Comparison of touch‐up ablation rate and pulmonary vein isolation durability between hot balloon and cryoballoon

Hojo, Rintaro; Fukamizu, Seiji; Tokioka, Sayuri; Inagaki, Daisuke; Miyazawa, Satoshi; Kawamura, Iwanari; Kitamura, Τakeshi; Sakurada, Harumizu; Hiraoka, Masayasu

doi:10.1111/jce.14485

Cited by 11 publications

(15 citation statements)

References 13 publications

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“…Among the PVI procedures, the anterior ridge and carina area of the LSPV is the thickest area, which profoundly cuts down the energy penetration depth, hinders the creation of a transmural lesion, and concentrates more PV reconnections ( 20 ). Hojo et al reported that a balloon temperature of 70–73°C could reduce TUAs, thereby improving the outcomes ( 14 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of Hot Balloon vs. Cryoballoon Ablation for Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Meta-Regression

Peng

Liu

Tian

et al. 2021

Front. Cardiovasc. Med.

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Background: Balloon-based catheter ablations, including hot balloon ablation (HBA) and cryoballoon ablation (CBA), have rapidly emerged as alternative modalities to conventional catheter atrial fibrillation (AF) ablation owing to their impressive procedural advantages and better clinical outcomes and safety. However, the differences in characteristics, effectiveness, safety, and efficacy between HBA and CBA remain undetermined. This study compares the characteristic and prognosis differences between HBA and CBA.Methods: Electronic search was conducted in six databases (PubMed, Embase, Cochrane Library, Web of Science, ClinicalTrial.gov, and medRxiv) with specific search strategies. Eligible studies were selected based on specific criteria; all records were identified up to June 1, 2021. The mean difference, odds ratios (ORs), and 95% confidence intervals (CIs) were calculated to evaluate the clinical outcomes. Heterogeneity and risk of bias were assessed using predefined criteria.Results: Seven studies were included in the final meta-analysis. Compared with CBA, more patients in the HBA group had residual conduction and required a higher incidence of touch-up ablation (TUA) [OR (95% CI) = 2.76 (2.02–3.77), P = 0.000]. The most frequent sites of TUA were the left superior pulmonary veins (PVs) in the HBA group vs. the right inferior PVs in the CBA group. During HBA surgery, the left and right superior PVs were more likely to have a higher fluid injection volume. Furthermore, the procedure time was longer in the HBA group than in the CBA group [weighted mean difference (95% CI) = 14.24 (4.39–24.09), P = 0.005]. Patients in the CBA group could have an increased risk of AF occurrence, and accepted more antiarrhythmic drug therapy; however, the result was insignificant.Conclusions: HBA and CBA are practical ablation approaches for AF treatment. Patients who received HBA had a higher incidence of TUA and longer procedure time. Clinical outcomes during the mid-term follow-up between HBA and CBA were comparable.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=259487, identifier: CRD42021259487.

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Section: Discussionmentioning

confidence: 99%

Effects of Hot Balloon vs. Cryoballoon Ablation for Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Meta-Regression

Peng

Liu

Tian

et al. 2021

Front. Cardiovasc. Med.

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“…Although a high balloon temperature setting has been reported to improve the Hotballoon catheter's success rate at the LSPV, additional RF touch-up is recommended to avoid severe PV stenosis, especially in the introduction period. 12 Despite the fact that RF touch-up was frequently required, the Hotballoon catheter was very effective in the long term (Figure 3).…”

Section: Hotballoonmentioning

confidence: 99%

Early experiences with three types of balloon-based ablation catheters in patients with paroxysmal atrial fibrillation

et al. 2021

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BACKGROUND Although balloon-based ablation catheters are expected to improve the feasibility and quality of pulmonary vein isolation (PVI) in patients with atrial fibrillation (AF), they must be introduced to physicians in the proper setting to ensure their correct usage.OBJECTIVE To identify the optimal clinical settings for learning the techniques for 3 balloon-based ablation catheters (Cryoballoon, Hotballoon, and Laserballoon).METHODS We introduced 3 balloon catheters in 50 consecutive patients with paroxysmal AF each during the introduction periods. Clinical parameters were compared among the groups and between these groups and their steady-state controls. RESULTSThe completion rate of PVI by sole balloon procedures was 56% with the Hotballoon catheter, which was lower than those of the Cryoballoon and Laserballoon catheters (each 88%). Radiofrequency touch-up was most frequently required at the bottom aspect of the inferior pulmonary veins (PVs) in the Cryoballoon group and at the anterior aspect of the superior PVs in the Hotballoon and Laserballoon groups. The Laserballoon catheter had the longest average PVI procedural time (89.2 6 40 vs 58.4 6 22 minutes for Hotballoon, 65.1 6 25 minutes for Cryoballoon, P , .001), but the difference was ultimately removed by the learning curve. There was no significant difference in the major complication or recurrence-free survival rates among the catheter types.CONCLUSIONS All 3 balloon-based catheter types allowed feasibility and quality for PVI, even during the learning period. To introduce these new catheters without complications, an experiences of 20 cases with specific clinical settings should be met for each catheter type.

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“…With a conventional HB, we set the target internal balloon temperature of 70 °C or 73 °C maintained by delivery of RF current into the balloon to stir the fluid inside for 2–3 min for each PV. There was no information available from the conventional balloon, and the only way to confirm whether the ablation was effective was the pulmonary venous potential obtained from the circular mapping catheter [15] . However, the intra-tube temperature sensor, which is a new sensor, allows us to observe the balloon surface temperature, thereby increasing the information we can obtain.…”

Section: Discussionmentioning

confidence: 99%

Impact of monitoring surface temperature during pulmonary vein isolation in a second-generation hot balloon system

Fukunaga

Sekiguchi

Asano

et al. 2022

IJC Heart & Vasculature

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Background A surface temperature sensor can be used to visualize the effect of hot balloon (HB) catheters. This study evaluated the efficacy and safety of a second-generation HB system with surface temperature monitoring in patients with atrial fibrillation (AF). Methods Twenty patients (age: 69.6 ± 9.7 years, 11 male participants) who underwent first-time pulmonary vein isolation (PVI) using a second-generation HB were included. For each pulmonary vein (PV), the acute isolation rate and effective therapeutic range of surface temperature were investigated. Results Eighty-three PVs (including three right middle PVs) were isolated in 20 patients using an HB with a surface temperature sensor. Sixty-eight PVs were isolated using the first application. Fifteen PVs (left superior PV [LSPV], n = 7 [35%]; left inferior PV, n = 2 [10%]; right superior PV, n = 3 [15%]; right inferior PV, n = 3 [15%]) showed early intraoperative reconduction and required second applications. One LSPV required radiofrequency touch-up at the carina. The optimal balloon surface temperature and application time were evaluated, and a median value of 58 °C and integral value of 1000 °C·s were identified from the receiver operating characteristic curve to be useful effective indicators. However, for LSPV, the PV potential of carina or ridge likely often remained and needed to be independently considered. There was no periprocedural complication including severe pulmonary vein stenosis. During the observation period (median: 280 days, interquartile range: 261–318 days), 17 patients (85%) achieved and maintained sinus rhythm. Conclusions Second-generation HBs with a surface temperature sensor are expected to provide favorable outcomes in AF ablation treatment.

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Comparison of touch‐up ablation rate and pulmonary vein isolation durability between hot balloon and cryoballoon

Cited by 11 publications

References 13 publications

Effects of Hot Balloon vs. Cryoballoon Ablation for Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Meta-Regression

Effects of Hot Balloon vs. Cryoballoon Ablation for Atrial Fibrillation: A Systematic Review, Meta-Analysis, and Meta-Regression

Early experiences with three types of balloon-based ablation catheters in patients with paroxysmal atrial fibrillation

Impact of monitoring surface temperature during pulmonary vein isolation in a second-generation hot balloon system

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