoing pulmonary vein isolation (PVI) were seldom reported.
Case presentation
We describe an AF ablation using the novel short-tip third-generation cryoballoon in a patient with resected pulmonary vein. All pulmonary veins were successfully isolated without complication. The short-tip third-generation cryoballoon shows advantageous profile in PVI for AF patients with previous pulmonary surgery.
Conclusions
This report indicates that for AF patient who had previous resected PV surgery, the short-tip CB 3 provides an ideal device option for real-time PVI.
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19
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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: 0.6] [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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20
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You L, Yao L, Zhou B, Jin L, Yin H, Wu J, Yin G, Yang Y, Zhang C, Liu Y, Xie R. Effects of different ablation strategies on long-term left atrial function in patients with paroxysmal atrial fibrillation: a single-blind randomized controlled trial. Sci Rep 2019; 9:7695. [PMID: 31118449 PMCID: PMC6531434 DOI: 10.1038/s41598-019-44168-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 05/08/2019] [Indexed: 12/12/2022] Open
Abstract
Restoration of sinus rhythm in atrial fibrillation (AF) by radiofrequency catheter ablation (RFCA) is associated with a transient stunning of left atrial (LA) function. However, the long-term effects of different ablation strategies on LA function remain undetermined. We performed randomized controlled trial to evaluate the effects of RFCA, cryoablation, and 3D mapping-guided cryoablation on LA function of proximal AF patients within 1 year. The 3D mapping-guided cryoablation was defined as a maximum of two cryoablation procedures for each pulmonary vein accompanied by RFCA for additional points until complete pulmonary vein isolation was achieved. Conventional and speckle tracking echocardiographic analyses were performed to evaluate LA function. Among the 210 patients (70 in each group) included, a trend of decreasing LA systolic and diastolic function was observed in all groups, as evidenced by decreases in peak A-wave velocity, the global LA peak systolic strain, the peak strain rate, the peak early diastolic strain rate, and the peak late diastolic strain rate within 7 days to 3 months after ablation followed by gradual recovery thereafter. However, the temporal changes in the above four strain parameters among the three groups did not differ significantly within 1 year after ablation (all p > 0.05). Parameters of the LA emptying fraction and LA dimensions were not significantly affected. These results suggested that stunning of LA function occurred within 7 days to 3 months after ablation, and different strategies of AF ablation did not differentially affect the temporal changes in LA function up to 1 year after ablation.
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Affiliation(s)
- Ling You
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Lixia Yao
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Bolun Zhou
- Xiangya School of Medicine, Central South University, Changsha, People's Republic of China
| | - Lili Jin
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Honglin Yin
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Jinglan Wu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Guangli Yin
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Ying Yang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Chenfeng Zhang
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Yue Liu
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China
| | - Ruiqin Xie
- Division of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, People's Republic of China.
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21
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Abstract
Since the cryoballoon (CB) was introduced into clinical practice, more than 400,000 patients have undergone a pulmonary vein (PV) isolation with a CB throughout the world. Although the efficacy of the first-generation CB was limited, the recently introduced second-generation CB has achieved a greater uniformity in cooling, which has facilitated a shorter time to PV isolation, shorter procedural times, higher rates of freedom from atrial fibrillation and low rates of PV reconnections. Currently, a single short freeze strategy with a single 28 mm balloon has become the standard technique based on the balance of procedural efficacy and safety. However, enhanced cooling characteristics may also result in a greater potential for collateral damage to non-cardiac structures. Knowledge about the potential complications is essential when performing the procedure. In this article, we describe the important complications that should be noted during a CB procedure, and how to minimise the risk of complications based on our experience.
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Affiliation(s)
- Shinsuke Miyazaki
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui Fukui, Japan
| | - Hiroshi Tada
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, University of Fukui Fukui, Japan
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22
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KJ. Durable cryoballoon-based left atrial appendage isolation: Catheter maneuver, occlusion grade, contact force, and time to isolation. J Cardiovasc Electrophysiol 2019; 30:1278-1279. [PMID: 30868679 DOI: 10.1111/jce.13895] [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: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shaojie Chen
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Boris Schmidt
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Stefano Bordignon
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Laura Perrotta
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Fabrizio Bologna
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Takahiko Nagase
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - Kr Julian Chun
- The Frankfurt Academy for Arrhythmias, Cardioangiologisches Centrum Bethanien Frankfurt, Medizinische Klinik III, Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
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23
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Chen S, Schmidt B, Bordignon S, Perrotta L, Bologna F, Nagase T, Chun KRJ. Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol). J Cardiovasc Electrophysiol 2019; 30:272-283. [DOI: 10.1111/jce.13818] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/11/2018] [Accepted: 11/28/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Shaojie Chen
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Boris Schmidt
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Stefano Bordignon
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Laura Perrotta
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Fabrizio Bologna
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - Takahiko Nagase
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
| | - K. R. Julian Chun
- Frankfurt Academy For Arrhythmias (FAFA), Cardioangiologisches Centrum Bethanien (CCB), Medizinische Klinik III, Agaplesion Markus KrankenhausFrankfurt am Main Germany
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