Individualized cryoballoon energy pulmonary vein isolation guided by real-time pulmonary vein recordings, the randomized ICE-T trial

Chun, K.R. Julian; Stich, Marie; Fürnkranz, Alexander; Bordignon, Stefano; Perrotta, Laura; Dugo, Daniela; Bologna, Fabrizio; Schmidt, Boris

doi:10.1016/j.hrthm.2016.12.014

Cited by 137 publications

(144 citation statements)

References 25 publications

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“…1,4,9,10 Real-time PV recordings gained further importance since a correlation of the time to isolation (TTI) of the PV with arrhythmia-free survival was demonstrated. 11, 12 Therefore, novel ablation strategies take the individual TTI into account when setting the total application time, aiming at shorter freeze cycles and thus at reduction of potential complications such as phrenic nerve (PN) palsy and esophageal thermal injury. 12- 14 The consistent application of these TTI-guided ablation protocols, however, is hampered by a limited real-time verification of PV isolation (PVI) when using currently available 15-or 20-mm diameter circular mapping catheters with 8 electrodes.…”

Section: Periprocedural Managementmentioning

confidence: 99%

“…12- 14 The consistent application of these TTI-guided ablation protocols, however, is hampered by a limited real-time verification of PV isolation (PVI) when using currently available 15-or 20-mm diameter circular mapping catheters with 8 electrodes. [11][12][13][14] continuous PN pacing was performed using a diagnostic catheter positioned in the superior vena cava (6F; Inquiry TM , St. Jude Medical). PN capture was monitored by tactile feedback of diaphragmatic contraction when the operator's hand was placed on the patient's abdomen.…”

Section: Periprocedural Managementmentioning

confidence: 99%

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Does Size Matter? Cryoballoon-Based Pulmonary Vein Isolation Using a Novel 25-mm Circular Mapping Catheter

Reißmann

Schlüter

Santoro

et al. 2018

Circ J

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Section: Periprocedural Managementmentioning

confidence: 99%

Section: Periprocedural Managementmentioning

confidence: 99%

Does Size Matter? Cryoballoon-Based Pulmonary Vein Isolation Using a Novel 25-mm Circular Mapping Catheter

Reißmann

Schlüter

Santoro

et al. 2018

Circ J

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“…Subsequent studies have reinforced fairly good midterm outcomes in patients submitted to CB ablation. However, the optimal freezing strategy is still under debate 3–7 . Prolonged freezing cycles may achieve more durable PVI at the cost of longer procedures and an increased risk of injury to extracardiac structures (eg, phrenic nerve, esophagus, bronchial tree) 8–10 .…”

Section: Introductionmentioning

confidence: 99%

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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Introduction Ablation with second‐generation cryoballoon technology evolves as an effective and safe alternative to radiofrequency for atrial fibrillation ablation procedures. Nevertheless, the optimal freezing strategy remains unknown. Our objective was to identify the procedural cryoablation parameters predicting successful peri‐pulmonary vein (PV) lesions by directly analyzing Postablation gaps in late‐gadolinium‐enhanced cardiac magnetic resonance (LGE‐CMR). Methods and Results Forty‐nine consecutive patients (196 PVs) undergoing ablation with second‐generation cryoballoon at our center were included. The number and duration of cryoballoon application to achieve PV isolation were left to operator discretion. Gap number and length were quantified in all patients with a LGE‐CMR performed 3 months postablation. Application time (420 ± 217 seconds), number of applications (2.1 ± 1.2), application time after electrical isolation (311 ± 194 seconds) and minimum temperature (−45.8 ± 6.5°C) were similar in the 4 PVs. Gaps were observed in 148 PVs (76%), averaging 1.3 ± 1 gaps per vein. Gaps were longer and more frequent in the right PVs (91% vs 59% in left PVs, P < .001). Neither the number, total duration of applications, nor postisolation application time predicted relative length or number of gaps. Conclusions After successful PV isolation was achieved in patients undergoing cryoablation, increasing the number of applications, the total application time or application time postisolation did not result in a reduction in the number or the relative length of gaps.

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“…Consequently, studies were initiated to redefine AFA dosing parameters (Figure and Table ), including (a) examining the requirement for multiple cryofreeze applications (including the bonus freeze and freeze‐thaw‐refreeze applications); (b) evaluating reductions in freeze duration; and/or (c) investigating intraprocedural data with regard to balloon characteristics (eg, balloon nadir temperature, acute time‐to‐isolation [TTI], and balloon thaw time) that could be used to inform real‐time, individualized dosing . Through these studies, TTI < 60 seconds has been identified as a strong intraprocedural predictor of CBA longer‐term PVI durability . When observed, real‐time TTI of pulmonary vein (PV) signals provide a measurable parameter of acute cardiac tissue damage that can predict a durable longer‐term freedom from AF recurrence …”

Section: Introductionmentioning

confidence: 99%

Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons

Getman

Wißner

Ranjan

et al. 2019

Cardiovasc electrophysiol

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BackgroundPreclinical and clinical studies have utilized periprocedural parameters to optimize cryoballoon ablation dosing, including acute time‐to‐isolation (TTI) of the pulmonary vein, balloon rate of freezing, balloon nadir temperature, and balloon‐thawing time. This study sought to predict the Arctic Front Advance (AFA) vs Arctic Front Advance Pro (AFA Pro) ablation durations required for transmural pulmonary vein isolation at varied tissue depths.MethodsA cardiac‐specific, three‐dimensional computational model that incorporates structural characteristics, temperature‐dependent cellular responses, and thermal‐conductive properties was designed to predict the propagation of cold isotherms through tissue. The model assumed complete cryoballoon‐to‐pulmonary vein (PV) circumferential contact. Using known temperature thresholds of cardiac cellular electrical dormancy (at 23°C) and cellular nonviability (at −20°C), transmural time‐to‐isolation electrical dormancy (TTIED) and cellular nonviability (TTINV) were simulated.ResultsFor cardiac thickness of 0.5, 1.25, 2.0, 3.0, 4.0, and 5.0 mm, the 23°C isotherm passed transmurally in 33, 38, 46, 62, 80, and 95 seconds during cryoablation utilizing AFA and 33, 38, 46, 63, 80, and 95 seconds with AFA Pro. Using the same cardiac thicknesses, the −20°C isotherm passed transmurally in 40, 55, 78, 161, 354, and 696 seconds during cryoablation with AFA and 40, 54, 78, 160, 352, and 722 seconds with AFA Pro.ConclusionThis model predicted a minimum duration of cryoballoon ablation (TTINV) to obtain a transmural lesion when acute TTI of the PV was observed (TTIED). Consequently, the model is a useful tool for characterizing CBA dosing, which may guide future cryoablation dosing strategies.

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Individualized cryoballoon energy pulmonary vein isolation guided by real-time pulmonary vein recordings, the randomized ICE-T trial

Cited by 137 publications

References 25 publications

Does Size Matter? Cryoballoon-Based Pulmonary Vein Isolation Using a Novel 25-mm Circular Mapping Catheter

Does Size Matter? Cryoballoon-Based Pulmonary Vein Isolation Using a Novel 25-mm Circular Mapping Catheter

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Relationship between time‐to‐isolation and freeze duration: Computational modeling of dosing for Arctic Front Advance and Arctic Front Advance Pro cryoballoons

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