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For: Kanthasamy V, Breitenstein A, Schilling R, Hofer D, Tiongco B, Ang R, Hunter R, Earley M, Ahsan S, Mangiafico V, Honarbakhsh S, Ahluwalia N, Maclean E, Creta A, Finlay M. Catheter ablation of atrial fibrillation with a multi-electrode radiofrequency balloon; first and early two centre experience in Europe. J Cardiovasc Electrophysiol 2023;34:1350-1359. [PMID: 36598422 DOI: 10.1111/jce.15799] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/11/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023]

Number

Cited by Other Article(s)

Teumer Y, Miesbichler C, Katov L, Mayer B, Rottbauer W, Bothner C, Weinmann K. Comparison between a Novel Radiofrequency-Balloon and a Standard Cryo-Balloon in Pulmonary Vein Isolation: A Propensity-Score-Matched Analysis. J Clin Med 2024;13:963. [PMID: 38398276 PMCID: PMC10889331 DOI: 10.3390/jcm13040963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/02/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open

Teumer Y, Miesbichler C, Hauke A, Katov L, Bothner C, Pott A, Müller M, Walter B, Rottbauer W, Dahme T, Weinmann K. Atrial Fibrillation Ablation with a Novel Fully 3D-Mapping-Integrated Multi-Electrode Radiofrequency Balloon Catheter. J Clin Med 2023;13:207. [PMID: 38202216 PMCID: PMC10779570 DOI: 10.3390/jcm13010207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 01/12/2024] Open

Zylla MM, Starrach L, Rahm AK, Thomas D, Frey N, Lugenbiel P. Implementation of the multielectrode radiofrequency-balloon in real-world clinical practice-operator learning curve and procedural outcome at a high-volume center. Front Cardiovasc Med 2023;10:1208250. [PMID: 38034374 PMCID: PMC10682364 DOI: 10.3389/fcvm.2023.1208250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 07/03/2023] [Indexed: 12/02/2023] Open

Almorad A, Del Monte A, Teumer Y, El Haddad M, Pannone L, Della Rocca DG, Audiat C, Cespón-Fernández M, Mouram S, Ramak R, Overeinder I, Bala G, Sorgente A, Ströker E, Sieira J, Brugada P, La Meir M, de Asmundis C, Chierchia GB. Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes. J Clin Med 2023;12:6256. [PMID: 37834900 PMCID: PMC10573603 DOI: 10.3390/jcm12196256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/15/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open

Abstract

Previous clinical studies on pulmonary vein isolation (PVI) with radiofrequency balloons (RFB) reported safe and effective procedures for a 20 s RF delivery via posterior electrodes. Recent recommendations from the manufacturer suggest reducing the application time to 15 s on the posterior wall (PW) when facing the esophagus region. Here, we retrospectively assess whether 15 s of RF delivery time on posterior electrodes is safe while still ensuring lesion metrics of sufficient quality. This retrospective study included 133 patients with paroxysmal and persistent atrial fibrillation who underwent PVI using an RFB (Heliostar, Biosense Webster, Inc., Irvine, CA, USA) at two European centers. The ablation protocol was set for an RF duration of 20 s/60 s for the posterior/anterior electrodes. A multielectrode temperature probe was systematically used. In the case of an esophageal temperature rise (ETR) above 42 °C (ETR+), an endoscopic evaluation was performed. All posterior electrode lesion metric dynamics (temperature (T) and impedance (Z)) were collected from the RFB generator and analyzed offline. In total, 2435 posterior electrode applications were analyzed. With an RF delivery of 19.8 (19.7-19.8) s, the median impedance drop was 18.4 (12.2-25.2) Ω, while the temperature rise was 11.1 (7.1-14.9) °C. Accordingly, impedance (84.6 (79.3-90.2) Ω) and temperature plateaus (38 (35.3-41.1) °C) were reached at 13.9 (10.6-16) s and 16.4 (12.6-18.5) s, respectively. Overall, 99.6% and 95.8% of electrodes reached 90% (16.6 Ω) and 95% (17.5 Ω) of their impedance drops within 15 s of RF delivery, while 97.2% and 92.8% achieved 90% (34.2 °C) and 95% (36.1 °C) of their temperature rise to reach the plateaus within 15 s of RF delivery. An ETR >42 °C occurred in 37 (30.1%) patients after 17.7 ± 2.3 s of RF delivery. In the ETR+ group, the impedance drop and temperature rise on the posterior electrodes were higher compared to patients where ETR was <42 °C. Two asymptomatic thermal esophageal injuries were observed. In conclusion, 15 s of RF delivery on the posterior electrodes provides a good balance between safety, with no esophageal temperature rise, and efficacy with high-profile lesion metrics.

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Affiliation(s)

Alexandre Almorad Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Alvise Del Monte Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Yannick Teumer Department of Medicine II, Ulm University Medical Center, 89070 Ulm, Germany;
Milad El Haddad Independent Researcher, 00790 Helsinki, Finland;
Luigi Pannone Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Domenico Giovanni Della Rocca Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Charles Audiat Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
María Cespón-Fernández Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Sahar Mouram Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Robbert Ramak Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Ingrid Overeinder Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Gezim Bala Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Antonio Sorgente Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Erwin Ströker Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Juan Sieira Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Pedro Brugada Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Mark La Meir Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium;
Carlo de Asmundis Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)
Gian-Battista Chierchia Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium; (A.D.M.); (L.P.); (D.G.D.R.); (C.A.); (M.C.-F.); (S.M.); (R.R.); (I.O.); (G.B.); (A.S.); (E.S.); (J.S.); (P.B.); (G.-B.C.)

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Almorad A, Del Monte A, Della Rocca DG, Pannone L, Ramak R, Overeinder I, Bala G, Ströker E, Sieira J, Dubois A, Sorgente A, El Haddad M, Iacopino S, Boveda S, de Asmundis C, Chierchia GB. Outcomes of pulmonary vein isolation with radiofrequency balloon vs. cryoballoon ablation: a multi-centric study. Europace 2023;25:euad252. [PMID: 37671682 PMCID: PMC10481252 DOI: 10.1093/europace/euad252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/14/2023] [Indexed: 09/07/2023] Open

Abstract

AIMS

Cryoballoon (CB) ablation is the mainstay of single-shot pulmonary vein isolation (PVI). A radiofrequency balloon (RFB) catheter has recently emerged as an alternative. However, these two technologies have not been compared. This study aims to evaluate the freedom from atrial tachyarrhythmias (ATas) at 1 year: procedural characteristics, efficacy, and safety of the novel RFB compared with CB for PVI in patients with paroxysmal atrial fibrillation (AF).

METHODS AND RESULTS

This prospective multi-centre study included consecutive patients with symptomatic drug-resistant paroxysmal AF who underwent PVI with RFB or CB between July 2021 and January 2022 from three European centres. A total of 375 consecutive patients were included, 125 in the RFB group and 250 in the CB. Both groups had comparable clinical characteristics. At 12.33 ± 4.91 months, ATas-free rates were 83.20% and 82.00% in the RFB and CB groups, respectively (P > 0.05). Compared with the CB group, the RFB group showed a shorter procedure time [59.91 (45.80-77.12) vs. 77.0 (35.13-122.71) min (P < 0.001)], dwell time [19.59 (14.41-30.24) vs. 27.03 (17.11-57.21) min (P = 0.04)], time to isolation, and thermal energy delivery in all pulmonary veins (P < 0.001). First-pass isolation was comparable. No major complications occurred in either group, with no stroke, atrio-oesophageal fistula, or permanent phrenic nerve injury. Transient phrenic nerve palsy occurred more frequently with CB than RFB (7.20% vs. 3.20%; P = 0.02). Oesophageal temperature rise occurred in 21 (16.8%) patients in the RFB group, and gastroscopy showed erythema in two of them with complete recovery after 30 days.

CONCLUSIONS

The RFB appears to have a safety and efficacy profile similar to that of the CB for PVI. Shorter procedural times appear to be driven by shorter left atrial dwell and thermal delivery times.

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Affiliation(s)

Alexandre Almorad Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Alvise Del Monte Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Domenico Giovanni Della Rocca Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Luigi Pannone Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Robbert Ramak Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Ingrid Overeinder Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Gezim Bala Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Erwin Ströker Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Juan Sieira Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Aurélie Dubois Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Antonio Sorgente Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Milad El Haddad Independent Researcher, Helsinki, Finland
Saverio Iacopino Arrhythmology Department, Maria Cecilia Hospital SPA, Cotignola, Italy
Serge Boveda Département de Rythmologie, Clinique Pasteur, 45 avenue de Lombez, BP 27617, 31076 Toulouse Cedex 3, France
Carlo de Asmundis Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
Gian-Battista Chierchia Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium

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