2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary

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“…1 Additionally, we compared fluoroscopy and RF ablation times in the HC and MC. Complications were defined using an adapted form of the 2017 HRS AF ablation guidelines.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Temporal trends in safety and complication rates of catheter ablation for atrial fibrillation

Muthalaly

John

Schaeffer

et al. 2018

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“…We found a reduction of mean degree of stenosis with a trend which failed the significance ( P = .05). However, based on the Heart Rhythm Society consensus statement classification, there was a significant reduction of severity of PVS mainly driven by a shift from moderate to mild PVS ( P = .0001) . A few single‐center studies investigated the short‐ and medium‐term follow‐up of PVS .…”

Section: Discussionmentioning

confidence: 99%

Natural course of acquired pulmonary vein stenosis after radiofrequency ablation for atrial fibrillation—Is routine follow‐up imaging indicated or not?

Schoene

Shamloo

Sommer

et al. 2019

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Introduction Thermal injury during radiofrequency ablation (RFA) of atrial fibrillation (AF) can lead to pulmonary vein stenosis (PVS). The aim of the present study was to analyze the natural course of RFA‐induced PVS with regard to the grade of stenosis, clinical symptoms, and mortality during long‐term follow‐up. Methods and Results All patients with follow‐up imaging for radiofrequency‐induced untreated PVS were retrospectively assessed. From 2004 to 2017, the total rate of PVS following AF ablation in our center was 0.78% (87 of 11 103). Thirty‐eight patients with a total of 54 untreated PVS underwent follow‐up including imaging scan. The mean degree of stenosis at the time of diagnosis was 57% ± 27% vs 45% ± 35% (P = .05) after a mean follow‐up of 43 ± 31 months. There was a shift in severity of the PVS: 18 of 54 (33%) vs 16 of 54 (30%) severe PVS, 19 of 54 (35%) vs 10 of 54 (18%) moderate PVS, and 17 of 54 (32%) vs 28 of 54 (52%) mild PVS (P = .0001). The mean symptom score decreased significantly during follow‐up (1.8 ± 1.0 vs 0.4 ± 0.5, P = .0001). Each of the four patients with progression of PVS underwent another pulmonary vein isolation for AF recurrence following pulmonary vein reconduction during follow‐up period. Conclusion This study showed a spontaneous reduction in stenosis grade and symptoms of PVS over a 3.5‐year follow‐up. Consequently, routine follow‐up imaging of PVS seems not to be necessary. However, additional RF energy delivery to stenotic pulmonary veins should be avoided if possible. In case of conduction recovery, the ablation line should be done wide‐antrally and follow‐up imaging of PVS is recommended.

“…Cryoballoon (CB) pulmonary vein (PV) isolation (CB‐PVI) has become an established strategy for catheter ablation of paroxysmal atrial fibrillation (AF), and currently second‐generation CBs (Arctic Front Advance, Medtronic, Minneapolis, MN) is the standard tool in clinical practice owing to their high efficacy . In CB‐PVI, complete vein occlusion is required to create an adequate lesion and for a successful cryoapplication because blood leaking over the CB prevents sufficient balloon and tissue cooling.…”

Section: Introductionmentioning

confidence: 99%

Pressure‐guided second‐generation cryoballoon pulmonary vein isolation: Prospective comparison of the procedural and clinical outcomes with the conventional strategy

Hasegawa

Miyazaki

Kaseno

et al. 2019

Background: The utility of pressure waveform analyses to assess pulmonary vein (PV) occlusions has been reported in cryoballoon PV isolation (CB‐PVI) using first‐generation CBs. This prospective randomized study compared the procedural and clinical outcomes of pressure‐guided and conventional CB‐PVI. Methods and Results: Sixty patients with paroxysmal atrial fibrillation underwent CB‐PVI with 28‐mm second‐generation CBs. PV occlusions were assessed either by real‐time pressure waveforms without contrast utilization (pressure‐guided group) or contrast injections (conventional group) and randomly assigned. Before the randomization, 24 patients underwent pressure‐guided CB‐PVIs. In the derivation study, a vein occlusion was obtained in 88/96 (91.7%) PVs among which 86 (97.7%) were successfully isolated by the application. In the validation study, the nadir balloon temperature and total freezing time did not significantly differ per PV between the two groups. The positive predictive value of the vein occlusion for predicting successful acute isolations was similar (93 of 103 [90.2%] and 89 of 98 [90.8%] PVs; P = 1.000), but the negative predictive value was significantly higher in pressure‐guided than angiographical occlusions (14 of 17 [82.3%] vs 7 of 22 [31.8%]; P = .003). Both the procedure (57.7 ± 14.2 vs 62.6 ± 15.8 minutes; P = .526) and fluoroscopic times (16.3 ± 6.4 vs 20.1 ± 6.1; P = .732) were similar between the two groups, however, the fluoroscopy dose (130.6 ± 97.7 vs 353.2 ± 231.4 mGy; P < .001) and contrast volume used (0 vs 17.5 ± 7.7 mL; P < .001) were significantly smaller in the pressure‐guided than conventional group. During 27.8 (5‐39) months of follow‐up, the single procedure arrhythmia freedom was similar between the two groups (P = .438). Conclusions: Pressure‐guided second‐generation CB‐PVIs were similarly effective and as safe as conventional CB‐PVIs. This technique required no contrast utilization and significantly reduced radiation exposure more than conventional CB‐PVIs.