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

Abstract

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.

Effectiveness of a manual dragging laser irradiation technique using the first‐generation endoscopic laser balloon ablation system for pulmonary vein isolation

“…Previous studies have reported that acute PV isolation using an LB1 alone with the point-by-point technique reached a sufficiently high success rate even with a certain long procedure time. 9,14 In this study, the PV isolation rate using an LB1 alone with the novel dragging technique reached a comparably high rate with a shorter procedure time than the conventional point-by-point technique. In RF ablation, a certain number of PVs have been observed to reconnect after ablation due to a noncontiguity between the point-by-point lesions along the ablation line.…”

“…To create continuity and transmural ablation lesions using LB1, it is recommended to overlap the laser irradiation applications by 30–50% 8 . However, this conventional method leads to an increase in the frequency of laser irradiations and the duration of the procedure 9 . The third‐generation LB (LB3) with an automated dragging system has been reported to shorten the duration of the procedure 10,11 .…”

Comparison of Cryoballoon and Contact Force-Sensing Radiofrequency Ablation for Persistent Atrial Fibrillation in Clinical Practice

“…Because the cryoballoon is non-compliant, it is difficult to occlude a PV that has been deformed into a teardrop or severe oval shape due to vertebral body compression or to dilate the balloon in a LA that is considerably less than the balloon diameter; therefore, such patients are less indicated for cryoballoon PVI. 4 Eligible patients for cryoballoon ablation were selected based on preprocedural computed tomography (CT) images, and patients who had a severely thin LA or deformed PV were excluded. PVI was performed in all cases using a cryoballoon (cryoballoon group) or RF catheter (CFRF group).…”

“…Cryoballoon Ablation The cryoballoon ablation procedure was performed as previously described. 4 Briefly, after voltage mapping of the LA and PV, a 15-Fr steerable sheath (FlexCath Advance, Medtronic Inc., MN, USA) was placed. A 28-mm second-or fourth-generation cryoballoon (ArcticFront Advance, or ArcticFront Advance Pro, Medtronic Inc.) was inflated at the orifice of each PV and anchored using a 20-mm circular mapping wire catheter with 10-pole electrodes (Achieve, Medtronic Inc.).…”

“…2, 3 Many balloon catheters provide good outcomes as specific PVI devices; however, until recently, their indication was limited to paroxysmal AF in Japan. 4 In recent years, it has been reported that a sufficient therapeutic effect may be obtained with PVI alone even in persistent AF, and the cryoballoon has become available for the treatment of patients with persistent AF. [5][6][7][8][9][10][11] Therefore, use of the cryoballoon is expected to expand the treatment modalities for persistent AF in clinical settings as an alternative device.…”