Cryoballoon temperature predicts acute pulmonary vein isolation (original) (raw)
Related papers
Cardiology Journal
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, nationwide CB ablation registry were gathered. Successful application (SA), was defined as achieving durable intraprocedural vein isolation with time to isolation in 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 and 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.
Netherlands Heart Journal, 2020
Low oesophageal temperatures (OTs) during cryoballoon pulmonary vein isolation (PVI) have been associated with complications. This study assessed the incidence of low OT in clinical practice during cryoballoon PVI and verified possible predictive values for low OT. Consecutive patients who underwent PVI using the second-generation cryoballoon were retrospectively included. The distance from the oesophagus to the different pulmonary veins (PVs) (OP distance), body mass index (BMI), sex, age, balloon temperature and application time were studied as potential predictors of low OTs. Computed tomography was performed before the procedure to determine the OP distance. OT was measured using an oesophageal temperature probe. Applications were ended prematurely if the OT reached <16 °C. Low and ultralow OT were defined as OT <20 and <16 °C respectively. Two hundred and four patients were included. Low OT was observed in 54 patients (26%) and 27 patients (13%) reached ultralow OTs. O...
Cardiology Journal
Background: The current study sought to assess the impact of the intraprocedural heart rhythm (sinus rhythm SR vs. atrial fibrillation AF) on acute procedural characteristics, durability of pulmonary vein isolation (PVI) and long-term clinical outcomes of cryoballoon (CB) ablation. Methods: A total of 195 patients with symptomatic paroxysmal (n = 136) or persistent AF (n = 59) underwent CB-based PVI. Ablation procedures were either performed in SR (SR group; n = 147) or during AF (AF group; n = 48). Persistent AF was more frequent in the AF group than in the SR group (62% vs. 20%). All other patient baseline characteristics did not differ between the two groups. 2 Results: The nadir temperature during the CB applications was significantly lower in the AF group than in patients in the SR group (-49 interquartile range,-44;-54°C vs.-47 -42;-52°C, p = 0.002). Median procedure and fluoroscopy times as well as the rate of real-time recordings were not different between the two groups. Repeat ablation for the treatment of atrial arrhythmia recurrence was performed in 60 patients (SR: 44 30% patients; AF: 16 33% patients), with a trend towards a lower rate of PV reconnections in the AF group (p = 0.07). There was no difference in 3-year arrhythmia-free survival (p = 0.8). Conclusions: Cryoballoon-based PVI during AF results in lower nadir balloon temperatures and a trend towards a higher durability of PVI as compared to procedures performed in SR. The rate of real-time PVI recordings was not affected by the intraprocedural heart rhythm.
Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2015
Studies on the use of the second-generation 28 mm cryoballoon (CB) for the treatment of atrial fibrillation (AF) have reported superior 1-year clinical outcome. Customarily, a bonus freeze cycle is applied after pulmonary vein isolation (PVI). The purpose of the present study was to assess the 1-year clinical outcome following PVI foregoing a bonus freeze cycle. Patients with drug-refractory paroxysmal AF (PAF) or persistent AF underwent PVI using the second-generation 28 mm CB. The freeze cycle duration was set at 240 s. No bonus freeze cycle was applied. Clinical follow-up (FU) included 12-lead ECGs and 24h-Holter ECGs at 3, 6, and 12 months. A total of 45 patients (age 60 ± 11 years, mean LA diameter 42.1 ± 8.6 mm, n = 38 [84%] PAF) underwent CB-based PVI. Of 177 pulmonary veins (PVs) identified, 176/177 (99%) PVs were successfully isolated. The mean number of CB applications was 1.2 ± 0.4, 1.5 ± 0.8, 1.4 ± 0.7, 1.1 ± 0.3 and 1.7 ± 1.2 for the right superior PVs, right inferior P...
Journal of arrhythmia, 2018
Limited data exist on indicators of durable pulmonary vein isolation (PVI) undergoing cryoballoon ablation (CBA) for atrial fibrillation (AF). We investigated whether balloon temperature and time to PVI can be used to predict early PV reconduction (EPVR), including residual PV conduction and adenosine triphosphate-induced dormant conduction and the relation between touch-up ablation of EPVR sites and mid-term recurrence of AF. We obtained procedural and outcome data from the records of 130 consecutive patients who underwent CBA and followed up for 13.4 months. EPVR was identified in 86 (17%) PVs of 61 (47%) patients. Balloon temperatures during 30 seconds (-27 ± 5.7°C vs -31 ± 5.5°C), 60 seconds (-36 ± 5.6°C vs -41 ± 5.4°C), and at the nadir point (-41 ± 7.4°C vs -49 ± 7.0°C) were significantly higher, and the time to PVI was longer (90 ± 50 seconds vs 52 ± 29 seconds) in PVs with EPVR than in those without ( < 0.0001 for all). Among PVs without EPVR, the time to PVI was longer a...
Clinical Research in Cardiology, 2009
Background Cryoballoon ablation (Arctic Front, Cryocath TM ) represents a novel technology for pulmonary vein isolation (PVI). The initial phase of a freeze is crucial for cryolesion formation which is determined by local temperature depending on blood flow. We investigated the impact of right ventricular rapid pacing (RVRP) on temperature kinetics in patients (pts) with paroxysmal atrial fibrillation (PAF). Methods and results Right ventricular rapid pacing was performed from the RV apex. Absolute minimal temperature (MT,°C), temperature slopes [time (s) to 80% MT; dT/dt), area under the curve (AUC) and arterial blood pressure (ABP, mmHg) were compared (group I: with RVRP vs. group II: without RVRP). RVRP (mean duration 55 ± 7 s) was performed in 11 consecutive PAF pts (41 PVs, age 58 ± 9 years, LA size 44 ± 6 mm, normal ejection fraction). Only freezes with identical balloon positions were analyzed (11/41 PVs). RVRP (cycle length 333 ± 3 ms) induced a significant drop in ABP (group I: 45 ± 3 mmHg vs. group II: 100 ± 18 mmHg, p \ 0.001). MT was not different between group I and group II (-45.0 ± 4.4 vs. -44.3 ± 3.4°C, p = 0.46), whereas slope (38.0 ± 4.6 s vs. 51.6 ± 14.4 s, p = 0.0034) and AUC (1090 ± 4.6 vs. 1181 ± 111.2, p = 0.02) was significantly changed. In one pt, a ventricular tachycardia was induced. PVI was achieved in 41/41 PVs. Conclusion Right ventricular rapid pacing significantly accelerates cryoballoon cooling during the initial phase of a freeze possibly suggesting improved cryolesions.
Heart rhythm : the official journal of the Heart Rhythm Society, 2016
Limited data exists on cryoablation of atrial fibrillation (Cryo-AF) using the newly-available third-generation (AFA-ST) cryoballoon. In this multicenter study, we evaluated the safety and efficacy of Cryo-AF using the AFA-ST versus the second-generation (AFA) cryoballoon. We examined the procedural safety and efficacy and acute and mid-term results from 355 consecutive patients (72% with paroxysmal AF) who underwent a first-time Cryo-AF using AFA-ST (n=102) or AFA (n=253). Acute isolation was achieved in 99.6% of all PVs (AFA-ST=100% vs. AFA=99.4%; p=0.920). Time-to-pulmonary vein (PV) isolation (TT-PVI) was recorded in 89.2% of PVs using AFA-ST versus 60.2% with AFA; p<0.001. PVs targeted with AFA-ST required fewer applications (1.6±0.8 vs. 1.7±0.8; p=0.023), whereas there were no differences in balloon nadir temperature (AFA-ST=-47.0±7.3⁰C vs. AFA=-47.5±7.8⁰C; p=0.120) or thaw time (AFA-ST=41±24 sec vs. AFA=44±28 sec; p=0.056). However, AFA-ST was associated with shorter left ...
Authorea (Authorea), 2021
Introduction: Cryoballoon ablation (CBA) has become a standard treatment for paroxysmal atrial fibrillation (PaAF) but limited data is available for outcomes in patients with persistent atrial fibrillation (PeAF). Methods: We analyzed the first 944 patients included in the Spanish Prospective Multi-center Observation Post-market Registry to compare characteristics and outcomes of patients undergoing CBA for PeAF versus PaAF. Results: A total of 944 patients (57.8±10.4 years; 70.1% male) with AF (27.9% persistent) were prospectively included from 25 centers. PeAF patients were more likely to have structural heart disease (67.7 vs 11.4%; p<0.001) and left atrium dilation (72.6 vs 43.3%; p<0.001). CBA of PeAF was less likely to be performed under general anesthesia (10.7 vs 22.2%; p<0.001), with an arterial line (32.2 vs 44.6%; p<0.001) and assisted transeptal puncture (11.9 vs 17.9%; p=0.025). During an application, PeAF patients had a longer time to-30°C (35.91±14.20 vs 34.93±12.87 sec; p=0.021) and a colder balloon nadir temperature during vein isolation (-35.04±9.58 vs-33.61±10.32ºC; p=0.004), but received fewer bonus freeze applications (30.7 vs 41.1%; p<0.001). There were no differences in acute pulmonary