Comparison of Balloon Catheter Ablation Technologies for Pulmonary Vein Isolation: The Laser Versus Cryo Study

Bordignon, Stefano; Chun, KR Julian; Gunawardene, Melanie; Fuernkranz, Alexander; Urban, Verena; Schulte‐Hahn, Britta; Nowak, Bernd; Schmidt, Boris

doi:10.1111/jce.12192

Cited by 53 publications

(53 citation statements)

References 28 publications

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“…Contact force sensing for conventional RF ablation with a mapping catheter was recently introduced, allowing operators to assess the contact force and force vector [27, 28]. 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].…”

Section: Discussionmentioning

confidence: 99%

“…During PVI, a circumferential lesion set is created at the base of the PVs so that these PVs are electrically isolated from the left atrium [1, 2]. Several techniques are used to perform the ablation, including point-by-point radiofrequency (RF) catheter ablation, [3, 4] cryoballoon ablation, [5] laser balloon ablation [5–8] and multi-electrode ablation (MEA) [3, 9, 10]. The last-mentioned is no longer in use due to its association with asymptomatic cerebral embolism, [11–14] but the newly designed gold multi-electrode ablation (Gold-MEA) catheter, building on its predecessor, combines several characteristics that may improve lesion formation and reduce complications.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…This explains the remarkable success rates of LB in comparison with CB. 26 Moreover, remapping studies after RF-guided procedures report disappointing results, while LB-treated patients display high chronic isolation rates even outperforming the 1st-generation CB. 14,16,26, 27 In the present analysis, CB-guided ablation gave the largest ISA.…”

Section: Lesion Location and Differences In Iasamentioning

confidence: 99%

What Is the Acute Antral Lesion Size After Pulmonary Vein Isolation Using Different Balloon Ablation Technologies?

Perrotta

Konstantinou

Bordignon

et al. 2017

Circ J

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Background: Clinical outcome after pulmonary vein isolation (PVI) may be linked to both durability of PVI and the antral lesion size. Data on balloon-guided technologies are scarce. We investigated the size of the isolated surface area (ISA) acutely after PVI achieved by cryoballoon (CB) or laser balloon (LB), both using voltage mapping. Methods and Results:In 40 patients (73% male, mean age 66±9 years), a bipolar voltage map before and after PVI in sinus rhythm was acquired to delineate the isolated antral surface area (IASA, contiguous area of low voltage <0.5 mV) and the ISA (relative size of the low-voltage area in relation to the whole antral surface area including the posterior wall). IASA (CB: 57±14 cm 2 vs. LB: 42±15 cm 2 ; P=0.002) as well as ISA (65±8% vs. 54±10%; P=0.001) were significantly larger in the CB than in the LB group. No periprocedural complications occurred. During a mean follow-up of 326±142 days, 4/20 and 5/20 patients experienced an AF/AT recurrence in the CB and LB groups, respectively. No differences in clinical outcome were observed between patients with a large (≥55%) or small (<55%) ISA. Conclusions:Balloon-guided PVI is associated with antral lesion formation. CB-guided PVI is associated with the largest ISA as compared with LB procedures. ISA size did not correlate with clinical outcome after a single procedure in the present study population.

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“…62 Complication rates have generally been low with the EAS. Phrenic nerve palsy has been reported in 2% to 4% of patients (Table II in the Data Supplement) and phrenic nerve monitoring with superior vena cava pacing is recommended when isolating the right-sided veins.…”

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confidence: 99%

Recent Advances in Lesion Formation for Catheter Ablation of Atrial Fibrillation

Barnett

Bahnson

Piccini

2016

Circ: Arrhythmia and Electrophysiology

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Comparison of Balloon Catheter Ablation Technologies for Pulmonary Vein Isolation: The Laser Versus Cryo Study

Cited by 53 publications

References 28 publications

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

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

What Is the Acute Antral Lesion Size After Pulmonary Vein Isolation Using Different Balloon Ablation Technologies?

Recent Advances in Lesion Formation for Catheter Ablation of Atrial Fibrillation

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