Balloon-Based Ablation Technologies

Bhardwaj, Rahul; Neužil, Petr; Reddy, Vivek Y.; Dukkipati, Srinivas R.

doi:10.1016/j.ccep.2020.02.008

Cited by 4 publications

(4 citation statements)

References 48 publications

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“…Depending on the energy source for PVI, cryoablation was associated with higher dose area product 7820 (4195-13,853) cGycm 2 versus 7178 (3668-13,423) cGycm 2 (p < .001). In contrast to our data, the fluoroscopy time in this study was not different for radiofrequency catheter ablation with 24 min in comparison to cryoablation with 22(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32) min.In a multicenter study, comparing contact force (CF)-guided radiofrequency (RF) with second-generation cryoballoon (CB) ablation Squara et al26 reported a DAP of 4853 cGycm 2 at a mean fluoroscopy time off 19.3 ± 8.2 min in the CB group and a DAP of 4273 cGycm 2 at mean fluoroscopy time of 17.6 ± 11 min in the RF group with comparable efficacy and complication rates in both groups. Procedure times were shorter in the CB group (109.6 ± 40 min) as compared to the RF group (122.5 ± 40.7 min).…”

contrasting

confidence: 99%

“…On the other hand, cryoballoon PVI is associated with high procedural reproducibility and safety 6 despite a shorter learning curve, 12 so that this approach is gaining more and more acceptance. CB ablation is nowadays becoming the first choice in ablation of patients with paroxysmal atrial fibrillation 13 , 14 , 15 even in centers without advanced fluoroscopy units and non‐fluoroscopic imaging capabilities.…”

Section: Introductionmentioning

confidence: 99%

“…CB ablation is nowadays becoming the first choice in ablation of patients with paroxysmal atrial fibrillation [13][14][15] even in centers without advanced fluoroscopy units and non-fluoroscopic imaging capabilities.…”

Section: Introductionmentioning

confidence: 99%

“…The mean DAP for PVI was 3737 (3735-13,628) cGycm 2 at fluoroscopy times of 23 min. Over the entire study period of 7 years a relevant reduction of fluoroscopy time from 45 min to 16(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) min accompanied by a reduction in radiation exposure from16,213 (9466-26,732) cGycm 2 to 3455 (1643-6365) cGycm 2 could be achieved. Depending on the energy source for PVI, cryoablation was associated with higher dose area product 7820 (4195-13,853) cGycm 2 versus 7178 (3668-13,423) cGycm 2 (p < .001).…”

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confidence: 98%

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X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

Heinroth

Blum

Drexler

et al. 2022

Journal of Arrhythmia

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Background Facing an increasing number of radiofrequency ablation (RF) and cryoballoon ablation (CB) procedures for treatment of AF radiation exposure and its reduction is a focus point for interventional electrophysiologists. Objective This study evaluated the procedural parameters of the different ablation methods focusing on radiation exposure and the BMI of the patients. Methods One thousand one hundred and thirty‐three first procedural cases of pulmonary vein isolation in patients with paroxysmal and persistent AF treated with RF and CB‐based techniques were analyzed retrospectively over a period of 7 years focusing on the endpoints dose area product (DAP, cGycm2), fluoroscopy time (FT, min) and procedural time (PT, min). Results Of the 1133 patients (mean age 63.4 ± 11.4 years, BMI 28.9 ± 4.7) 335 patients received an RF procedure, 211 patients were treated with the cryoballoon first generation (CB1), and 587 patients with cryoballoon second generation (CB2), respectively. The mean DAP for the PVI was 508 ± 654 cGycm2 in RF procedures, 1077 ± 683 cGycm2 in CB1‐procedures, and 587 ± 489 cGycm2 in CB2‐procedures with fluoroscopy times significantly shorter in RF procedures (9.6 ± 5.2 min) as compared to 17.7 ± 5.9 min in CB1‐ and 16.3 ± 6.3 min in CB2‐procedures (p < .001). At the same time, the procedure duration using RF (115 ± 33.5 min) was significantly longer than both in CB1 (96 ± 16.8 min) and CB2 procedures (75 ± 15.9 min). Conclusions Despite longer fluoroscopy durations in the CB technique, the CB2 resulted in a comparable low radiation exposure in PVI as compared to RF, accompanied by shorter procedure durations.

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confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 98%

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X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

Heinroth

Blum

Drexler

et al. 2022

Journal of Arrhythmia

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Anatomical-guided third-generation laser balloon ablation for the treatment of paroxysmal atrial fibrillation assessed by continuous rhythm monitoring: results from a multicentre prospective study

Ciconte,

Schiavone,

Rovaris

et al. 2024

Europace

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Aims The third-generation laser balloon (LB3) is an established ablation device for pulmonary vein isolation (PVI) that allows direct visualization of the anatomical target. Equipped with an automatic circumferential laser delivery modality, it aims at continuous circumferential PVI, improving both acute and clinical outcomes. We sought to evaluate the clinical efficacy of LB3 ablation using an anatomical-based approach without verifying electrical isolation. Methods and results Among 257 paroxysmal AF patients undergoing LB3 ablation across four Italian centres, 204 (72% male, mean age 60.4 ± 11.1 years) were included. The primary endpoint was freedom from any atrial tachyarrhythmia (ATa) recurrence after the blanking period (BP), assessed with implantable cardiac monitors (ICMs). All pulmonary veins (PVs) were targeted using the LB3, with the RAPID mode used on an average of 96 ± 8, 86 ± 19, 98 ± 11, and 84 ± 15% for the left superior, left inferior, right superior, right inferior PV, and left common ostium, respectively. Freedom from arrhythmia recurrences was 84.8% at 1, 80.4% at 2, and 76.0% at 3 years. An ATa burden ≥ 5% was documented in 2.5, 4.4, and 5.4% at 1, 2, and 3 years, respectively. Relapses during the BP [hazard ratio (HR) = 2.182, P = 0.032] and left atrial dilation (HR = 1.964, P = 0.048) were independent predictors of recurrences. Conclusion Anatomical-guided LB3 ablation for paroxysmal AF is a safe and effective approach, providing excellent clinical outcomes as assessed by ICM over nearly 3 years of follow-up.

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Epicardial Connections After a Conventional Pulmonary Vein Antrum Isolation in Patients With Atrial Fibrillation

Nyuta

Takemoto

Sakai

et al. 2022

Circ J

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wave front propagation, especially in low voltage zones. By performing HDM mapping inside the PVAI lines after conventional encirclement lesions, we hoped to identify any RPs associated with ECs inside our PVAI lines. Thus, the purpose of this study was to determine the prevalence and number of ECs inside the PVAI lines after a conventional PVAI, and the effect of an EC ablation on the outcomes in patients with non-valvular paroxysmal (pAF), persistent (persAF), and long-lasting AF (LLAF). Methods Baseline Clinical Characteristics of the Patient GroupsThe present study was approved by the institutional review committee and ethics review board of our hospital, the Ethical Review Board of Steel Memorial Yawata Hospital. The procedures were followed in accordance with the Declaration of Helsinki and the ethical standards of the responsible committee on human experimentation. Moreover, we enrolled this study in an international registry of P ulmonary vein (PV) antrum isolation (PVAI) with radiofrequency catheter ablation (RFCA) has proven to be a useful strategy for atrial fibrillation patients (AF) worldwide. 1 To prevent initiating and maintaining AF, a complete PVAI should be a target of the AF treatment. 1 However, in spite of establishing complete PVAI lines, we rarely experience and encounter remaining potentials (RPs) inside our PVAI lines detected by high-density mapping (HDM). Then, when we perform pacing from the ablation catheter on the RPs inside our PVAI lines, we confirm that the pacing can capture RPs and conduct to the atrium. This finding indicates the existence of epicardial connection(s) (ECs) from inside the PVAI lines to the atrium after establishing complete conventional PVAI lines. The recent Intellamap Orion 2 (Boston Scientific Corporation, Marlborough, MA, USA) and Advisor TM HD Grid 3 (Abbott, Plymouth, MN, USA) advanced catheter technologies, which are directional HDM catheters, can not only identify low voltages and small local electrical signals, but also more importantly can capture the direction of the

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Balloon-Based Ablation Technologies

Cited by 4 publications

References 48 publications

X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

X‐ray exposure in cryoballoon versus radiofrequency ablation for atrial fibrillation over 7 years: A single center study

Anatomical-guided third-generation laser balloon ablation for the treatment of paroxysmal atrial fibrillation assessed by continuous rhythm monitoring: results from a multicentre prospective study

Epicardial Connections After a Conventional Pulmonary Vein Antrum Isolation in Patients With Atrial Fibrillation

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