Improved 1‐Year Clinical Success Rate of Pulmonary Vein Isolation with the Second‐Generation Cryoballoon in Patients with Paroxysmal Atrial Fibrillation

Fürnkranz, Alexander; Bordignon, Stefano; Dugo, Daniela; Perotta, Laura; Gunawardene, Melanie; Schulte‐Hahn, Britta; Nowak, Bernd; Schmidt, Boris; Chun, Julian K R

doi:10.1111/jce.12417

Cited by 162 publications

(124 citation statements)

References 23 publications

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“…1 The reported 1-year clinical success rates range from 80% to 84% for PAF and ≤69% for persistent AF. [2][3][4][5][6][7] The first 2-year outcome data approved this finding with 73% of patients showing stable sinus rhythm (SR). 8 One explanation for these encouraging success rates may be a persistent high rate of PVI over time.…”

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confidence: 72%

“…The 1-year clinical success rate after second-generation CB-based PVI in patients having PAF ranges between 80% and 84%. 2,3,5,6 Promising 1-year success rates were also reported for persistent AF with freedom from ATA recurrence in ≤69% of patients. 4,7,16 However, better cooling characteristics and clinical efficacy may in turn be associated with a higher incidence of damage to extracardiac structures, such as the esophagus or the phrenic nerve.…”

Section: Discussionmentioning

confidence: 94%

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Once Isolated, Always Isolated?

Heeger

Wißner

Mathew

et al. 2015

Circ: Arrhythmia and Electrophysiology

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The regular TS was exchanged over a guidewire for a 12F steerable TS (Flexcath Advance, Medtronic Inc., Minneapolis, MN). The © 2015 American Heart Association, Inc. Original ArticleBackground-The second-generation cryoballoon delivers effective pulmonary vein isolation (PVI) associated with superior 1-year clinical outcome. However, data on reconduction of previously isolated PV are sparse. Methods and Results-A total of 421 patients underwent second-generation 28-mm cryoballoon-based PVI in 2 centers (St.George's hospital and Harburg hospital, Hamburg, Germany) between June 2012 and May 2015. Sixty-six of 421 (16%) patients (39/66, 59% women; mean age, 63±10 years, mean left atrium diameter, 45±6 mm) with a history of paroxysmal (40/66, 61%) or persistent atrial fibrillation and atrial tachyarrhythmia recurrences despite previous successful secondgeneration 28-mm cryoballoon-based PVI were included in this analysis. During the index PVI, the standard freeze cycle duration was 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 15 of 66 (23%) patients, whereas no bonus freeze cycle was applied in the remaining patients. Repeat procedures were performed after a median of 205 (131-357) days following the index ablation. Electric reconduction was assessed for all PVs, and reablation was performed using radiofrequency energy. Persistent electric isolation was noted in 178 of 258 (69%) PVs. In 17 of 66 (26%) patients, all previously targeted PVs remained isolated. A significant difference toward highest reconduction rate for the posteroinferior segment of the right inferior PV was found (P=0.0002). Conclusions-The second-generation cryoballoon ablation is associated with a high rate of persistent PVI. The posteroinferior segment of the right inferior PV showed the highest reconduction rate and seems to be a predilection site for PV reconduction.

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mentioning

confidence: 72%

Section: Discussionmentioning

confidence: 94%

Once Isolated, Always Isolated?

Heeger

Wißner

Mathew

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…A beavatkozás után 1 évvel a CF-RF csoport 76,5%-a, a CB-csoport 81%-a volt ritmuszavarmentes AAD nélkül, a legújabb nemzetközi közlemények is hasonló sikerarányról számolnak be [13][14][15]. A szövődményrátában tapasztalt különbségek nem jelentősek a két csoport között, mindkét módszer biztonságosnak mondható.…”

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“…Egy beavatkozás után a betegek 83,6%-a bizonyult aritmiamentesnek [14]. Marijon és mtsai a CF-RF ablatiós katéter 1 éves utánkövetési adatait közöl-ték, kontrollcsoportként párhuzamba állították a technikát egy, a CF mérésére nem alkalmas irrigációs RF-katé-terrel.…”

Section: áBraunclassified

A paroxysmalis pitvarfibrilláció kezelésének transzkatéteres ablatiós technikái: új generációs krioballon vagy kontakterő-méréssel kombinált rádiófrekvenciás ablatio?

et al. 2016

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Bevezetés: A paroxysmalis pitvarfibrilláció eszközös kezelésében elterjedt a kontakterő-méréssel kombinált rádiófrek-venciás ablatio és az új generációs krioballonnal végzett ablatiós módszer. Célkitűzés: A szerzők célja, hogy összeha-sonlítsák a két ablatiós módszerrel kezelt betegek utánkövetési adatait. Módszer: Prospektív módon 96 (rádiófrekven-ciás ablatio: 58, krioballon: 38) beteg (65 férfi, 28-70 év) procedurális és 1 éves utánkövetési adatait elemezték. A beavatkozás után 1, 3, 6 és 12 hónappal EKG-, Holter-monitoros vizsgálat és ambuláns vizit történt. Eredmények: A procedúraidő és a sugáridő a két csoportban: rádiófrekvenciás ablatio: 118,5 ± 15 perc; 15,8 ± 6 perc; krioballon: 73,5 ± 16 perc (p<0,05); 13,8 ± 4,1 perc (p = 0,09) volt. A rádiófrekvenciás csoportban 76,5%, a krioballoncsoportban 81% volt az 1 éves sikerarány. A rádiófrekvenciás csoportban 1 esetben percutan punkcióval kezelhető pericardialis tamponád, a krioballoncsoportban 2 esetben átmeneti nervusphrenicus-bénulás történt. Következtetések: Primer pitvarfibrilláció ablatiót követően a két módszerrel hasonló 1 éves sikerarány érhető el, a krioballon alkalmazásakor szignifikánsan alacsonyabb procedúraidővel. Orv. Hetil., 2016, 157(22), 849-854. Kulcsszavak: pitvarfibrilláció, ablatio, rádiófrekvenciás ablatio, krioballonCatheter ablation for paroxysmal atrial fibrillation: new generation cryoballoon or contact force sensing radiofrequency ablation?Introduction: Contact force sensing radiofrequency ablation and the new generation cryoballoon ablation are prevalent techniques for the treatment of paroxysmal atrial fibrillation. Aim: The authors aimed to compare the procedural and 1-year outcome of patients after radiofrequency and cryoballoon ablation. Method: 96 patients with paroxysmal atrial fibrillation (radiofrequency ablation: 58, cryoballoon: 38 patients; 65 men and 31 women aged 28-70 years) were enrolled. At postprocedural 1, 3, 6 and 12 months ECG, Holter monitoring and telephone interviews were performed. Results: Procedure and fluorosocopy time were: radiofrequency ablation, 118.5 ± 15 min and 15.8 ± 6 min; cryoballoon, 73.5 ± 16 min (p<0.05) and 13.8 ± 4.,1 min (p = 0.09), respectively. One year later freedom from atrial fibrillation was achieved in 76.5% of patients who underwent radiofrequency ablation and in 81% of patients treated with cryoballoon. Temporary phrenic nerve palsy occurred in two patients and pericardial tamponade developed in one patient. Conclusions: In this single center study freedom from paroxysmal atrial fibrillation was similar in the two groups with significant shorter procedure time in the cryoballoon group.

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“…Radiofrequency catheter ablation (RFCA) is most established minimally invasive approach and more popular for the surgeons, which aims to perform the pulmonary vein isolation (PVI) by delivering the ablative energy point by point. Recently, there are more novel technologies to address the AFib, such as balloon cryoablation [3], laser balloon ablation [4], and so on. Among all the potential solutions, PVI using the steerable ablation catheter is still the most popular and considered as the gold standard for most patients.…”

Section: Introductionmentioning

confidence: 99%

A Contact-Aided Asymmetric Steerable Catheter for Atrial Fibrillation Ablation

Gao

Zou

Liang

et al. 2017

IEEE Robot. Autom. Lett.

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Abstract-Electrical isolation using the ablation catheter has been widely used as the golden standard for the treatment of atrial fibrillation. Clinical practice shows that the tip orientation affects the formation of the effective lesion size. However, the traditional unidirectional or bidirectional catheter with the compliant bending shapes cannot provide great orientation capability to target the lesion paths asymmetric to the catheter's entry point. In this letter, we propose a two-dimensional (2-D) tendon-actuated asymmetric catheter to render two different bending characteristics to adapt to the special anatomy. The contact-aided compliant mechanism is adopted by designing the asymmetric blocks to form the self-collision in one lateral bending direction. Kinematics with asymmetric bends under the free bend and constraint bend are investigated. The algorithm of 3-D path exploration in the confined workspace is proposed to validate the reachability. The bending angles of two asymmetric bends are compared and the 3-D phantom study is carried out to validate its effectiveness. Results indicate that the contact-aided compliant mechanism can be integrated with the steerable catheter successfully to help form the different bending characteristics, finally improving the tip orientation capability to the specific ablation line lesions.Index Terms-Asymmetric bend, contact-aided compliant mechanism, path exploration, steerable catheter.

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Improved 1‐Year Clinical Success Rate of Pulmonary Vein Isolation with the Second‐Generation Cryoballoon in Patients with Paroxysmal Atrial Fibrillation

Abstract: Clinical outcome of PVI using the CB2 was significantly improved when compared to the CB1.

Cited by 162 publications

References 23 publications

Once Isolated, Always Isolated?

Once Isolated, Always Isolated?

A paroxysmalis pitvarfibrilláció kezelésének transzkatéteres ablatiós technikái: új generációs krioballon vagy kontakterő-méréssel kombinált rádiófrekvenciás ablatio?

A Contact-Aided Asymmetric Steerable Catheter for Atrial Fibrillation Ablation

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