Evaluation of cryoballoon pulmonary vein isolation lesions during the acute and chronic phases using a high-resolution mapping system

Sekihara, Takayuki; Miyazaki, Shinsuke; Aoyama, Daisetsu; Nagao, Moeko; Tsuji, Toshihiko; Kakehashi, Shota; Mukai, Moe; Eguchi, Tomoya; Hasegawa, Kanae; Uzui, Hiroyasu; Tada, Hiroshi

doi:10.1007/s10840-022-01225-w

Cited by 5 publications

(4 citation statements)

References 21 publications

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“…In the right septal antrum and on the left anterior ridge, the maps also showed an effective reduction of the isthmus line. These data are similar to those from previous studies using the Arctic Front cryoballon system ( 6 , 9 ). A recent study analyzed the ablation lesion set in a subpopulation of nine patients who had undergone cryoablation by means of the POLARx™ system with the aid of a circular mapping catheter ( 10 ).…”

Section: Discussionsupporting

confidence: 91%

“…Theoretically the semi-elastic thermoplastic material used for this balloon and the constant pressure during the ablation phase could allow for better compliance and stability during veins occlusion. After CB ablation by means of the standard technology, characterization of the lesion set has revealed a large area of antral PVI in the acute phase and significant regression of the cryoablated zone during second procedures ( 8 , 9 ). Only one study, involving 8 patients, has evaluated acute lesion characteristics after PVI with the POLARx™; this showed a large antral lesion and ablation of 50% of the posterior wall ( 10 ).…”

Section: Introductionmentioning

confidence: 99%

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Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

Spera

Narducci²,

Bencardino³

et al. 2022

Front. Cardiovasc. Med.

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IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair, respectively (p = 0.0068). The mean posterior wall (PW) area was 22.9 ± 2 cm2 and, following PV isolation, 44.8 ± 6% of the PW area was ablated. After CB ablation, complete isolation of each PV was documented by the POLARMap™ catheter in all patients. By contrast, confirmatory UHDM and the Lumipoint™ tool unveiled PV signals in 1 out of 114 of the PVs (0.9%). Over 30-day follow-up, no major procedure-related adverse events were reported. After a mean follow-up of 333 days, 89.7% of patients were free from arrhythmia recurrence.ConclusionThe lesion extension achieved by the new CB ablation system involved the PV antrum, with less than 50% of the PW remaining untouched. The new system, with short tip and circular mapping catheter, failed to achieve PV isolation in only 0.9% of all PVs treated.Clinical trial registration[http://clinicaltrials.gov/], identifier [NCT03793998].

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

Spera

Narducci²,

Bencardino³

et al. 2022

Front. Cardiovasc. Med.

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“…To minimize the effect of differences in assessment method, we investigated chronological changes in %ablation lesion area by calculating relative ablation lesion area to total PV-LA surface area. In addition, the decrease from an acute lesion of CBA to a chronic lesion identified by high-resolution voltage mapping, as reported previously 22 , at least supported our finding identified in CBA lesions.…”

Section: Limitationssupporting

confidence: 92%

“…21 Acute ablation lesions after CBA significantly regressed during the chronic phase on high-resolution voltage mapping. 22 Past and present evidence suggests that, because of insufficient energy penetration and/or acute edema, the ablation lesion area may have been overestimated when compared with subsequent chronic ablation lesions assessed by cMRI imaging.…”

Section: Comparison Of Ablation Lesions After Cba and Hbamentioning

confidence: 73%

Chronic Ablation Lesions after Cryoballoon and Hot Balloon Ablation of Atrial Fibrillation

et al. 2023

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Background: Chronological changes in ablation lesions after cryoballoon ablation (CBA) and hot balloon ablation (HBA) of atrial fibrillation (AF) remain unclear. Methods:Of 90 patients who underwent initial balloon-based catheter ablation of AF and cardiac magnetic resonance imaging (cMRI) 3 months after ablation, data from 48 propensity score-matched patients (24 per group; 34 males; age 62±10 years) were analyzed. High-density pulmonary vein-left antrum (PV-LA) voltage mapping was performed after PV isolation, and low voltage areas around the PV ostia were defined as the total acute ablation lesion area (cm 2 ). cMRI-derived dense fibrotic tissue localized around PVs was defined as the total chronic ablation lesion area (cm 2 ). The percentage of total ablation lesion areas to total PV-LA surface area (%ablation lesion) was calculated during each phase, and %acute ablation lesion and %chronic ablation lesion areas were compared in patients who had undergone CBA and HBA. Results:The %acute ablation lesion area was larger for the CBA group than for the HBA group (30.8±5.8% vs. 23.0±5.5%, p < 0.001). There was no difference in %chronic cMRI-derived ablation lesion area (24.8±10.8% vs. 21.1±11.6%, p = 0.26) between groups. The rates of chronic AF recurrence were 12.5% and 8.3%, respectively (p = 0.45; log-rank test). LA volume and LA surface area were strongly associated with AF recurrence, but %chronic ablation lesion area was not (27±8% vs. 23±12%, p = 0.39). Conclusion:Large acute ablation lesions after CBA were smaller during the chronic phase. The size of chronic ablation lesions and the rate of AF

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Different time course effect of autonomic nervous modulation after cryoballoon and hotballoon catheter ablations for paroxysmal atrial fibrillation

Suzuki

Inden

Shimizu

et al. 2023

J Interv Card Electrophysiol

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Evaluation of cryoballoon pulmonary vein isolation lesions during the acute and chronic phases using a high-resolution mapping system

Cited by 5 publications

References 21 publications

Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

Chronic Ablation Lesions after Cryoballoon and Hot Balloon Ablation of Atrial Fibrillation

Different time course effect of autonomic nervous modulation after cryoballoon and hotballoon catheter ablations for paroxysmal atrial fibrillation

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