Learning Curve in Cryoballoon Ablation of Atrial Fibrillation

Wójcik, Maciej; Berkowitsch, Alexander; Greis, Harald; Zaltsberg, Sergej; Hamm, Christian W.; Pitschner, Heinz F.; Kuniss, Malte; Neumann, Thomas

doi:10.1253/circj.cj-13-1253

Cited by 23 publications

(15 citation statements)

References 25 publications

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“…The decline in procedure time can be explained by the fast learning curve and the change from a bonus freeze to a nonbonus freeze protocol. The fast learning curve for the cryoballoon procedure has been described in previous studies . Because longer procedure times increase the rate of complications, reducing the procedure time is one of the major issues in preventing complications.…”

Section: Discussionmentioning

confidence: 93%

The Total Incidence of Complications and the Impact of an Anticoagulation Regime on Adverse Events After Cryoballoon Ablation of Atrial Fibrillation: A Single‐Center Study of 409 Patients

Koektuerk

Turan

Yorgun

et al. 2016

Cardiovascular Therapeutics

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SUMMARYAim: Data evaluating the complications of pulmonary vein isolation (PVI) using secondgeneration cryoballoons (CB) related to different anticoagulation regimes are limited. This study evaluates the total complications and the impact of novel oral anticoagulants (NOACs) compared to phenprocoumon on adverse events in the setting of PVI using CB. Methods and results: PVI was performed using second-generation CB by two experienced investigators. A total of 409 patients (58.9% male; mean age = 61 AE 10 years) with atrial fibrillation were included in this study. In group I, 150/409 (36.7%) patients received phenprocoumon therapy, and in group II, 259/409 (63.3%) patients were treated with NOACs (rivaroxaban: n = 193; dabigatran: n = 48; and apixaban: n = 18). In both groups, the rates of major complications were similar (group I [phenprocoumon]: four pts (2.7%) vs. Group II [NOACs]: seven pts (2.7%); P = 0.999). In this cohort, 275 patients were ablated with the bonus freeze protocol, and 134 patients were ablated without bonus freezes. The procedure duration significantly decreased with the bonus freeze protocol from 102.3 AE 24.6 min to 68.5 AE 16.2 min (P < 0.001). The impact of the bonus freeze on the postprocedural increase of C-reactive protein (CRP) levels was significant compared to the postprocedural CRP levels after procedures without the bonus freeze protocol (postprocedural CRP level+ bonus protocol: 1.6 AE 1.2 mg/L vs. postprocedural CRP level+ nonbonus protocol: 1.3 AE 1.3 mg/L; P = 0.04). Conclusion: The incidence of adverse events in PVI using the second-generation CB with the periprocedural administration of NAOCs was not significantly different compared to phenprocoumon. Further, large-scale randomized studies are needed to evaluate the safety of two anticoagulation regimes comparing vitamin K antagonists and NOACs, as well as different NOAC regimes, in patients undergoing PVI using cryoballoon ablation.

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Section: Discussionmentioning

confidence: 93%

The Total Incidence of Complications and the Impact of an Anticoagulation Regime on Adverse Events After Cryoballoon Ablation of Atrial Fibrillation: A Single‐Center Study of 409 Patients

Koektuerk

Turan

Yorgun

et al. 2016

Cardiovascular Therapeutics

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“…Available data on the the influence of operator experience as related to the safety and efficacy results with these simplified approaches are also limited. Wójcik et al [15] reported on the procedural experience gained over 8 years with CBA in a high-volume center. A continuous decrease in fluoroscopy and procedure times was observed in each subsequent year and in multivariate analysis both the year of procedure and the preablation ALARMEc (Atrial fibrillation type, LA size, Renal insufficiency, MEtabolic syndrome, cardiomyopathy) risk score were independent predictors of procedure and fluoroscopy times.…”

Section: Previous Studies On Learning Curve In Af Ablationmentioning

confidence: 99%

“…Sairaku et al [14] have reported a significantly higher incidence of procedure-related complications and a lower arrhythmia-free survival at 6-month follow-up with double Lasso catheterguided encircling PVI in the first 52 as compared with the following 156 patients who underwent the ablation. Wójcik et al [15] have demonstrated a learning curve effect with CBA as indicated by the decline in procedure and fluoroscopy times. However, improvement in the long-term outcome over time has been attributed to a more careful patient selection and not to operator experience per se.…”

Section: Introductionmentioning

confidence: 99%

Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation

et al. 2015

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“…As with any new technology, a learning curve is expected. 23 This might have influenced the result of relatively high PV reconnection rates at the 2nd procedure in the CBA group, although the AF recurrence rate in the CBA group was comparable to that in other CBA studies. 24 This is in contrast with RF in which the outcomes of AF ablation are considered to be more operator-dependent than those of CBA.…”

Section: Study Limitationsmentioning

confidence: 69%

Comparison of the Safety and Efficacy of Automated Annotation-Guided Radiofrequency Ablation and 2nd-Generation Cryoballoon Ablation in Paroxysmal Atrial Fibrillation

Tanaka

Ninomiya

et al. 2019

Circ J

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Background: Automated ablation lesion annotation with optimal settings for parameters including contact force (CF) and catheter stability may be effective for achieving durable pulmonary vein isolation. Methods and Results:We retrospectively examined 131 consecutive patients who underwent initial catheter ablation (CA) for paroxysmal atrial fibrillation (PAF) by automatic annotation system (VISITAG module)-guided radiofrequency CA (RFCA) (n=61) and 2nd-generation cryoballoon ablation (CBA) (n=70) in terms of safety and long-term efficacy. The automatic annotation criteria for the RFCA group were as follows: catheter stability range of motion ≤1.5 mm, duration ≥5 s, and CF ≥5 g. We ablated for >20 s with a force-time integral >150 gs at each site, before moving to the next site. Each interlesion distance was <6 mm. Procedural complications were more frequent in the CBA group (1.6% vs. 10.0%, P=0.034). Across a median follow-up of 2.98 years, 88.5% and 70.0% of patients in the RFCA and CBA groups, respectively, were free from recurrence (log-rank test, P=0.0039). There was also a significant difference in favor of RFCA with respect to repeat ablations (3.3% vs. 24.3%, log-rank test, P=0.0003).Conclusions: RF ablation guided by an automated algorithm that includes CF and catheter stability parameters showed better long-term outcomes than CBA in the treatment of patients with PAF without increasing complications.

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Learning Curve in Cryoballoon Ablation of Atrial Fibrillation

Cited by 23 publications

References 25 publications

The Total Incidence of Complications and the Impact of an Anticoagulation Regime on Adverse Events After Cryoballoon Ablation of Atrial Fibrillation: A Single‐Center Study of 409 Patients

The Total Incidence of Complications and the Impact of an Anticoagulation Regime on Adverse Events After Cryoballoon Ablation of Atrial Fibrillation: A Single‐Center Study of 409 Patients

Learning curve in circular multipolar phased radiofrequency ablation of atrial fibrillation

Comparison of the Safety and Efficacy of Automated Annotation-Guided Radiofrequency Ablation and 2nd-Generation Cryoballoon Ablation in Paroxysmal Atrial Fibrillation

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