Cryoballoon antral pulmonary vein isolation vs contact force-sensing radiofrequency catheter ablation for pulmonary vein and posterior left atrial isolation in patients with persistent atrial fibrillation

Yokokawa, Miki; Chugh, Aman; Latchamsetty, Rakesh; Ghanbari, Hamid; Crawford, Thomas; Jongnarangsin, Krit; Cunnane, Ryan; Saeed, Mohammed; Sunkara, Bipin; Tezcan, Mehmet; Bogun, Frank; Pelosi, Frank; Morady, Fred; Oral, Hakan

doi:10.1016/j.hrthm.2018.06.047

Cited by 28 publications

(24 citation statements)

References 13 publications

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“…This meta‐analysis compares the clinical outcomes of patients with persistent AF who underwent PVI alone versus PVI with PWI. We evaluated six studies (two RCTs and four observational studies) that included a total of 1334 patients 16‐21 . To date, this is the largest meta‐analysis evaluating the role of adjunctive PWI specifically in patients with persistent AF.…”

Section: Discussionmentioning

confidence: 99%

“…The randomized control trial ( NCT03057548) comparing pulmonary vein ablation with or without left atrial posterior wall ablation in persistent atrial fibrillation is excluded as trial data has not been released (“PIVoTAL http://ClinicalTrials.gov,” n.d.). Overall, six studies met the inclusion criteria in which two were randomized clinical trials (RCTs) and four were observational studies 16‐21 …”

Section: Methodsmentioning

confidence: 99%

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Clinical outcomes of adjunctive posterior wall isolation in persistent atrial fibrillation: A meta‐analysis

Salih

Darrat²,

Ibrahim

et al. 2020

Cardiovasc electrophysiol

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Background: Pulmonary vein isolation (PVI) is the cornerstone of atrial fibrillation (AF) ablation but the recurrence rate remains relatively high in persistent patients with AF. Therefore, posterior wall isolation (PWI) in addition to PVI has been proposed to increase freedom from AF.Objective: To evaluate the success of adjunctive PWI in persistent AF. Methods:We searched electronic database using specific terms. The primary outcomes are recurrence rate of AF and recurrence of atrial arrhythmias. The secondary outcomes were atrial flutter/tachycardia (AFL/AT), procedure time, fluoroscopy time, and procedure related complications. Estimated risk ratios (RRs) and 95% confidence intervals (CIs) were evaluated.Results: Six studies were included (1334 patients with persistent AF). Adjunctive PWI resulted in a significant reduction in the recurrence rate of AF compared with patients who had PVI only (19.8% vs 29.1%; RR, 0.64; 95% CI, 0.42-0.97; P < .04; I 2 = 76%). There was a significant reduction in the recurrence rate of all atrial arrhythmia (30.8% vs 41.1%; RR, 0.75; 95% CI, 0.60-0.94; P < .01; I 2 = 60%). Compared with PVI only, adjunctive PWI did not increase the rate of AFL or AT (11.6% vs 13.9%; RR, 0.85; 95% CI, 0.54-1.32; P < .46; I 2 = 47%) or the rate of procedure related complications (4.6% vs 3.6%; RR, 1.25; 95% CI, 0.72-2.17; P < .44; I 2 = 0%). Conclusion:In patients with persistent AF, adjunctive PWI was associated with decreased recurrence of AF and atrial arrhythmias compared with PVI alone without an increased risk of AFL or AT or procedure related complications. K E Y W O R D Satrial fibrillation, atrial flutter, meta-analysis, posterior wall isolation, pulmonary vein isolation 1 | BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia, with a prevalence of 0.5% to 1% of the population, 1 and is expected to rise even more over the next decades. 2 Historically management of AF has been geared toward rate control, or rhythm control with antiarrhythmic drugs. Over the last two decades, catheter ablation has emerged as an alternative for rhythm control with medications and is now a recognized first line therapy for the treatment of AF in select populations. This is emphasized for instance in the recent American College of Cardiology updated guidelines, which states that catheter ablation may be used in selected patients with symptomatic AF and heart failure with low ejection fraction based on data to support reduced hospitalization and potentially even reduce mortality. 3

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Clinical outcomes of adjunctive posterior wall isolation in persistent atrial fibrillation: A meta‐analysis

Salih

Darrat²,

Ibrahim

et al. 2020

Cardiovasc electrophysiol

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“…Recent published evidence comparing the best potential technique for both approaches (Cryoballoon Antral Pulmonary Vein Isolation vs. Force-Sensing Radiofrequency Catheter Ablation for Pulmonary Vein and Posterior Left Atrial Isolation) showed no differences in ef icacy between the two approaches after the irst ablation procedure in patients with persistent AF. Nevertheless, and contrary to our approach, in this study the second ablation procedure in case of recurrence was performed using RF in the whole population, so making our approach for second procedure ablation unique and never reported so far [7]. Furthermore, given the lack of evidence in the literature regarding the best approach for a second AF ablation procedure, our approach is the irst speci ically focusing on it.…”

Section: Discussionmentioning

confidence: 87%

“…Two are the most widely accepted techniques for PVI: point-by-point radiofrequency (RF) ablation or cryoballoon ablation (CB). Several trials have proved their equivalence in terms of success and complications, and both are approved to be used in current practice [3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Recurrence of atrial fibrillation after pulmonary vein isolation, should we change the energy and technique?

Ramos¹,

Durante-López²,

Mirelis³

et al. 2020

J Cardiol Cardiovasc Med

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Background: Pulmonary vein isolation (PVI) is the accepted standard nowadays for atrial fi brillation (AF) ablation. The most widespread ablation techniques are cryoballoon (CB) and point-by-point radiofrequency (RF) ablation. Comparative studies between both techniques have shown their equivalence for the fi rst ablation procedure, but no trial has explored the potential incremental benefi t of crossing over the ablation technique after AF recurrence.Objective: To explore the potential incremental benefi t of a crossover ablation strategy for AF recurrences, comparatively with repeating the same ablation energy used for the fi rst procedure.Methods: Retrospective analysis of patients undergoing a second AF ablation procedure after documented AF recurrence. Patients were excluded if all 4 PV were isolated at the beginning of the second procedure or extra-PVI ablation was used for the second procedure. Crossover group (n = 16) included patients in which two diff erent techniques were used for the fi rst and second procedure (CB-RF or RF-CB). Control group (n = 23) for those with same ablation procedure (RF-RF of CB-CB). Acute procedure end-point was PVI of all four pulmonary veins. Patients were followed-up at 3, 6, and 12 months with an electrocardiogram and a 24 h-holter. Arrhythmia-free survival at 1 year after the second ablation procedure was studied, comparing effi ciency and safety of the two approaches (crossover vs. same energy). Success was defi ned as freedom from AF or atrial tachycardia lasting > 30 s off antiarrhythmic drugs (AADs)Results: A cohort of 39 paroxysmal and persistent AF patients was analyzed. PVI after the second procedure was 100% in all patients in both groups. There were no baseline relevant diff erences between the two groups. No deaths or hospitalizations occurred during follow up (data censored at 24h moths). At 1 year, arrhythmia free-survival was signifi cantly higher in the crossover group compared to control group [93,3% vs. 47,8%;; p = 0,009]. Conclusion:Crossing the ablation technique (point-by-point radiofrequency or cryoballoon PVI) after AF recurrence signifi cantly improved arrhythmia free-survival at one year, despite no diff erence in acute success (PVI isolation). Randomized controlled trials with a higher amount of patients are needed to confi rm the results and widespread this approach.Recurrence of atrial fi brillation after pulmonary vein isolation, should we change the energy and technique? https://www.heighpubs.org/jccm 074 https://doi.

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“…Others have reported increased success with a supplemental RF posterior wall "box" lesion set, 3,5 albeit with an increased risk of freezing injury to the esophagus. 10 This, in our experience, does not seem to occur with cryoballoon ablation of the posterior wall using the Navik 3D™ three-dimensional (3D) mapping system (APN Health LLC, Waukesha, WI, USA). The exact distance between the esophageal temperature probe and the distal marker on the cryoballoon can be calculated, and thermal effects on the esophagus can be mitigated by subtle repositioning such that the distal cooling surface (ie, the front half) of the balloon is oriented away from the esophagus and does not press the atrial wall into the esophagus.…”

mentioning

confidence: 77%

Cryoballoon Pulmonary Vein Isolation and Roof and Posterior Wall Debulking Using Navik 3D™: A New Technique for Atrial Fibrillation Ablation

Niazi

Erickson

Chaudhari

et al. 2020

J Innov Cardiac Rhythm Manage

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The success rates of traditional endocardial ablation techniques for managing atrial fibrillation remain modest. Recently, the performance of posterior wall ablation in conjunction with pulmonary vein (PV) isolation (PVI) has been reported to increase the chance of success following endocardial ablation. We report a systematic approach for the isolation of the PVs and ablation of the left atrial roof and posterior wall using a cryoballoon guided by the novel Navik 3D™ mapping system (APN Health LLC, Waukesha, WI, USA) and offer preliminary data including procedure, fluoroscopy, and cryoablation times for review. Patients (n = 52) aged 63 years ± 10 years with paroxysmal (n = 42), persistent (n = 11), or chronic (n = 2) atrial fibrillation underwent cryoballoon ablation for PVI and/or the left atrial roof, posterior wall, anterior ganglion plexi (GP), or mitral isthmus line. Lesions were accurately delivered to the PVs, left atrial roof, posterior wall, anterior GP, or mitral isthmus line as appropriate. Acute PVI was achieved in 98% of all patients, and eight (15%) required direct current cardioversion to restore sinus rhythm at the end of the procedure. The mean ± standard deviation procedure, fluoroscopy, and cryoballoon ablation times were 149 minutes ± 39 minutes, 33 minutes ± 30 minutes, and 41 minutes ± 14 minutes, respectively. The Navik 3D™ mapping system is believed to be the only available mapping system that allows for the visualization and location of the cryoballoon in three dimensions, enabling the operator to deliver contiguous, overlapping lesions on the roof and posterior wall of the left atrium. It also facilitates precise measurement of the distance between the esophageal temperature probe and the cryoballoon, thereby helping to avoid freezing damage to the esophagus.

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Cryoballoon antral pulmonary vein isolation vs contact force-sensing radiofrequency catheter ablation for pulmonary vein and posterior left atrial isolation in patients with persistent atrial fibrillation

Cited by 28 publications

References 13 publications

Clinical outcomes of adjunctive posterior wall isolation in persistent atrial fibrillation: A meta‐analysis

Clinical outcomes of adjunctive posterior wall isolation in persistent atrial fibrillation: A meta‐analysis

Recurrence of atrial fibrillation after pulmonary vein isolation, should we change the energy and technique?

Cryoballoon Pulmonary Vein Isolation and Roof and Posterior Wall Debulking Using Navik 3D™: A New Technique for Atrial Fibrillation Ablation

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