Cryoablation for paroxysmal and persistent AF in patients with structural heart disease and preserved ejection fraction: Clinical outcomes from 1STOP, a multicenter observational project

Perego, Giovanni Battista; Iacopino, Saverio; Molon, Giulio; Arena, Giuseppe; Verlato, Roberto; Pieragnoli, Paolo; Curnis, Antonio; Allocca, Giuseppe; Nicolis, Daniele; Sciarra, Luigi; Catanzariti, Domenico; Senatore, Gaetano; Rovaris, Giovanni; Brasca, F.; Tondo, Claudio

doi:10.1016/j.jjcc.2019.02.015

Cited by 11 publications

(7 citation statements)

References 61 publications

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“…Patients with AF who had undergone CB‐PVI (using CB‐1, −2, −3, or −4) in 47 Italian institutions from April 2012 to April 2019 were prospectively followed through in‐hospital visits according to each center's clinical practice through the framework of the Italian ClinicalService and 1STOP project . In brief, the project (Clinical Trial Registration: NCT01007474) is a prospective examination of CB ablations conducted in Italian cardiology centers.…”

Section: Methodsmentioning

confidence: 99%

“…The description of the CB catheter ablation procedure has been previously published . In general, patients were treated with general anesthesia or conscious sedation during the procedure, and a heparin bolus was delivered at the time of the transseptal needle puncture into the left atrium.…”

Section: Methodsmentioning

confidence: 99%

“…Consequently, we examined patients that were treated for AF using the CB‐1 vs CB‐2 vs CB‐3 vs CB‐4. These four cohorts were compared in a real‐world multicenter examination of procedural safety and efficacy utilizing a retrospective review of data held within the 1STOP Italian registry project …”

Section: Introductionmentioning

confidence: 99%

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A comparison of acute procedural outcomes within four generations of cryoballoon catheters utilized in the real‐world multicenter experience of 1STOP

Iacopino

Pieragnoli

Arena

et al. 2019

Cardiovasc electrophysiol

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Introduction Four generations of the cryoballoon (CB) catheter were retrospectively evaluated in a real‐world examination of patients with atrial fibrillation (AF). Methods and Results Four hundred eighty patients (27% female and 60 ± 10 years) suffering from AF, underwent pulmonary vein (PV) ablation with one‐of‐four generations of the CB catheter. The total cohort was divided into four groups of patients: 120 with first‐generation (CB‐1); 120 with second‐generation (CB‐2); 120 with third‐generation (CB‐3); and 120 with fourth‐generation (CB‐4). Equal group sizes were achieved by examining the last 120 patients treated in each cohort, attempting to minimize the effect of a learning curve between the generations of CB catheter. Baseline clinical and patient characteristics were similar between the four cohorts, excepting age and the number of tested antiarrhythmic drugs. Procedure, fluoroscopy, and left atrial dwell times were significantly lower in the CB‐4 cohort compared to previous generations of the CB catheters, while the acute procedural success rate was comparable across all catheter groups (>99%). Total acute procedural complications were low (2.5%), and acute complications were comparable within the CB‐2, CB‐3, and CB‐4 groups (0.8% reported in each cohort). The rate of time‐to‐isolation (TTI) visualization increased with later generations of the CB catheters. Conclusions The novel CB‐4 achieved significantly faster procedural ablation times in comparison to the previous generations, while still maintaining a low rate of acute complications. Also, the rate of TTI visualization was observed to be higher with the CB‐4 catheter. Further long‐term evaluation is necessary, including an assessment of AF recurrence and PV reconnection(s).

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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A comparison of acute procedural outcomes within four generations of cryoballoon catheters utilized in the real‐world multicenter experience of 1STOP

Iacopino

Pieragnoli

Arena

et al. 2019

Cardiovasc electrophysiol

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“…Discontinuation of vitamin K antagonists during the radiofrequency AF ablation procedure was reported to reduce the occurrence of periprocedural strokes and minor bleeding complications compared with bridging with low-molecular-weight heparin [6], and other studies using DOACs showed similar or better results [7][8][9]. Complications related to the vascular access sites are reported to be the most common complications during AF ablation [2] and the recent novel cryoballon [13] ablation with a large size sheath would increase the risk of access site complications.…”

Section: Discussionmentioning

confidence: 99%

Limited efficacy of a figure-of-eight suture for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants

Matsunaga‐Lee

Egami

Yanagawa

et al. 2020

Journal of Cardiology

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Introduction: There are limited data on the efficacy and safety of a figure-of-eight (FoE) suture technique after atrial fibrillation (AF) ablation with uninterrupted oral anticoagulants (OACs). This study evaluated the predictors of bleeding complications at the femoral puncture site after placing a FoE suture to achieve hemostasis after AF ablation with OACs. Methods: We enrolled 287 consecutive patients who underwent a 1st session of AF ablation using radiofrequency or cryoballoon ablation. Hemostasis of the femoral puncture site was achieved using the FoE suture technique followed by a 4-h bed rest. We compared the various factors that might be correlated with bleeding complications between the patients with bleeding and those with non-bleeding complications. Results: The bleeding complications were observed in 31 patients (11%). In the univariate analysis, cryoballoon ablation (52% vs. 29%, p = 0.009), HAS-BLED score (2.1 AE1.0 vs.1.7 AE 1.1, p = 0.030), and the CHA2DS2-VASc score (3.2 AE 1.5 vs. 2.6 AE 1.6, p = 0.049) were significantly associated with bleeding complications at the femoral puncture site. In the multivariate logistic regression analysis after an adjustment for antiplatelet therapy, cryoballoon ablation was an independent predictor of an increased incidence of the bleeding complications at the femoral puncture site (odds ratio 2.77, 95% CI 1.29-6.02, p = 0.009). Conclusion: Cryoballoon AF ablation was correlated with bleeding complications after a FoE suture technique with uninterrupted OACs.

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“…Since the majority of AF triggers originate within the PVs, eliminating the source of AF has been established as the most important strategy for AF ablation [1][2][3]. Recently it has been reported that even patients with heart failure and structural heart disease have had good outcomes with catheter ablation for AF [4,5].…”

Section: Introductionmentioning

confidence: 99%

Analysis of the driving mechanism in paroxysmal atrial fibrillation: comparison of the activation sequence between the left atrial body and pulmonary vein

Kiyama

Kanazawa

Yamabe

et al. 2020

Journal of Cardiology

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Background: It has been shown that most paroxysmal atrial fibrillation (AF) can be terminated by pulmonary vein (PV) isolation alone, suggesting that rapid discharges from PV drive AF. To define the driving mechanism of AF, we compared the activation sequence in the body of left atrium (LA) to that within PV. Methods: Endocardial noncontact mapping of LA body (LA group; n = 16) and selective endocardial mapping of left superior PV (LSPV) (PV group; n = 13) were performed in 29 paroxysmal AF patients. The frequency of pivoting activation, wave breakup, and wave fusion observed in LA were compared to those in LSPV to define the driving mechanism of AF. Circumferential ablation lesion around left PV was performed after right PV isolation to examine the effect of linear lesion around PV on AF termination both in LA and PV groups. Results: The frequency of pivoting activation, wave breakup, and wave fusion in PV group were significantly higher than those in LA group (36.5 AE 17.7 vs 5.0 AE 2.2 times/seconds, p < 0.001, 10.1 AE 4.3 vs 5.0 AE 2.2 times/seconds, p = 0.004, 18.1 AE 5.7 vs 11.0 AE 5.2, p = 0.002). Especially in the PV group, the frequency of pivoting activation was significantly higher than that of wave breakup and wave fusion (36.5 AE 17.7 vs 10.1 AE 4.3 times/seconds, p < 0.001, 36.5 AE 17.7 vs 18.1 AE 5.7 times/seconds, p < 0.001). These disorganized activations in LSPV were eliminated by the circumferential ablation lesion around left PV (pivoting activation; 36.5 AE 17.7 vs 9.3 AE 2.3 times/seconds, p < 0.001, wave breakup; 10.1AE1.3 times/ seconds, p = 0.003, wave fusion; 18.1 AE 5.7 vs 5.7 AE 1.8, p < 0.001), resulted in AF termination in all patients in both LA and PV groups. Conclusions: Activation sequence within PV was more disorganized than that in LA body. Frequent episodes of pivoting activation rather than wave breakup and fusion observed within PV acted as the driving sources of paroxysmal AF.

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Cryoablation for paroxysmal and persistent AF in patients with structural heart disease and preserved ejection fraction: Clinical outcomes from 1STOP, a multicenter observational project

Cited by 11 publications

References 61 publications

A comparison of acute procedural outcomes within four generations of cryoballoon catheters utilized in the real‐world multicenter experience of 1STOP

A comparison of acute procedural outcomes within four generations of cryoballoon catheters utilized in the real‐world multicenter experience of 1STOP

Limited efficacy of a figure-of-eight suture for hemostasis after cryoballoon atrial fibrillation ablation with uninterrupted oral anticoagulants

Analysis of the driving mechanism in paroxysmal atrial fibrillation: comparison of the activation sequence between the left atrial body and pulmonary vein

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