Durability of pulmonary vein isolation following cryoballoon ablation: Lessons from a large series of repeat ablation procedures

Mugnai, Giacomo; Cecchini, Federico; Ströker, Erwin; Paparella, Gaetano; Iacopino, Saverio; Sieira, Juan; Greef, Yves De; Tomasi, Luca; Bolzan, Bruna; Bala, Gezim; Overeinder, Ingrid; Almorad, Alexandre; Gauthey, Anaïs; Sorgente, Antonio; Ribichini, Flavio; Asmundis, Carlo de; Chierchia, Gian‐Battista

doi:10.1016/j.ijcha.2022.101040

Cited by 10 publications

(16 citation statements)

References 19 publications

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“…One of the hottest issues in the field of AF ablation is PV isolation durability post RF, CB or pulsed field ablation. Several studies have analyzed data from redo electroanatomical mapping procedures post index CB ablation and have reported frequent PV sites of conduction recovery as well as having assessed procedural and biophysical indicators of PV reconnection ( Table 2 ) [ 58 , 59 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 ].…”

Section: Predictors Of Pv Reconnectionmentioning

confidence: 99%

Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

Tsiachris

Antoniou

Doundoulakis

et al. 2023

JCDD

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Nowadays, the cryoballoon (CB) constitutes an established alternative to radio frequency (RF) ablation for pulmonary vein isolation (PVI), which offers the possibility to isolate the PVs with a single application. Since the introduction of the second-generation CB, we prospectively collected our data to optimize the procedure on >1000 consecutive patients who underwent CB PVI performed in our center. It is expected that subsequent guidelines will suggest first-line PVI through CB in patients with paroxysmal AF with a class I indication. Indeed, in the long-term follow-up (36 months) of the EARLY-AF trial, CB had a lower incidence of persistent atrial fibrillation episodes compared to the anti-arrhythmic drugs group. We now review the current best practices in an effort to drive consistent outcomes and minimize complications. PV isolation through CB is the most studied single-shot technique for atrial fibrillation ablation, having shown the potential to alter the natural history of the arrhythmia. Several procedural tips and tricks can improve procedural flow and effectiveness. In the present article we provided not only technical details but measurable biophysical parameters that can reliably guide the operator into achieving the best outcome for his patients.

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Section: Predictors Of Pv Reconnectionmentioning

confidence: 99%

Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

Tsiachris

Antoniou

Doundoulakis

et al. 2023

JCDD

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“…Only radiofrequency was used as the energy source for redo ablation and a detailed description of our procedures has been already described elsewhere. 17 In brief, after a double trans-septal puncture, a 3D electroanatomical map (EAM) of the LA was created and electrical PV isolation was checked with the CMMC. PV reconnection was defined as a gap of conduction between LA and PV not present at the end of the index CB-A.…”

Section: Repeat Ablation Proceduresmentioning

confidence: 99%

“…Those findings are in line with most of the largest studies on CB-A-related complications which reported rates of PNP ranging from 3.5% to 10.8%. 17,24,25 Two out of three vascular complications were minor and even the only major vascular complication (arterial pseudoaneurysm) was conservatively managed without the need for surgical repair. One case of severe urosepsis occurred during the hospital stay of a patient in the elderly group; it is actually already known as a possible complication secondary to urinary catheterization during AF ablation procedures.…”

Section: Complicationsmentioning

confidence: 99%

Cryoballoon ablation for atrial fibrillation in octogenarians: a propensity score-based analysis with a younger cohort

Cecchini

Mugnai

Kazawa

et al. 2023

Journal of Cardiovascular Medicine

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Background In terms of safety and efficacy, cryoballoon ablation (CB-A) has become a valid option for achieving pulmonary vein isolation (PVI) in patients affected by symptomatic atrial fibrillation. However, CB-A data in octogenarians are still scarce and limited to single-centre experiences. The present multicentre study aimed to compare the outcomes and complications of index CB-A in patients older than 80 years with a cohort of younger patients. Methods and results We retrospectively enrolled 97 consecutive patients aged ≥80 years who underwent PVI using the second-generation CB-A. This group was compared with a younger cohort of patients using a 1:1 propensity score matching. After the matching, 70 patients from the elderly group were analysed and compared with 70 younger patients (control group). The mean age was 81.4 ± 1.9 years among octogenarians and 65.2 ± 10.2 years in the younger cohort. The global success rate after a median follow-up of 23 [18–32.5] months was 60.0% in the elderly group and 71.4% in the control group (P = 0.17). Phrenic nerve palsy was the most common complication occurring in a total of 11 patients (7.9%): in 6 (8.6%) patients in the elderly group and in 5 patients (7.1%) in the younger group (P = 0.51). Only two (1.4%) major complications occurred: one (1.4%) femoral artery pseudoaneurysm in the control group, which resolved with a tight groin bandage, and one (1.4%) case of urosepsis in the elderly group. Arrhythmia recurrence during the blanking period and the need for electrical cardioversion to restore sinus rhythm after PVI were found to be the only independent predictors of late arrhythmia relapses. Conclusions The present study showed that CB-A PVI is as feasible, safe and effective among appropriately selected octogenarians as it is in younger patients.

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“…However, it is hard to isolate all PVs permanently and PV reconduction (reconnection or gap) in one or more PVs was reported in more than 80% of patients in previous studies and meta‐analyses 5–8 . Novel ablation techniques and technologies like CLOSE‐guided PVI using contact‐force (CF)‐sensing RF ablation catheter and three‐dimensional‐mapping system 9,10 and novel CB generations 11 reduced the rate of PV reconduction. However, it can be still difficult to isolate all PVs because of patient‐based differences in cardiac anatomy (e.g., variability in PV anatomy, endocardial and epicardial connections, variability in atrial wall/myocardium thickness at some regions, connection with coronary veins), additional role of the autonomic nervous system, genetics, uncontrolled modifiable cardiovascular risk factors, and fibrotic atrial cardiomyopathy 2,12–14 .…”

Section: Figurementioning

confidence: 99%

“…system 9,10 and novel CB generations 11 reduced the rate of PV reconduction. However, it can be still difficult to isolate all PVs because of patient-based differences in cardiac anatomy (e.g., variability in PV anatomy, endocardial and epicardial connections, variability in atrial wall/myocardium thickness at some regions, connection with coronary veins), additional role of the autonomic nervous system, genetics, uncontrolled modifiable cardiovascular risk factors, and fibrotic atrial cardiomyopathy.…”

mentioning

confidence: 99%

Reconduction (reconnection or gap) after pulmonary vein isolation for paroxysmal atrial fibrillation ablation is a multifactorial process rather than a battle of fire and ice alone!

Canpolat

2023

Cardiovasc electrophysiol

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Atrial fibrillation (AF) is a multifaceted, complex, and progressive arrhythmia which resulted in electrical, contractile, and structural atrial remodeling. 1 There is an interplay between trigger(s) and substrate for disease initiation and maintenance. 2 After the definition of pulmonary veins (PVs) as an important trigger of atrial ectopic beats and AF paroxysms, 3 pulmonary vein isolation (PVI) has become a cornerstone of all AF ablation procedures. 2 Although PVI is an anatomic and empirical approach rather than a pathophysiological treatment in each patient, it is an objective, standard, and reproducible endpoint independent of the mechanism(s) of AF. The last few decades witnessed a significant advancement and evolution in AF management, particularly in the field of catheter ablation. 2 Radiofrequency (RF) and cryogenic (cryoballoon [CB]) energy are two main sources of catheter ablation for AF with similar efficacy and safety profile in paroxysmal AF. 4 However, it is hard to isolate all PVs permanently and PV reconduction (reconnection or gap) in one or more PVs was reported in more than 80% of patients in previous studies and meta-analyses. [5][6][7][8] Novel ablation techniques and technologies like CLOSE-guided PVI using contact-force (CF)sensing RF ablation catheter and three-dimensional-mapping

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Durability of pulmonary vein isolation following cryoballoon ablation: Lessons from a large series of repeat ablation procedures

Cited by 10 publications

References 19 publications

Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

Best Practice Guide for Cryoballoon Ablation in Atrial Fibrillation: The Compilation Experience of More than 1000 Procedures

Cryoballoon ablation for atrial fibrillation in octogenarians: a propensity score-based analysis with a younger cohort

Reconduction (reconnection or gap) after pulmonary vein isolation for paroxysmal atrial fibrillation ablation is a multifactorial process rather than a battle of fire and ice alone!

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