Lessons from individualized cryoballoon sizing. Is there a role for the small balloon?

Hartl, Stefan; Dorwarth, Uwe; Bunz, Benedikt; Wankerl, Michael; Ebersberger, Ullrich; Hoffmann, Ellen; Straube, Florian

doi:10.1016/j.jjcc.2016.12.016

Cited by 6 publications

(9 citation statements)

References 21 publications

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“…The effectiveness of CBA can be explained by a durable and wide antral circumferential PVI by the 28 mm CB, which ablates approximately two thirds of the posterior wall and empirically gathers additional arrhythmogenic substrate beyond common PV‐triggers 26 . Additionally, our center‐specific advanced TTI‐guided ablation protocol with a very conservative cut‐off TTI of 45 s allowing for single freeze treatment, and the option to use the 23 mm CB size in addition in very small PV with difficult anatomy 20 could have a positive effect on durable PVI and the low rate of phrenic nerve injury.…”

Section: Discussionmentioning

confidence: 99%

“…Our ablation procedure protocol has been described before in detail 19–22 and was adjusted during the time course with respect to current scientific findings. In case of unknown coronary status cardiac computed tomography (CT) or magnetic resonance imaging (MRI) was performed before ablation 23 to rule out relevant stenosis and/or to build a three‐dimensional (3D) reconstruction of the LA/PV‐anatomy 20 . Intracardiac thrombi were ruled out using transesophageal echocardiography before ablation.…”

Section: Methodsmentioning

confidence: 99%

“…The 28 mm CB was the preferred balloon size. The 23‐mm CB was only allowed if PV diameters were exclusively small (≤ 21 mm) 20 to lower the risk of potential complications such as PV stenosis or phrenic nerve palsy (PNP). Transseptal puncture, antral positioning of the balloon, and complete occlusion (including color doppler imaging), and diaphragmatic motion during phrenic nerve pacing was visualized by intracardiac echocardiography (Vivid I, GE Healthcare EUROPE, GE Ultraschall Deutschland GmbH).…”

Section: Methodsmentioning

confidence: 99%

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Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all‐comer study

Hartl

Dorwarth

Pongratz

et al. 2021

Cardiovasc electrophysiol

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Introduction The objective was to analyze the impact of patient age on clinical characteristics, procedural results, safety, and outcome of cryoballoon ablation (CBA) as the primary approach in the interventional treatment of symptomatic atrial fibrillation (AF). Methods and Results The single‐center prospective observational study investigated consecutive patients who underwent initial left atrial ablation for symptomatic paroxysmal (PAF) or persistent AF (persAF). Age groups (A–F) of less than 40, 40–49, 50–59, 60–69, 70–79 and more than or equal to 80 years were evaluated. Follow‐up (FU) included ECG, Holter monitoring and assessment of AF‐symptoms. From 2012 to 2016, a total of 786 patients (64 ± 11 years, range 21–85) underwent CBA. With advancing age, more cardiovascular comorbidities and larger LA diameter were observed, more females were included (each p < .001). PAF (57%) and persAF (43%, p = .320) were equally distributed over all age groups. Age was neither related to procedural parameters, nor to the complication rate (3.9%, p = .233). Median FU was 38 months. Two non‐procedure related noncardiac deaths occurred late during FU. Freedom from arrhythmia was independent of age at 18 months (p = .210) but decreased for patients more than or equal to 70 years at 24 months (p = .02). At 36 months, freedom from arrhythmia was 66%–74% (groups A–D), 54% (E) and 49% (F), respectively (p = .002). LA diameter and persAF were independent predictors, whereas age was a dependent predictor of recurrence. Conclusion CBA as the primary approach in the initial ablation procedure is safe and highly effective in the young, middle aged, and elderly population. LA diameter and persAF, but not ageing, were independent predictors for arrhythmia recurrence.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all‐comer study

Hartl

Dorwarth

Pongratz

et al. 2021

Cardiovasc electrophysiol

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“…The procedure has been described in detail in previous studies (6,(9)(10)(11)(12)(13)(14). Prior to the procedure, baseline characteristics were documented, and all the patients underwent transthoracic and transesophageal echocardiography.…”

Section: Cryoballoon Proceduresmentioning

confidence: 99%

Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

Straube

Pongratz

Kosmalla

et al. 2021

Front. Cardiovasc. Med.

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Background: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure.Material and Methods: Prospectively, patients with symptomatic persistent AF scheduled for AF ablation all underwent cryoballoon PVI. Technical enhancements, laboratory management, safety, single-procedure outcome, predictors of recurrence, and durability of PVI were evaluated.Results: From 2007 to 2020, a total of 1,140 patients with persistent AF, median age 68 years, underwent cryoballoon ablation (CBA). Median left atrial (LA) diameter was 45 mm (interquantile range, IQR, 8), and Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes mellitus, prior Stroke or TIA or thromboembolism (doubled), Vascular disease, Age 65 to 74 years, Sex category (CHA2DS2-VASc) score was 3. Acute isolation was achieved in 99.6% of the pulmonary veins by CBA. Median LA time and median dose area product decreased significantly over time (p < 0.001). Major complications occurred in 17 (1.5%) patients including 2 (0.2%) stroke/transitory ischemic attack (TIA), 1 (0.1%) tamponade, relevant groin complications, 1 (0.1%) significant ASD, and 4 (0.4%) persistent phrenic nerve palsy (PNP). Transient PNP occurred in 66 (5.5%) patients. No atrio-esophageal fistula was documented. Five deaths (0.4%), unrelated to the procedure, occurred very late during follow-up. After initial CBA, arrhythmia recurrences occurred in 46.6% of the patients. Freedom from atrial arrhythmias at 1-, and 2-year was 81.8 and 61.7%, respectively. Independent predictors of recurrence were LA diameter, female sex, and use of the first cryoballoon generation. Repeat ablations due to recurrences were performed in 268 (23.5%) of the 1,140 patients. No pulmonary vein (PV) reconduction was found in 49.6% of the patients and 73.5% of PVs. This rate increased to 66.4% of the patients and 88% of PVs if an advanced cryoballoon was used in the first AF ablation procedure.Conclusion: Cryoballoon ablation for symptomatic persistent AF is a reasonable strategy in the initial AF ablation procedure.

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“…For 23 mm balloons, PVI mostly occurs in the tubular part of the ostium, while the 28 mm balloon creates a larger lesion in the left atrium[42]. The 28 mm CB is conventional for all PV, whereas 23 mm cryoballoons may be an appropriate option for patients with small PV diameters to achieve better contact and effective PVI[43,44].6.2. TEE and ICE Are Helpful.…”

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confidence: 99%

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

Huang

Wang

Song

2020

BioMed Research International

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Atrial fibrillation (AF) is a common arrhythmia contributing to severe outcomes, including cardiac dysfunction and stroke, and it has drawn great attention around the world. Drug therapies have been available for many years to terminate AF and control heart rate. However, the results from clinical studies on drug therapies have been discouraging. Mounting evidence indicates that radiofrequency catheter ablation (RFCA) is a safe and effective method to maintain sinus rhythm, especially in patients who are drug intolerant or for whom the drugs are ineffective, although it is a technically demanding and complex procedure. Fortunately, a novel application, cryoballoon ablation (CBA), with outstanding characteristics has been widely used. Great outcomes based on CBA have manifested its significant role in the treatment of AF. However, how to improve the safety and efficacy of CBA is a question that has not been well-answered. Would it be helpful to develop a different generation of cryoballoon? Is bonus freezing beneficial, or not? Is it better to prolong freezing time? Dose CBA combined with RFCA bring higher success rates? In this review, we comprehensively summarized useful applications for improving outcomes of CBA in AF patients.

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Lessons from individualized cryoballoon sizing. Is there a role for the small balloon?

Cited by 6 publications

References 21 publications

Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all‐comer study

Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all‐comer study

Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

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