Comparison between superior vena cava ablation in addition to pulmonary vein isolation and standard pulmonary vein isolation in patients with paroxysmal atrial fibrillation with the cryoballoon technique (original) (raw)
Related papers
Europace, 2011
Atrial fibrillation • Radiofrequency balloon • Pulmonary vein isolation • Radiofrequency ablation • Catheter ablation • Single-shot predictors What's new? • Single-shot ablation technology demonstrated equal efficacy to point-by-point ablation to achieve pulmonary vein isolation (PVI). • PVI with the multielectrode radiofrequency balloon catheter (RFB) is safe and effective, with a rate of major complications of 1%. • The RFB achieves fast and effective single-shot isolation, with a freedom from any atrial tachyarrhythmias of 82.9% after a mean followup of 10.1 ± 5.3 months. • Specific cutoffs of impedance drop (>19.2 Ω) and temperature rise (>11.1°C) demonstrated good predictive value for persistent single-shot isolation. These ablation parameters may be implemented during procedural workflow to determine the effectiveness of the ablation set.
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
First-line ablation prior to antiarrhythmic drug (AAD) therapy is an option for symptomatic paroxysmal atrial fibrillation (PAF); however, the optimal ablation technique, radiofrequency (RF), or cryoballoon (CB) has to be determined. The FREEZE Cohort Study compares RF and CB ablation. Treatment-naïve patients were documented in the FREEZEplus Registry. Periprocedural data and outcome were analysed. From 2011 to 2014, a total of 373/4184 (8.9%) patients with PAF naïve to AAD were identified. Pulmonary vein isolation (PVI) was performed with RF (n = 180) or CB (n = 193). In the RF group, patients were older (65 vs. 61 years, P < 0.01) compared with the CB group. The procedure time was significantly shorter and radiation exposure higher in the CB group. Major adverse events occurred in 1.6% (CB) and 3.7% (RF) of patients (P = 0.22). AF/atrial tachycardia (AT) recurrence until discharge was 4.5% (RF) and 8.5% (CB, P = 0.2). Follow-up (FU) ≥12 months was available in 99 (RF) and 107 ...
International journal of cardiology, 2018
Vasovagal responses (VR) encountered during radiofrequency pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (PAF) suggest ablation of the atrial tissue subjacent to the ganglionic plexi (GP) and confer durability of PVI. We hypothesized that VR during cryoballoon PVI (CB-PVI) in PAF can predict mid-term AF recurrence. We enrolled 39 patients who underwent PVI using 2nd generation cryoballoon for PAF from November 2014 to July 2016. We evaluated the long term outcomes for those who had VR during index procedure. A total of 39 patients (76% male, mean age 57 ± 9 years) underwent CB-PVI for PAF and 66.67% (26/39) had VR. VR was frequently observed in the LSPV (100%), followed by RSPV (64%), LIPV (60%), and less frequently, RIPV (28%). Overall, the mean difference in the HR and SBP, and the relative differences in the HR and SBP were observed during CB-PVI in the LSPV (mean difference in HR, p < 0.001; mean difference in SBP, p < 0.001; relative difference in HR, p...
Heart, 2010
Background To prevent atrial fibrillation (AF) recurrence after catheter ablation, pulmonary venous isolation (PVI) at an antral level is more effective than segmental ostial ablation. Cryoablation around the pulmonary venous (PV) ostia for AF therapy is potentially safer compared to radiofrequency ablation (RFA). The aim of this study was to investigate the efficacy of a strategy using a large cryoablation balloon to perform antral cryoablation with 'touch-up' ostial cryoablation for PVI in patients with paroxysmal and persistent AF. Methods Paroxysmal and persistent AF patients undergoing their first left atrial ablation were recruited. After cryoballoon therapy, each PV was assessed for isolation and if necessary, treated with focal ostial cryoablation until PVI was achieved. Follow-up with Holter monitoring was performed. Clinical outcomes of the cryoablation protocol were compared, with consecutive patients undergoing PVI by RFA. Results 124 consecutive patients underwent cryoablation. 77% of paroxysmal and 48% of persistent AF subjects were free from AF at 12 months after a single procedure. Over the same time period, 53 consecutive paroxysmal AF subjects underwent PVI with RFA and at 12 months, 72% were free from AF at 12 months (p¼NS). There were too few persistent AF subjects (n¼8) undergoing solely PVI by RFA as a comparison group. Procedural and fluoroscopic times during cryoablation were significantly shorter than RFA. Conclusions PV isolation can be achieved in less than 2 h by a simple cryoablation protocol with excellent results after a single intervention, particularly for paroxysmal AF.
International Journal of Cardiology, 2018
Background: Real-time visualization of the electrical activity of the pulmonary veins (PV) is not always possible in the setting of atrial fibrillation (AF) cryoballoon ablation. We investigated the relation between the effective documentation of time to PV isolation and the clinical outcome in a cohort of patients with paroxysmal AF who underwent cryoballoon ablation. Methods: One thousand forty two consecutive patients were enrolled. An inner lumen mapping catheter was typically used to visualize real-time electrical activity inside the PVs. Results: Time to PV isolation was documented in all targeted PVs in 391 patients (Group 1), in 651 patients it was not possible to record PV potentials and assess time to PV isolation in at least one PV (Group 2). In Group 1 a longer procedure duration and ablation time were observed, while a longer fluoroscopy time was observed in Group 2. After a mean follow-up of 14 ± 11 months, 209/1042 (20%) patients had an atrial arrhythmia recurrence (20.2% in Group 1, 19.9% in Group 2, p = 0.25). Complications occurred in 54/1042 (5.2%) patients without any difference among the two study groups. Conclusion: In our retrospective analysis, in about two thirds of patients undergoing cryoballoon ablation it was not possible to acutely assess time to PV isolation in all PVs. However, one-year freedom from clinically symptomatic atrial tachyarrhythmia was similar to that of patients in which time to PV isolation was documented in all targeted veins. Clinical Trial Registration: clinicaltrials.gov (NCT01007474).
Pacing and Clinical Electrophysiology, 2019
BackgroundCurrently available second‐generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exist about 1‐year outcomes of CB2 ablation, data on long‐term outcomes are scarce.ObjectiveWe aimed to assess the long‐term outcomes of PVI using CB2 in a large‐scale symptomatic atrial fibrillation (AF) population at our tertiary referral center.MethodsIn this nonrandomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa)‐free survival was defined as the absence of AF, atrial flutter, or atrial tachycardia recurrence ≥30 s following a 3 months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models.ResultsAcute procedural success rate was 99.8% (1898/1902 PVs). Me...
Europace, 2011
We examined the efficacy and safety of pulmonary vein (PV) isolation, using a cryoballoon catheter. Methods and results We studied 117 consecutive patients presenting with paroxysmal (n ¼ 92) or persistent (n ¼ 25) atrial fibrillation (AF), who underwent attempts at isolation of 442 PV with a cryoballoon catheter. They were followed in our ambulatory department for every 3 months, or earlier if they reported symptoms. A 48 h ambulatory electrocardiogram was recorded at the 3-month visit. We analysed the immediate and long-term procedural and clinical outcomes. We isolated 385 of 442 PV (87%) with a single cryoballoon application. In 19 patients (16%), an irrigated-tip radiofrequency (RF) catheter was used to create a supplemental focal lesion. A median of nine applications per procedure (range 6-12) was delivered. The mean, overall procedural duration was 155 + 43 min (range 75-275), and mean duration of fluoroscopic exposure was 35 + 15 min (range 12-73). At the end of the procedure, 103 patients (88%) were in sinus rhythm. Over a median period of 9.6 months (range 3-12), 11 patients were lost to followup. At 3, 6, 9, and 12 months of follow-up, respectively, 79, 79, 79, and 69% of patients presenting with paroxysmal AF had remained recurrence free, vs. 83, 73, 59, and 45% of patients, respectively, with persistent AF. Phrenic nerve palsy was the most frequent, although reversible complication. Conclusions Pulmonary vein isolation, using a cryoballoon catheter, was completed with a high rate of procedural and long-term success and low rate of minor complications. Supplemented, when needed, by focal RF, cryoballoon ablation was a safe and an effective alternative to a circumferential RF procedure.
Europace, 2008
Aims Pulmonary vein isolation (PVI) with cryoenergy delivered through a balloon is a new approach in the treatment of atrial fibrillation (AF), but long-term follow-up is lacking. The aim of this study was to provide insight in the success rate and the incidence of recurrences. Methods and results Patients with symptomatic AF despite anti-arrhythmic drugs (AADs) were treated with cryoballoon PVI. Daily transtelephonic ECG monitoring, 24 h Holter-ECG, and an arrhythmiafocused questionnaire were used to document AF. One hundred and forty-one patients completed a follow-up of 457 + 252 days. Before ablation, Holter-ECG showed AF in 45%, including 16% continuous AF throughout the recording. Event recording revealed a median AF burden of 26%. The questionnaire showed a median of weekly AF complaints lasting for hours. All but one patient had successful PVI with a single procedure. After ablation, AF (defined as lasting for more than 30 s) was seen in 11% of Holter-ECGs, with 1% continuous AF. The event recording showed an AF burden of 9%. The median patient reported no more AF-related symptoms. Recurrence during the first 3 months was predictive for later recurrence. A second procedure was performed in 24 patients. The freedom of AF was 59% without AADs after 1,2 procedures. Four right phrenic nerve paralyses occurred, all resolving within 6 months. No PV stenoses were observed. Conclusion Pulmonary vein isolation with a cryothermal balloon is an effective treatment for paroxysmal AF, resulting in a clinical success rate comparable to studies involving radiofrequency ablation. Temporary right phrenic nerve paralysis is the most important complication.
Journal of atrial fibrillation, 2019
Aims Pulmonary vein isolation (PVI) can be accomplished using radiofrequency (RF) or second generation cryoballoon (CB2). We aimed to compare the freedom from very late recurrence (VLR) defined as recurrence beyond one year in patients who were AF-free during the first post-procedural year after PVI using CB2 or RF. Methods Consecutive patients who underwent PVI by RF or CB2 ablation between August 2014 and December 2015 were included. The primary endpoint was the occurrence of VLR in follow-up after 12 months. Patients who experienced recurrence between the first 3 to 12 months after PVI and those who did not complete 15-month follow-up time were excluded. Results 139 patients were included: 68 underwent PVI by CB2 and 71 using RF. The global VLR rate was of 22.15%. The freedom from VLR beyond 12-month follow-up was of 84.5% (57 patients) for the CB2 group vs. 71% (50 patients) in the RF group (p=0.037). 15 patients underwent re-ablation (11 of the RF group and 4 of the CB2 group):...