Pulmonary vein electrophysiology during cryoballoon ablation as a predictor for procedural success

Dorwarth, Uwe; Schmidt, Martin; Wankerl, Michael; Krieg, Juergen; Straube, Florian; Hoffmann, Ellen

doi:10.1007/s10840-011-9585-x

Cited by 60 publications

(39 citation statements)

References 18 publications

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“…9,14 Detailed information is provided in the Appendix in the Data Supplement. In a subgroup of patients, an ET probe (SensiTherm, St. Jude Medical, Saint Paul, MN) was used.…”

Section: Ablation Procedures and Verification Of Pvimentioning

confidence: 99%

“…15 Recently, we have published data on predictors for intraprocedural reconduction using the first CB generation. 9 The cutoff TTI for predicting a stable PVI was 83 seconds. A new predictive cutoff TTI for procedural success with CBG2 cannot be calculated because of the low number of reconducting veins with CBG2.…”

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confidence: 99%

“…[3][4][5] Cryoballoon (CB) ablation is a safe and effective option to achieve permanent PVI and freedom from AF. [6][7][8][9] Clinical Perspective on p 299…”

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confidence: 99%

See 2 more Smart Citations

Comparison of the First and Second Cryoballoon

Straube

Dorwarth

Schmidt

et al. 2014

Circ: Arrhythmia and Electrophysiology

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There were 2 main objectives:1. To compare the procedural efficacy of CBG1 and CBG2 by analyzing rates of acute PVI, time to isolation (TTI), balloon © 2014 American Heart Association, Inc. Original ArticleBackground-Cryoballoon (CB) ablation results in >70% freedom from atrial fibrillation at 1 year. Single-center data of the first (CBG1) and second (CBG2) cryoballoon, recently introduced, were analyzed to compare safety and efficacy. Methods and Results-From March 2011 to December 2012, CB ablation with spiral mapping was performed consecutively in 484 patients with symptomatic atrial fibrillation. CBG1 was used in 364 of 484 (75%) and CBG2 in 120 of 484 (25%) patients. Periprocedural data were analyzed. Acute pulmonary vein (PV) isolation with CB only was achieved in 99.86% and 100% of veins with CBG1 and CBG2, respectively (P=0.43). Number of applications until PV isolation decreased significantly with CBG2 (1.45±0.81 versus 1.28±0.64; P=0.001). Procedural, left atrial, and fluoroscopy time were reduced by −5%, −11%, and −15% (P<0.05), respectively. Two balloons were used less frequently. Time to isolation decreased significantly with 23-mm (48 versus 33 seconds; P<0.0001) and 28-mm CBG2 (76 versus 52 seconds; P<0.0001). Early PV reconduction rarely occurred with CBG2 (2.6% versus 0.42%; P=0.0023). In-hospital atrial fibrillation recurrence rates were similar. Balloon temperatures were significantly warmer with 23-mm CBG2 and a trend for colder balloon temperature with 28-mm CBG2 were observed compared with their predecessors. Comparable low rates of phrenic nerve palsy were recorded (1.1% versus 1.7%; P=0.64). Esophageal temperatures were similar. Major complication rates were low (3.3% versus 3.33%; P=1.0). Conclusions-CBG2 attains high rates of acute PV isolation within a significant faster and less complex procedure. Time to isolation is shorter, and PV isolation is achieved with fewer applications using CBG2. These enhancements were not at the cost of complications. Study PopulationFrom 2007 to November 2012, all patients undergoing CB ablation for catheter ablation of symptomatic AF at our center were prospectively enrolled in a consecutive fashion. Informed consent was obtained from all patients for the observational registry study which was approved by the local ethical committee. Baseline characteristics, periprocedural data, and follow-up during blanking period for procedure-associated complications were assessed prospectively. For this interim analysis, we included only patients undergoing a CB procedure in combination with the Achieve spiral mapping catheter (Medtronic Inc., Minneapolis, MN) introduced in March 2011 as the standard catheter to our laboratory for positioning of the balloon and real-time PV potential recordings. Until May 2012, all patients were treated with the Arctic Front, and afterward, all patients were treated with the Arctic Front Advance. Ablation Procedure and Verification of PVICB procedure was performed with an anatomy-based individualized approach as described before u...

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“…9,14 Detailed information is provided in the Appendix in the Data Supplement. In a subgroup of patients, an ET probe (SensiTherm, St. Jude Medical, Saint Paul, MN) was used.…”

Section: Ablation Procedures and Verification Of Pvimentioning

confidence: 99%

mentioning

confidence: 99%

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Comparison of the First and Second Cryoballoon

Straube

Dorwarth

Schmidt

et al. 2014

Circ: Arrhythmia and Electrophysiology

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“…A recent study by Dorwarth et al demonstrated that sustained PVI was associated with a shorter mean time to conduction block (39 seconds) when compared to PVs with recovered PV conduction (125 seconds) [43]. The authors identified a cut-off time of 83 seconds for the prediction of stable sustained PVI without reconduction (86% sensitivity and 97% specificity).…”

Section: How To Perform Cryoballoon Ablationmentioning

confidence: 99%

“…In contrast to the relatively high rate of procedural reconnection observed in studies of RF-based AF ablation (up to 50% in some series), the rate of acute reconnection post CBA appears to be low. In studies employing waiting periods of up to 60 minutes, the pooled rate of acute recurrence among the 749 treated PVs was <1% [40,43,46-48]. Moreover, in contrast to RF-based ablation, the use of adjunctive pharmacologic agents such as adenosine and/or isoproterenol does not appear to provide additional prognostic information in patients undergoing CBA [40,49,50].…”

Section: How To Perform Cryoballoon Ablationmentioning

confidence: 99%

Cryoballoon Ablation for Atrial Fibrillation

Andrade

Dubuc

Guerra

et al. 2012

Indian Pacing and Electrophysiology Journal

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Focal point-by-point radiofrequency catheter ablation has shown considerable success in the treatment of paroxysmal atrial fibrillation. However, it is not without limitations. Recent clinical and preclinical studies have demonstrated that cryothermal ablation using a balloon catheter (Artic Front©, Medtronic CryoCath LP) provides an effective alternative strategy to treating atrial fibrillation. The objective of this article is to review efficacy and safety data surrounding cryoballoon ablation for paroxysmal and persistent atrial fibrillation. In addition, a practical step-by-step approach to cryoballoon ablation is presented, while highlighting relevant literature regarding: 1) the rationale for adjunctive imaging, 2) selection of an appropriate cryoballoon size, 3) predictors of efficacy, 4) advanced trouble-shooting techniques, and 5) strategies to reduce procedural complications, such as phrenic nerve palsy.

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Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation

Vogt

2013

The Practice of Catheter Cryoablation for Cardiac Arrhythmias

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Pulmonary vein electrophysiology during cryoballoon ablation as a predictor for procedural success

Abstract: This study, the largest to date, showed that real-time monitoring of PV conduction during cryoballoon freezing can be safely performed with a circular mapping catheter. A cutoff time of 83 s to PV isolation was predictive of sustained procedural PV isolation success without reconduction.

Cited by 60 publications

References 18 publications

Comparison of the First and Second Cryoballoon

Comparison of the First and Second Cryoballoon

Cryoballoon Ablation for Atrial Fibrillation

Cryoballoon Pulmonary Vein Isolation for Atrial Fibrillation

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