Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome

Belle, Yves Van; Janse, Petter; Rivero‐Ayerza, Máximo; Thornton, Andrew; Jessurun, Emile R.; Theuns, Dominic; Jordaens, Luc

doi:10.1093/eurheartj/ehm227

Cited by 270 publications

(242 citation statements)

References 41 publications

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“…The cryoballoon procedure was performed similarly to the CBA technique described elsewhere [8,9]. Right femoral vein, left femoral vein, and left femoral artery punctures were performed with Seldinger technique in patients who had CBA.…”

Section: Ablation Proceduresmentioning

confidence: 99%

Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence

et al. 2017

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A b s t r a c tBackground: Myocardial injury induced by catheter ablation (CA) for atrial fibrillation (AF) leads to elevated biomarker levels.Aim: This prospective study examined levels of myocardial injury biomarkers (creatinine kinase [CK], myocardial bound for CK [CK-MB], and troponin I [TnI]) and their impact on AF recurrence following two different ablation strategies, namely: cryoballoon ablation (CBA) and radiofrequency ablation (RFA). We also aimed to evaluate the relationship between AF recurrence after CA and other clinical, echocardiographic and procedural parameters. Methods:We enrolled 98 patients with AF, 21% of whom had persistent AF and 79% had paroxysmal AF. 58% of patients underwent CBA, and 42% underwent RFA. CK, CK-MB, and TnI levels were measured before and 6 h after the procedure. Patients had follow-up visits three, six, and nine months after the index procedure. Biomarker levels were compared between the patients with and without AF recurrence.Results: Post-ablation CK (postCK), post-ablation CK-MB (postCKMB), and post-ablation TnI (postTnI) levels were significantly high in the CBA and RFA groups (p < 0.001 for all). TnI elevation (DTnI) was correlated with age (p = 0.033) and median temperature reached during ablation (p < 0.005) in the CBA group, while it was correlated with application time in the RFA group (p < 0.001). Multivariate analysis in the CBA group revealed age and left atrium diameter as positive independent predictors (p = 0.029 and p = 0.046), and DTnI as a negative independent predictor for AF recurrence (p = 0.001). Elevated cardiac biomarkers were not associated with AF recurrence in the RFA group (p > 0.05). Conclusions:The levels of all cardiac biomarkers were elevated after CBA and RFA. Elevated TnI levels after CBA were independent negative predictors of AF recurrence. Measurement of TnI levels after CBA may be useful for the prediction of better clinical outcome.

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Section: Ablation Proceduresmentioning

confidence: 99%

Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence

et al. 2017

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“…Since cryothermia causes no PV stenosis [1][2][3] the ablation can safely be performed at the ostial level of the pulmonary vein, but the question remains to what extent cryoballoon ablation modifies the left atrial substrate. After a large experience in animal testing was achieved by several authors [4][5][6][7] the first human results are promising as a treatment for paroxysmal atrial fibrillation (AF) [8]. The aim of this study was to evaluate the effect of the cryothermal balloon on the antral regions of the left atrium.…”

mentioning

confidence: 99%

Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins

Belle

Knops

Janse

et al. 2009

J Interv Card Electrophysiol

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Introduction The 28 mm cryoballoon catheter is a device used for pulmonary vein isolation (PVI). The aim of this study was to evaluate the extent of the ablation in the antral regions of the left atrium. Methods and Results Eighteen patients with drug refractory, symptomatic, paroxysmal AF were enrolled. A 3D electroanatomic reconstruction of the left atrium was made before and after successful PVI with the 28 mm cryoballoon. Markers were placed at the ostium. Sixteen patients were mapped. Fourteen patients had 4 veins each, and 2 patients had a common ostium of the left sided veins. All separate ostia were isolated in the antral region. The two common ostia showed ostial isolation. There was a significant difference in vein size between the common (29 and 31 mm) and the separate ostia (19±4 mm) (p<0.01). The performance of an additional segmental ablation if balloon PVI did not eliminate all electrical activity, did not influence the extent of the ablation. The earliest left atrial activation during sinus rhythm was located in the superior septal region before ablation in all patients. After ablation, two patients showed a substantial downward shift towards the middle and inferior septal region respectively (NS). Four patients demonstrated a slight downward shift of the first activation.Conclusions In cryoballoon PVI, the majority of the veins undergo antral isolation. Veins with a diameter larger than the balloon, are isolated ostially. In individual cases, the left atrial activation sequence appears to be altered after ablation.Keywords Ablation . Arrhythmia . Cryoballoon . Cryoablation . Catheter ablation . Tachyarrhythmias . Atrial fibrillation . Pulmonary veins IntroductionThe cryothermal balloon, or cryoballoon, is a novel technology, developed for pulmonary vein (PV) isolation. It is a catheter based device with the potential of performing a circumferential ablation, thus isolating the PV muscular sleeves in a limited number of applications. Since cryothermia causes no PV stenosis [1][2][3] the ablation can safely be performed at the ostial level of the pulmonary vein, but the question remains to what extent cryoballoon ablation modifies the left atrial substrate. After a large experience in animal testing was achieved by several authors [4][5][6][7] the first human results are promising as a treatment for paroxysmal atrial fibrillation (AF) [8]. The aim of this study was to evaluate the effect of the cryothermal balloon on the antral regions of the left atrium. Methods InclusionPatients with documented symptomatic paroxysmal AF despite antiarrhythmic drugs, at two or more occasions,

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“…33 Maan et al 34 did an extensive review of AF ablation complications, including of cryoballoon-associated complications, and reported that the most frequent complication was phrenic nerve palsy, which is specifically more likely to occur when a smaller 23 mm (rather than 28 mm) balloon is used to isolate the right superior PV. [35][36][37] …”

Section: Data On Complications Reported In Published Studiesmentioning

confidence: 99%

Atrial Fibrillation Catheter Ablation: Overcoming Complications and Improving Success

Mathew

2017

J Innov Cardiac Rhythm Manage

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ABSTRACT. Careful patient selection and optimization of the management of active medical conditions prior to proceeding with catheter ablation for atrial fibrillation (AF) is critical to reducing complications and improving ablation success. AF ablation performed on patients who have not been offered appropriate antiarrhythmic drug therapy must be tempered with the procedure risks, particularly for those patients having multiple comorbidities. The inability to comply with systemic anticoagulation for thromboembolic prophylaxis in AF is a contraindication to AF ablation, as premature termination of anticoagulation therapy can lead to catastrophic thromboembolic complications. Successful pulmonary vein isolation (PVI), the cornerstone of AF ablation, is demonstrated by entrance and exit block post ablation, with sustained absence of atrium-to-pulmonary vein conduction in both directions. Beyond PVI, there is no consensus for other endpoints for AF ablation, particularly in patients with persistent or longstanding persistent AF. Complications of PVI for AF have decreased in recent years as technology and knowledge in this field has evolved; however, the risks of cardiac tamponade, thromboembolic complications, esophageal injury, and pulmonary vein stenosis may still be formidable.

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Pulmonary vein isolation using an occluding cryoballoon for circumferential ablation: feasibility, complications, and short-term outcome

Cited by 270 publications

References 41 publications

Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence

Myocardial injury biomarkers after radiofrequency catheter and cryoballoon ablation for atrial fibrillation and their impact on recurrence

Electro-anatomical mapping of the left atrium before and after cryothermal balloon isolation of the pulmonary veins

Atrial Fibrillation Catheter Ablation: Overcoming Complications and Improving Success

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