Posterior box isolation as an adjunctive ablation strategy with the second-generation cryoballoon for paroxysmal atrial fibrillation: a comparison with standard cryoballoon pulmonary vein isolation

Bisignani, Antonio; Overeinder, Ingrid; Kazawa, Shuichiro; Iacopino, Saverio; Cecchini, Federico; Miraglia, Vincenzo; Osório, Thiago Guimarães; Boveda, Serge; Bala, Gezim; Mugnai, Giacomo; Monaco, Cinzia; Ströker, Erwin; Brugada, Pedro; Sieira, Juan; Galli, A.; Asmundis, Carlo de; Chierchia, Gian Battista

doi:10.1007/s10840-020-00812-z

Cited by 19 publications

(33 citation statements)

References 22 publications

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“…Whenever PV reconnection was identified, repeat PVI was performed using CB‐A as previously described. Our approach to LAPWI with CB‐A was described in detail elsewhere 9,10 . Briefly, after PVI, in order to achieve LAPWI, the Achieve®catheter was placed deeply in the LSPV to stabilize the CB‐A that was positioned with the distal freezing surface oriented towards the LAPW.…”

Section: Methodsmentioning

confidence: 99%

“…Our standard preprocedural management and ablation have been previously described in detail. 9 , 10 After a single transseptal puncture LA access was gained, through a steerable 15 Fr sheath (FlexCath Advance ® , Medtronic©) and an inner lumen mapping catheter (MC; Achieve ® , Medtronic©) was advanced and positioned in each PV ostium. A 28 mm CB‐A (Arctic Front Advance™, Medtronic©) was advanced inflated and positioned at PV ostium.…”

Section: Methodsmentioning

confidence: 99%

“…Our approach to LAPWI with CB‐A was described in detail elsewhere. 9 , 10 Briefly, after PVI, in order to achieve LAPWI, the Achieve®catheter was placed deeply in the LSPV to stabilize the CB‐A that was positioned with the distal freezing surface oriented towards the LAPW. As per our standard protocol, cryothermal lesions ranged from 120 to 180 seconds.…”

Section: Methodsmentioning

confidence: 99%

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Repeat procedures for recurrent persistent atrial fibrillation: A propensity‐matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon

Bisignani

Pannone

Bala

et al. 2021

Journal of Arrhythmia

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Aims To evaluate the clinical outcome in patients undergoing repeat procedures for recurrent persistent atrial fibrillation following an index cryoballoon (CB‐A) pulmonary vein isolation ablation on a mid‐term follow‐up of 12 months. Methods In this propensity score‐matched comparison, 50 patients undergoing left atrial posterior wall isolation (LAPWI) with the CB‐A were matched to 50 patients treated with additional linear ablation using radiofrequency catheter ablation (RFCA). Results Meantime to repeat the procedure was 9.74 ± 4.36 months. At 12 months follow‐up freedom from atrial tachyarrhythmias (ATas) was achieved in 82% of patients in the LAPWI group and in 62% of patients in the linear ablation group (P = .03). Regression analysis demonstrated that relapses during the blanking period and LA dimensions were independent predictors of ATas recurrences following the repeat procedure. Conclusion LAPWI using CB‐A is associated with a significantly higher freedom from atrial arrhythmias when compared with the RFCA mediated left atrial linear lesions on a mid‐term follow‐up of 12 months in patients with persAF undergoing a redo procedure.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Repeat procedures for recurrent persistent atrial fibrillation: A propensity‐matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon

Bisignani

Pannone

Bala

et al. 2021

Journal of Arrhythmia

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“…Our standard pre‐procedural management and CB‐A ablation has been previously described in detail 5,14 . All procedures were performed under general anesthesia and under esophageal temperature monitoring.…”

Section: Methodsmentioning

confidence: 99%

Feasibility and safety of left atrial posterior wall isolation with a new Cryoballoon technology in patients with persistent atrial fibrillation

Bisignani

Pannone

Miraglia

et al. 2022

Pacing Clinical Electrophis

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Background Left atrial posterior wall isolation (LAPWI) is often performed in addition to pulmonary vein isolation (PVI) in the setting of persistent atrial fibrillation (AF) ablation. The aim of this study was to evaluate the feasibility and safety of a new cryoballoon ablation system in achieving PVI + LAPWI isolation. Methods The study was a prospective, non‐randomized, single center study. Forty consecutive patients, undergoing PVI + LAPWI with the novel POLARx™, were compared to 40 consecutive patients who underwent the same procedure with the established Arctic Front Advance PRO™. Results Acute isolation was achieved in all PVs in both groups and left posterior wall isolation (LAPWI) was achieved in 38 patients (95%) in the POLARx group and in 36 patients (90%) in Arctic Front group. Procedural outcomes were similar between both groups, except for lower temperatures during cryoenergy in the POLARx group, for both pulmonary vein isolation (PVI) and LAPWI. Conclusion LAPWI + PVI with the novel POLARx™ Cryoballoon is feasible and safe; the results are comparable with the Arctic Front Advance PRO™ system.

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“…Although complete PWI can be successfully achieved using a 28-mm cryoballoon without the need for adjunct point-bypoint cryo/RFA, 15,47,48 in some studies this has been shown to be necessary in at least one-third of the patients, 4,14,18 particularly in those with LA diameter .48 mm. 4 A gap, if present, is normally encountered along the mid-portion of the inferior PW (Figure 8).…”

Section: Lapwmentioning

confidence: 99%

Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III

Aryana

Kuniss

et al. 2021

Heart Rhythm

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Although cryoballoon ablation of atrial fibrillation (AF) traditionally has been guided by pulmonary vein (PV) occlusion, there is evidence and growing interest in performing segmental, nonocclusive cryoballoon ablation to target not only large/common PVs but extra-PV structures such as the left atrial (LA) roof and posterior wall in conjunction with PV isolation. A number of studies have demonstrated improved clinical efficacy associated with nonocclusive cryoballoon ablation of the LA roof and posterior wall in addition to PV isolation, particularly in patients with persistent AF. Not only can the cryoballoon be used for targeting extra-PV structures through segmental, nonocclusive ablation, but the large size and durability of cryolesions coupled with the enhanced stability afforded through cryoadhesion render the cryoballoon an effective tool for such an approach. This article reviews the rationale and the practical approach to segmental, nonocclusive cryoballoon ablation of large/common PV antra and the LA roof and posterior wall.

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Posterior box isolation as an adjunctive ablation strategy with the second-generation cryoballoon for paroxysmal atrial fibrillation: a comparison with standard cryoballoon pulmonary vein isolation

Cited by 19 publications

References 22 publications

Repeat procedures for recurrent persistent atrial fibrillation: A propensity‐matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon

Repeat procedures for recurrent persistent atrial fibrillation: A propensity‐matched score comparison between left atrial linear ablation with radiofrequency and posterior wall isolation with the cryoballoon

Feasibility and safety of left atrial posterior wall isolation with a new Cryoballoon technology in patients with persistent atrial fibrillation

Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III

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