Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience

Aryana, Arash; Baker, James H.; Ginic, Martin A. Espinosa; Pujara, Deep; Bowers, Mark R.; O’Neill, Padraig Gearoid; Ellenbogen, Kenneth A.; Biase, Luigi Di; Reddy, Vivek Y.; Natale, Andrea

doi:10.1016/j.hrthm.2018.05.014

Cited by 136 publications

(156 citation statements)

References 25 publications

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“…Although the PVI is a standard established therapeutic strategy in AF ablation, the clinical outcome after an ablation procedure with only a PVI is still unsatisfactory, especially in non‐paroxysmal patients with AF. Recently, the second generation CB has been applied for linear ablation on the LAPW with a high success rate and without any serious complications including esophageal injury 6–9,13 . In this cohort, we were able to draw the clinical implications of the linear ablation on the LAPW with the CB from the result of a low arrhythmia recurrence rate (24.1%).…”

Section: Discussionmentioning

confidence: 89%

“…Recently, the second generation CB has been applied for linear ablation on the LAPW with a high success rate and without any serious complications including esophageal injury. [6][7][8][9]13 In this cohort, we were able to draw the clinical implications of the linear ablation on the LAPW with the CB from the result of a low arrhythmia recurrence rate (24.1%). In the re-do ablation cohort (n = 47), in 12 patients solely using a CB application failed to create a complete conduction block at the LAPW bottom line and included one patient who underwent a touch-up RF ablation, and the RF delivery was prematurely terminated due to an esophageal temperature rise.…”

Section: The Clinical Implications Of the Linear Ablation On The Lapwmentioning

confidence: 99%

“…Linear ablation in the left atrium (LA) including of the roof and bottom line of the LA posterior wall (LAPW) that connect the ostia of both‐sided superior PVs and inferior PVs, and the resultant LAPW isolation, is one of the additional therapeutic methods after the PVI 5 . There have been several reports in which an LAPW roof line creation and LAPW isolation could be successfully completed by the CB 6–9 . However, there have been few investigations regarding the long‐term durability of the lesions on the LAPW roof and bottom line created by the CB application.…”

Section: Introductionmentioning

confidence: 99%

“…5 There have been several reports in which an LAPW roof line creation and LAPW isolation could be successfully completed by the CB. [6][7][8][9] However, there have been few investigations regarding the longterm durability of the lesions on the LAPW roof and bottom line created by the CB application. The aim of the present study was to investigate the long-term durability of the linear lesions in the LA with the CB and to find reliable predictors of the durability of these lesions.…”

mentioning

confidence: 99%

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Clinical investigation of the durability of the lesions created by left atrial linear ablation with a cryoballoon

Shigeta

Okishige

Nishimura

et al. 2020

Cardiovasc electrophysiol

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Introduction Pulmonary vein isolation (PVI) and linear ablation with a roof line and bottom line on the left atrial (LA) posterior wall (LAPW) can be achieved with a cryoballoon (CB). This study sought to investigate the long‐term durability of these linear lesions. Methods and results Among 290 persistent patients with atrial fibrillation (AF) who had undergone linear ablation with a CB on the roof and bottom line of the LAPW in addition to the PVI, we analyzed those patients who underwent a re‐do AF ablation. Arrhythmia recurrence was confirmed in 70 (24%) out of 290 patients, and 47 (16%) patients underwent re‐do sessions. At the beginning of the re‐do ablation, we examined the reconnection sites of the linear lesions on the LAPW and PVI. Maintenance of the conduction block on the LAPW roof and bottom lines was observed in 35 out of 47 patients (74.5%), and 16 out of 35 patients (45.7%), respectively. The length of the roof line was significantly shorter in patients with preservation of the conduction block on the LAPW roof than in those without (36.2 ± 6.5 mm vs 41.6 ± 4.7 mm, P = .02). Conclusion Durable lesions could be obtained after linear ablation with the CB for the LAPW roof line, especially in those with a relatively short LAPW roof line. However, patients requiring touch‐up ablation with radiofrequency were included, and that was associated with a potential financial implication.

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Section: Discussionmentioning

confidence: 89%

Section: The Clinical Implications Of the Linear Ablation On The Lapwmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Clinical investigation of the durability of the lesions created by left atrial linear ablation with a cryoballoon

Shigeta

Okishige

Nishimura

et al. 2020

Cardiovasc electrophysiol

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“…Aryana et al. also demonstrated the successful clinical outcome of the isolation of the LAPW with CB applications . Even though their two patients had an LET lower than 15°C, no acute or long‐term adverse effects on the esophagus were reported in either patient.…”

Section: Discussionmentioning

confidence: 94%

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Shigeta

Okishige

Aoyagi

et al. 2019

Pacing Clinical Electrophis

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Background The cryoballoon (CB) can be utilized for extra pulmonary vein (PV) ablation such as for a left atrial (LA) posterior wall (LAPW) isolation. However, scrutiny of the esophageal injuries during the LAPW isolation has never been performed. We sought to thoroughly investigate the esophageal lesions (ELs) and gastric hypomotility (GH) caused by an LAPW isolation using a CB. Methods A total of 101 persistent atrial fibrillation patients who underwent an LAPW isolation using a CB were enrolled. The CB was applied on the roof and bottom area of the LAPW after a PV isolation. The luminal esophageal temperature (LET) was monitored by a thermistor probe during the CB applications. When the LET reached 15°C, the freezing application was prematurely interrupted. Esophagogastroscopy was performed on the next day following the ablation. Results All PVs were successfully isolated in all patients. A successful LAPW isolation solely with CB ablation was performed in 72 (71.3%) patients. Cryofreezing applications were prematurely interrupted due to low LETs in 49 (48.5%) patients predominantly during the LA bottom line ablation. ELs and GH were observed in 11 (10.9%) and 16 patients (15.8%), respectively. The nadir LET tended to be lower in patients with ELs and GH than in those without (ELs: 14.8 ± 4.5°C vs 17.4 ± 6.0°C, P = 0.17; GH: 15.5 ± 4.5°C vs 17.5 ± 6.1°C, P = 0.23, respectively). Conclusions Esophageal complications such as ELs and GH occur during the LAPW isolation with a CB. There was no reliable predictor of those adverse events.

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Feasibility, safety, and acute efficacy of the fourth‐generation cryoballoon for ablation of atrial fibrillation: Another step forward?

Rottner

Mathew

Reißmann

et al. 2020

Clinical Cardiology

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Background The second‐generation cryoballoon (CB2) is widely used for pulmonary vein (PV) isolation (PVI) in patients with paroxysmal atrial fibrillation (AF). Recently, the novel fourth‐generation CB (CB‐Advance PRO) was introduced, incorporating a shortened catheter tip. Hypothesis The aim of this study was to evaluate the feasibility and acute efficacy of PVI using the CB‐Advance PRO. Methods A total of 200 consecutive patients were analyzed. Hundred patients who underwent PVI due to symptomatic, drug‐refractory AF were treated with the CB‐Advance PRO (group I) and were included into this multicenter analysis. A group of 100 patients were treated with the CB2 and acted as controls (group II). Results In total, 739 of 739 PVs (100%) were successfully isolated. There was a nonsignificant trend in the incidence of online registration of PV signals between both groups (group I: 77.9% vs group II: 71.4%, P = .09). Median time to PVI (time to isolation [TTI]) and mean total freezing time were significantly shorter when using the CB‐Advance PRO (group I: 33 [23, 50] vs group II: 40 [26, 60] seconds and group I: 166 ± 29 vs group II: 183 ± 38 seconds, P < .01). In three of 100 (3%) patients of group I and one of 100 (1%) patients of group II, a transient phrenic nerve palsy occurred (P = .62). Conclusion The use of the novel CB‐Advance PRO is feasible and associated with a significant reduction in mean TTI and mean total freezing time as compared to the CB2.

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Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: A multicenter experience

Cited by 136 publications

References 25 publications

Clinical investigation of the durability of the lesions created by left atrial linear ablation with a cryoballoon

Clinical investigation of the durability of the lesions created by left atrial linear ablation with a cryoballoon

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Feasibility, safety, and acute efficacy of the fourth‐generation cryoballoon for ablation of atrial fibrillation: Another step forward?

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