One‐Year Follow‐Up After Single Procedure Cryoballoon Ablation: A Comparison Between the First and Second Generation Balloon

Giovanni, Giacomo Di; Wauters, Kristel; Chierchia, Gian‐Battista; Sieira, Juan; Levinstein, Moisés; Conte, Giulio; Asmundis, Carlo de; Baltogiannis, Giannis; Saitoh, Yukio; Ciconte, Giuseppe; Juliá, Justo; Mugnai, Giacomo; Irfan, Ghazala; Brugada, Pedro

doi:10.1111/jce.12409

Cited by 155 publications

(108 citation statements)

References 22 publications

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“…3 In studies using CB2, the PNP rate has ranged from 3.5% to 27.5% and the vast majority of cases regressed completely. [12][13][14][15][16][17] The rate of threatened PNP in our previous series using CB1 1 was identical to the 1 observed in this series with CB2: 12% versus 13.6%, respectively. This similarity occurred despite more frequent use of 28-mm CB2 (90% versus 32%).…”

Section: Discussionsupporting

confidence: 79%

Electromyographic Monitoring for Prevention of Phrenic Nerve Palsy in Second-Generation Cryoballoon Procedures

Franceschi

Koutbi

Gitenay

et al. 2015

Circ: Arrhythmia and Electrophysiology

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All procedures were performed under conscious sedation. Briefly, a quadripolar catheter Josephson curve (St. Jude Medical, Minnetonka, MN) was positioned on the His bundle and a deflectable quadripolar catheter (Xtrem catheter; Sorin Group) was placed in the coronary sinus by the femoral route. These 2 catheters were used as landmarks for transseptal puncture to allow placement of a steerable 15 Fr sheath © 2015 American Heart Association, Inc. Original ArticleBackground-Electromyography-guided phrenic nerve (PN) monitoring using a catheter positioned in a hepatic vein can aid in preventing phrenic nerve palsy (PNP) during cryoballoon ablation for atrial fibrillation. We wanted to evaluate the feasibility and efficacy of PN monitoring during procedures using second-generation cryoballoons. Methods and Results-This study included 140 patients (43 women) in whom pulmonary vein isolation was performed using a second-generation cryoballoon. Electromyography-guided PN monitoring was performed by pacing the right PN at 60 per minute and recording diaphragmatic compound motor action potential (CMAP) via a quadripolar catheter positioned in a hepatic vein. If a 30% decrease in CMAP amplitude was observed, cryoapplication was discontinued with forced deflation to avoid a PNP. Monitoring was unfeasible in 8 of 140 patients (5.7%), PNP occurred in 1. Stable CMAP amplitudes were achieved before ablation in 132 of 140 patients (94.3%). In 18 of 132 patients (13.6%), a 30% decrease in CMAP amplitude occurred and cryoablation was discontinued. Each time, recovery of CMAP amplitude took <60 s. In 9 of 18 cases, a second cryoapplication in the same pulmonary vein was safely performed. We observed no PNP or complication related to electromyography-guided PN monitoring. Conclusions-Electromyography-guided PN monitoring using a catheter positioned in a hepatic vein seems feasible and effective to prevent PNP during cryoballoon ablation using second-generation cryoballoon. (Circ Arrhythm Electrophysiol. 2015;8:303-307.

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Section: Discussionsupporting

confidence: 79%

Electromyographic Monitoring for Prevention of Phrenic Nerve Palsy in Second-Generation Cryoballoon Procedures

Franceschi

Koutbi

Gitenay

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…[2][3][4][5] Despite encouraging results, arrhythmic recurrences after the index procedure remain relatively frequent which, in most of cases, might be related to PV reconnections, potentially reflecting the lack of efficacy in achieving transmurality and homogeneous long-lasting lesions. [2][3][4][5][6][7] To date, little information is available about occurrence of late PV reconnection after CB-Adv ablation. 6 Although, recently published data indicates that roughly 90% of PVs are still isolated 3 months after CB-Adv ablation, 7 to the best of our knowledge, predictors of late PV reconnections after CB-Adv ablation for the treatment of AF have not been identified yet.…”

Section: P Ulmonary Vein Isolation (Pvi) Represents the Cornerstone Tmentioning

confidence: 99%

“…3,5 All CB-Adv ablation were performed under general anesthesia. Briefly, after obtaining LA access, through a steerable 15 Fr sheath (FlexCath Advance, Medtronic), inner lumen mapping catheter (MC; Achieve, Medtronic) was advanced in each PV ostium.…”

Section: Cryoballoon Ablation As Index Proceduresmentioning

confidence: 99%

On the Quest for the Best Freeze

Ciconte

Mugnai

Sieira

et al. 2015

Circ: Arrhythmia and Electrophysiology

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118

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Background— The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation. Methods and Results— A total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13.8 years) underwent a repeat procedure, after a mean 11.6±4.5 months (range, 3.5–19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI ( P =0.03) and failure to achieve −40°C within 60 s ( P =0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73–0.97; P <0.001). Conclusions— The rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of −40°C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.

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“…Compared with the first-generation CB (Arctic Front™), the secondgeneration CB (Arctic Front Advance™) has double number of freezing pores (8 instead of 4) with their more distal location, leading to more uniform ablation of PVs. This technology improved the procedural parameters such as procedure duration, fluoroscopy time, time to PVI, and had better clinical outcomes than first-generation CB 13) . Both ablation technologies have a similar clinical success rate ranging from 73% to 88% 2,3,[13][14][15] , however, there are few reports on the incidence and characteristics of DC provoked by ATP or adenosine between the CFbased RFA and CBA.…”

Section: Impact Of Different Technique Of Cb Ablation Vsmentioning

confidence: 99%

“…This technology improved the procedural parameters such as procedure duration, fluoroscopy time, time to PVI, and had better clinical outcomes than first-generation CB 13) . Both ablation technologies have a similar clinical success rate ranging from 73% to 88% 2,3,[13][14][15] , however, there are few reports on the incidence and characteristics of DC provoked by ATP or adenosine between the CFbased RFA and CBA. In the present study, the incidence of ATP-provoked DC was infrequent in both the CF-RFA group and CBA group, but the distribution of the DC was different.…”

Section: Impact Of Different Technique Of Cb Ablation Vsmentioning

confidence: 99%

Dormant Conduction after Second-Generation Cryoballoon-Mediated Pulmonary Vein Isolation for Atrial Fibrillation: Comparison with Contact Force-guided Irrigated-Tip Radiofrequency Ablation

Takahashi

Okumura

Watanabe

et al. 2017

Nichidai Igaku Zasshi

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Background: Both contact force (CF)-guided radiofrequency ablation (RFA) based pulmonary vein isolation (PVI) and second-generation cryoballoon ablation (CBA) based PVI may improve the procedural outcome. However, the clinical outcome after RFA-and CBA-based PVI remains unclear. Adenosine or adenosine triphosphate (ATP) administration after PVI is useful to detect dormant PV conduction (DC) after the ablation procedure, and the presence of DC has been shown to be related to AF recurrence.Methods: Out of 100 patients with paroxysmal AF (PAF), 50 underwent CF-guided PVI (25-30 W, 30 sec for each ablation: CF-RFA group), and the remaining 50 patients underwent cryoballoon ablation-based PVI (3 min cooling + 2 min bonus cooling for each PV: CBA group). Thirty minutes after PVI, a 30-mg bolus of ATP was administered. We compared the success rate of PVI, and incidence of DC after PVI between the CF-RFA and CBA groups.Results: The subsequent response was assessed for each vein using a ring catheter. In the CBA group, 180 (90%) of 200 PVs were isolated and 20 PVs (10%) (2 left superior PV (LSPV), 3 left inferior PV (LIPV), 4 right superior PV (RSPV), 11 right inferior PV (RIPV) from 14 of 50 patients (28%) required additional RFA because of residual potential at the PV or PV antra. After a waiting period of 30 min after the last energy application, acute PV reconduction was observed spontaneously in 13 PVs (6.5%) (6 LSPV, 3 LIPV, 4 RSPV) from 12 patients (24%) in the CF-RFA group. The DC sites provoked by ATP were 13 PVs (6.5%) (5 LSPV, 3 LIPV, 2 RSPV, 3 RIPV) from 8 patients (16%) in the CF-RFA group, compared with 9 PVs (4.5%) (2 LSPV, 4 LIPV, 1 RSPV, 2 RIPV) from 9 CBA patients (18%) (P = 1.000). AF recurred in 6/50 (12%) in both the CF-RFA and CBA groups at 1 year after the ablation (P = 1.000).Conclusions: There was no significant difference in the incidence of DC after PVI and the 12-month AF-free rate between the second-generation CBA-and CF-based RFA.

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One‐Year Follow‐Up After Single Procedure Cryoballoon Ablation: A Comparison Between the First and Second Generation Balloon

Abstract: Freedom from AF on 12 months follow-up was significantly higher in the CB-A group with respect to the first generation device. The most frequent complication observed was PNP.

Cited by 155 publications

References 22 publications

Electromyographic Monitoring for Prevention of Phrenic Nerve Palsy in Second-Generation Cryoballoon Procedures

Electromyographic Monitoring for Prevention of Phrenic Nerve Palsy in Second-Generation Cryoballoon Procedures

On the Quest for the Best Freeze

Dormant Conduction after Second-Generation Cryoballoon-Mediated Pulmonary Vein Isolation for Atrial Fibrillation: Comparison with Contact Force-guided Irrigated-Tip Radiofrequency Ablation

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