A relation between ablation area and outcome of ablation using 28‐mm cryoballon ablation: Importance of carina region

Nanbu, Tadafumi; Yotsukura, Akihiko; Sano, Futoshi; Suzuki, George; Ishidoya, Yuki; Yoshida, Izumi; Sakurai, Minoru

doi:10.1111/jce.13648

Cited by 17 publications

(20 citation statements)

References 41 publications

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“…In general, the superior PV is larger than the inferior PV, and the antral area becomes wider, corresponding to a larger PV. One disadvantage of CBA is that the isolation area becomes more distal and smaller with an increasing PV diameter . Another disadvantage is that the isolation area shrinks in the chronic phase, meaning that an arrhythmogenic area may emerge at a later stage .…”

Section: Discussionmentioning

confidence: 99%

“…All data were uploaded to the Zaiostation2 workstation (ZaioSoft, Tokyo) and reconstruction was performed at the 34% point of the R wave to the R‐wave interval on the electrocardiogram (ECG) for analysis. The LA‐PV junction was determined as previously reported . All distal PVs were removed at the junction, and the LA volume was calculated as that of the LA, including the LA appendage.…”

Section: Methodsmentioning

confidence: 99%

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Important factors in left atrial posterior wall isolation using 28‐mm cryoballoon ablation for persistent atrial fibrillation—Block line or isolation area?

Nanbu

Yotsukura

Suzuki

et al. 2019

Cardiovasc electrophysiol

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Introduction: Left atrial (LA) roof ablation using the cryoballoon technique, combined with pulmonary vein isolation (PVI), has been reported to be beneficial for ablation therapy in patients with persistent atrial fibrillation (AF). Left posterior wall ablation also results in improved patient outcomes. However, the contribution of these techniques to the success of cryoballoon ablation (CBA) treatment of AF is not known. The present study examined the influence of the roofline block and isolation area on outcomes after CBA. Methods and Results:We enrolled 78 patients with persistent AF. LA roof ablation was performed using a 28-mm cryoballoon with a single freezing of 3 minutes at each region (median number of freezes: 4) after PVI. After CBA, bipolar voltage amplitude mapping was performed during sinus rhythm using the NavX mapping system.Patients were divided into two subgroups according to the voltage and activation map: the roof-conduction (n = 46) and roofline-block groups (n = 32). Atrial tachyarrhythmia recurred in 20 patients of the conduction group and 4 patients of the roofline-block group. The rate of 12-month freedom from tachyarrhythmia after a single ablation procedure was 78% (95% confidence interval [CI], 60%-89%) in the roofline-block group and 45% (95% CI, 30%-60%) in the conduction group (P = .048).Cox proportional hazard analysis revealed that the isolated area was not a significant predictor of recurrence (hazard ratio, 0.94; 95% CI, 0.86-1.02; P = .15). Conclusion:Creating a complete roofline block is the major factor predicting the maintenance of sinus rhythm in patients with persistent AF. K E Y W O R D S ablation, atrial fibrillation, pulmonary vein, roofline block, sinus rhythm

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Important factors in left atrial posterior wall isolation using 28‐mm cryoballoon ablation for persistent atrial fibrillation—Block line or isolation area?

Nanbu

Yotsukura

Suzuki

et al. 2019

Cardiovasc electrophysiol

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“…However, large PVs will allow the advancement of the CB distally while the PV roof, antrum, and left atrial anterior/posterior wall near the PV junction remain intact. This means that CB ablation isolates a limited PV area . We hypothesized that a wide ablation area will eliminate more arrhythmic foci and lead to better outcomes.…”

Section: Introductionmentioning

confidence: 99%

“…This means that CB ablation isolates a limited PV area. [11][12][13] We hypothesized that a wide ablation area will eliminate more arrhythmic foci and lead to better outcomes. This study aimed to examine the electrophysiological differences in the repeat ablation, PV isolation, PV durability, and non-PV AF foci for patients who have undergone CB ablation and patients who have undergone RF ablation.…”

Section: Introductionmentioning

confidence: 99%

“…These results were not much different from those of previous studies.Miyazaki et al12 reported that the PV isolation area during the chronic phase after ablation using the second-generation CB was significantly smaller than the area encircled by circumferential PV isolation using the RF catheter. Nanbu et al13 reported that extensive PV isolation is superior to individual isolation for achieving freedom from atrial arrhythmia during long-term follow-up after CB ablation, and their data showed that PV isolation including the carina region was more important than the antral area to maintain stable sinus rhythm. PV isolation using the CB can sometimes achieve only PV isolation excluding the carina and LV antrum regions, where triggers for AF often originate.…”

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Differences in the electrophysiological findings of repeat ablation between patients who first underwent cryoballoon ablation and radiofrequency catheter ablation for paroxysmal atrial fibrillation

Inamura

Nitta

Inaba

et al. 2019

Cardiovasc electrophysiol

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Introduction Several studies have revealed that second‐generation cryoballoon (CB)‐based pulmonary vein (PV) isolation is noninferior to radiofrequency (RF)‐based PV isolation for patients with drug‐refractory paroxysmal atrial fibrillation (AF). However, electrophysiological differences in repeat ablation remain unclear. Methods and Results This study examined electrophysiological differences during the repeat ablation between patients who first underwent RF catheter ablation and CB ablation; PV durability and non‐PV AF foci were assessed for these patients. We enrolled 919 and 491 patients who underwent CB ablation (CB group) and RF catheter ablation (RF group), respectively, for paroxysmal AF between January 2013 and June 2017 at our institution. PV isolation using RF ablation involved the left atrium (LA) antrum and part of the LA posterior wall. After 2 years of follow‐up, 62 and 80 patients in the CB and RF groups, respectively, underwent repeat ablation. PV reconnections were more frequent in the RF group than in the CB group (left superior PV: 46.2% and 14.5%, P < .001; left inferior PV: 35.0% and 11.2%, P = .001; right superior PV: 40.0% and 22.6%, P = .031; right inferior PV: 36.2% and 19.4%, P = .039; PVs: 39.8% and 16.9%, P < .001). LA AF foci were more frequent in the CB group than in the RF group (27.4% and 7.5%; P = .002). Other non‐PV foci were prevalent in both groups. Conclusion Fewer LA‐PV reconnections occurred with CB ablation. However, extensive PV isolation may eliminate many LA AF foci.

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Fast anatomical mapping of the carina and its implications for acute pulmonary vein isolation

Shin

Koektuerk

Waibler³

et al. 2021

Journal of Arrhythmia

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Background Fast anatomical mapping (FAM) of the left atrium and pulmonary veins (PV) during PV isolation (PVI) generates anatomical information about the carina region additionally. We aimed to investigate the utility of these data in relation to conduction abilities of the intervenous carina. Methods We investigated 71 patients with drug‐refractory atrial fibrillation (AF) who underwent first‐time circumferential PVI using an electroanatomical mapping system. Carina width between ipsilateral PV was measured using FAM and an integrated distance measurement tool. Encirclings were divided into carina ablation and noncarina ablation groups based on the necessity of carina ablation to achieve PVI. Results In total, 142 encirclings were analyzed and first‐pass isolation was observed in 102 (72%) encirclings. Nonfirst‐pass PVI solely due to a gap on the line or persistent carina conduction was observed in 10 (7%) and 30 (21%) encirclings, respectively. Encirclings were classified into a carina ablation group (n = 30, 21%) and noncarina ablation group (n = 112, 79%). Carina width was significantly larger in the carina ablation vs nonarina ablation group (right: 11.9 ± 1.5 mm vs 8 ± 1.4 mm, P < .001/left: 12.1 ± 1.3 mm vs 8.1 ± 1.1 mm, P < .001) requiring additional carina ablation. Conclusion Carina‐related PV conduction is a common finding after the first‐pass ablation during PVI. Measurement of carina width using FAM is feasible and its value correlates with the necessity of carina ablation to achieve PVI.

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A relation between ablation area and outcome of ablation using 28‐mm cryoballon ablation: Importance of carina region

Abstract: Extensive isolation is superior to individual isolation for achieving freedom from atrial arrhythmia in long term follow-up by CBA. Evaluating PV diameter at the left atrial PV junction is essential for applying CBA.

Cited by 17 publications

References 41 publications

Important factors in left atrial posterior wall isolation using 28‐mm cryoballoon ablation for persistent atrial fibrillation—Block line or isolation area?

Important factors in left atrial posterior wall isolation using 28‐mm cryoballoon ablation for persistent atrial fibrillation—Block line or isolation area?

Differences in the electrophysiological findings of repeat ablation between patients who first underwent cryoballoon ablation and radiofrequency catheter ablation for paroxysmal atrial fibrillation

Fast anatomical mapping of the carina and its implications for acute pulmonary vein isolation

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