Balloon warming time is the strongest predictor of late pulmonary vein electrical reconnection following cryoballoon ablation for atrial fibrillation

Ghosh, Justin; Martin, Andrew; Keech, Anthony; Chan, Kim H.; Gomes, Sean; Singarayar, Suresh; McGuire, Mark A.

doi:10.1016/j.hrthm.2013.06.014

Cited by 73 publications

(77 citation statements)

References 21 publications

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“…11 The second-generation CB ablation used in our study improved the durability of PVI status with a complete PV occlusion (grade 4) in comparison by CB ablation combined with touch-up RF ablation, the results of our study could show that PVI by a combination of CB ablation and focal RF touch-up applications for the CGs may be useful and effective with a low risk of CBassociated complications.…”

Section: Previous Reportssupporting

confidence: 55%

Predictors of a Persistent Status of Pulmonary Vein Electrical Isolation by a Cryoballoon Application for Drug-Refractory Atrial Fibrillation

Kawaguchi

Okishige

Yamauchi

et al. 2018

Circ J

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of an AT after the index CB-PVI procedure were enrolled in this study. AT recurrence was defined as documented AT lasting longer than 30 s on 12-lead ECG or 24-h Holter ECG examination after a 3-month blanking period. Exclusion criteria included severe valvular disease, severe coronary artery disease, a left atrial diameter >55 mm, and the existence of a thrombus in the left atrium (LA).Written informed consent was given by all patients prior to the ablation procedure. This study protocol was approved by the institutional review board and conformed to the ethical guidelines of the 1975 Declaration of Helsinki. Procedural ManagementCardiac computed tomography (CT) and transesophageal echocardiography (TEE) were performed the day before the ablation procedure to analyze the anatomy of the LA and PV and to rule out any intracardiac thrombi. Patients underwent conscious sedation with propofol combined with dexmedetomidine hydrochloride during the index and re-do ablation procedures. CB ablation was performed as previously described. 4 Briefly, a 14Fr deflectable sheath (FlexCath, Medtronic, Minneapolis, MN, USA) was introduced into the LA after a single transseptal puncture P ulmonary vein isolation (PVI) is a widely accepted procedure for catheter ablation in patients with atrial fibrillation (AF). 1 The major cause of atrial tachyarrhythmias (ATs) after PVI is considered to be associated with PV reconnections. 2 PVI using the secondgeneration cryoballoon (CB) is regarded as highly effective for treating AF. 3 The durability of PVI after secondgeneration CB-based PVI (CB-PVI) may significantly contribute to the clinical outcome, but details of the results after CB-PVI have not been fully investigated. The aim of this study was to assess the clinical effect of CB-PVI during the index procedure on late PV reconnections examined during re-do procedures, and to find a predictor of the maintenance of PVI status after CB-PVI. Methods Inclusion and Exclusion CriteriaFrom July 2014 to March 2016, CB-PVI was performed in patients with drug-refractory AF. After the index CB-PVI procedure, re-do ablation procedures were performed in patients with drug-refractory recurrence of ATs. Consecutive patients undergoing a re-do procedure for a recurrence Predictors of a Persistent Status of Pulmonary Vein Electrical Isolation by a Cryoballoon Application for Drug-Refractory Atrial FibrillationNaohiko Kawaguchi, MD; Kaoru Okishige, MD; Yasuteru Yamauchi, MD; Manabu Kurabayashi, MD; Kenzo Hirao, MD Background: Pulmonary vein isolation (PVI) using a cryoballoon (CB) is utilized for treating atrial fibrillation. This study aimed to assess the effect of the procedural characteristics of CB-based PVI (CB-PVI) on late PV reconnections. Methods and Results:A total of 389 consecutive patients underwent the CB-PVI as their index procedure; 45 consecutive patients underwent re-do procedures (184±87 days after the index CB-PVI). A total of 146 of 178 PVs (82%) remained isolated. The occlusion grade was evaluated in 171 PVs. Complete PV occlusio...

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Section: Previous Reportssupporting

confidence: 55%

Predictors of a Persistent Status of Pulmonary Vein Electrical Isolation by a Cryoballoon Application for Drug-Refractory Atrial Fibrillation

Kawaguchi

Okishige

Yamauchi

et al. 2018

Circ J

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“…It gives reliable information about balloontissue contact, explaining the association of low temperatures with ablation efficiency. 13,14 As demonstrated in our series, a late PV reconnection was more frequent in those veins with a warmer nadir temperature and a delayed time to isolation. Interestingly, these findings are in agreement with previous studies, showing that a minimal temperature ≤51°C predicted successful isolation and no acute resumption of PV conduction.…”

Section: Predictors Of Late Pv Reconnectionssupporting

confidence: 54%

On the Quest for the Best Freeze

Ciconte

Mugnai

Sieira

et al. 2015

Circ: Arrhythmia and Electrophysiology

119

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Background— The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation. Methods and Results— A total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13.8 years) underwent a repeat procedure, after a mean 11.6±4.5 months (range, 3.5–19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI ( P =0.03) and failure to achieve −40°C within 60 s ( P =0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73–0.97; P <0.001). Conclusions— The rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of −40°C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.

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“…Lesions with a force-time integral >400 gs were significantly associated with more durable PVI lesions and improved ablation outcome [5, 29]. The cryoballoon allows assessment of freezing and thawing temperature, which is indicative of the tissue temperature and thus lesion delivery [30, 31]. Laser balloon ablation allows operators to visually perform lesions that overlap, to ensure transmurality and circumferentiality.…”

Section: Discussionmentioning

confidence: 99%

Effective contact and outcome after pulmonary vein isolation in novel circular multi-electrode atrial fibrillation ablation

et al. 2016

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IntroductionPulmonary vein (PV) reconnection is frequently the cause of recurrence of atrial fibrillation (AF) after ablation. The second-generation gold multi-electrode ablation (Gold-MEA) catheter has a new design possibly resulting in improved lesion formation compared with its predecessor. We aimed to determine the association between effective radiofrequency applications with the Gold-MEA catheter and outcome after AF ablation.Methods50 consecutive patients with paroxysmal AF underwent Gold-MEA (PVAC GOLDTM, Medtronic Inc.) ablation. The Gold-MEA catheter was navigated to the PV ostium by fluoroscopy. Duty-cycled radiofrequency ablations were performed at all PV ostia. Lesions were considered transmural when electrode temperature was >50 °C and power >3 W for >30 seconds. After the ablation procedure, patients visited the outpatient clinic at 3‑month intervals including 24-hour Holter ECGs.ResultsMean age was 56 years. All PVs were acutely isolated with the Gold-MEA catheter. Procedure time was 111 ± 22 minutes, ablation time was 24 ± 6.7 minutes and fluoroscopy time was 20 ± 8.1 minutes. No procedure-related complications were observed. One year after ablation, 60 % of patients were still free of arrhythmia recurrences after a single PV isolation attempt. The number of transmural lesions was associated with arrhythmia-free survival: 25.0 % in <72 transmural lesions, 64.3 % in 72–108 transmural lesions and 71.4 % in >108 transmural lesions (p = 0.029).ConclusionPV isolation can be performed successfully with the Gold-MEA catheter, with a favourable safety profile. Transmurality of lesions was associated with ablation success and may improve AF ablation success.

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Balloon warming time is the strongest predictor of late pulmonary vein electrical reconnection following cryoballoon ablation for atrial fibrillation

Cited by 73 publications

References 21 publications

Predictors of a Persistent Status of Pulmonary Vein Electrical Isolation by a Cryoballoon Application for Drug-Refractory Atrial Fibrillation

Predictors of a Persistent Status of Pulmonary Vein Electrical Isolation by a Cryoballoon Application for Drug-Refractory Atrial Fibrillation

On the Quest for the Best Freeze

Effective contact and outcome after pulmonary vein isolation in novel circular multi-electrode atrial fibrillation ablation

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