Single 3-minute freeze for second-generation cryoballoon ablation: One-year follow-up after pulmonary vein isolation

Ciconte, Giuseppe; Asmundis, Carlo de; Sieira, Juan; Conte, Giulio; Giovanni, Giacomo Di; Mugnai, Giacomo; Saitoh, Yukio; Baltogiannis, Giannis; Irfan, Ghazala; Coutiño-Moreno, Hugo Enrique; Hünük, Burak; Velagić, Vedran; Brugada, Pedro; Chierchia, Gian Battista

doi:10.1016/j.hrthm.2014.12.026

Cited by 173 publications

(148 citation statements)

References 19 publications

Supporting

Mentioning

133

Contrasting

Order By: Relevance

“…A comparison of persistently isolated PVs versus reconnected PVs failed to show a significant difference for the selected ablation strategy (P=0.93) and may argue in favor of a no bonus freeze protocol. 6,23 Nevertheless, the observed patients population is relatively small. Therefore, randomized trials with larger patient numbers and different ablation protocols will be necessary to draw final conclusions.…”

Section: Discussionmentioning

confidence: 99%

Once Isolated, Always Isolated?

Heeger

Wißner

Mathew

et al. 2015

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

The regular TS was exchanged over a guidewire for a 12F steerable TS (Flexcath Advance, Medtronic Inc., Minneapolis, MN). The © 2015 American Heart Association, Inc. Original ArticleBackground-The second-generation cryoballoon delivers effective pulmonary vein isolation (PVI) associated with superior 1-year clinical outcome. However, data on reconduction of previously isolated PV are sparse. Methods and Results-A total of 421 patients underwent second-generation 28-mm cryoballoon-based PVI in 2 centers (St.George's hospital and Harburg hospital, Hamburg, Germany) between June 2012 and May 2015. Sixty-six of 421 (16%) patients (39/66, 59% women; mean age, 63±10 years, mean left atrium diameter, 45±6 mm) with a history of paroxysmal (40/66, 61%) or persistent atrial fibrillation and atrial tachyarrhythmia recurrences despite previous successful secondgeneration 28-mm cryoballoon-based PVI were included in this analysis. During the index PVI, the standard freeze cycle duration was 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 15 of 66 (23%) patients, whereas no bonus freeze cycle was applied in the remaining patients. Repeat procedures were performed after a median of 205 (131-357) days following the index ablation. Electric reconduction was assessed for all PVs, and reablation was performed using radiofrequency energy. Persistent electric isolation was noted in 178 of 258 (69%) PVs. In 17 of 66 (26%) patients, all previously targeted PVs remained isolated. A significant difference toward highest reconduction rate for the posteroinferior segment of the right inferior PV was found (P=0.0002). Conclusions-The second-generation cryoballoon ablation is associated with a high rate of persistent PVI. The posteroinferior segment of the right inferior PV showed the highest reconduction rate and seems to be a predilection site for PV reconduction.

show abstract

Section: Discussionmentioning

confidence: 99%

Once Isolated, Always Isolated?

Heeger

Wißner

Mathew

et al. 2015

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

show abstract

“…After excluding non-compliant documents, only 16 articles were included in this study. In the remaining 16 articles [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], ERAF, LAD, AF duration, and persistent AF were mentioned 14, eight, six, and four times, respectively. There were three retrospective studies, 12 prospective studies, and one case-control study in the final 16 articles.…”

Section: Literature Search and Study Characteristicsmentioning

confidence: 99%

Predictors of late atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation: a meta-analysis

et al. 2017

View full text Add to dashboard Cite

A b s t r a c t Background:The recurrence rate of atrial fibrillation (AF) after cryoballoon ablation in drug refractory AF patients is high. Late-recurrence of AF has various predictors. Aim:The aim of the study was to explore the related risk factors that can effectively predict late AF recurrence after cryoballoon-based pulmonary vein isolation. Methods:The PubMed and Web of Science databases were searched from 1 January 2013 to 1 August 2016, and studies were chosen that met the pre-stated inclusion criteria. The reference lists of the retrieved articles were also reviewed. Two authors independently extracted information on the designs of the studies. The strength of the relationship between different risk factors and late recurrence was assessed by the adjusted hazard ratio.Results: A total of 16 papers met the inclusion criteria and were included in the meta-analysis. The hazard ratio of late atrial arrhythmia recurrence in patients with early recurrence was 4.19 compared with the reference group (95% CI 2.73-6.44, p < 0.00001); that of increased left atrial diameter was 1.25 (95% CI 1.12-1.3, p < 0.0001); that of a long duration of AF before ablation was 1.10 (95% CI 1.04-1.17, p < 0.0009); and that of persistent AF was 2.44 (95% CI 1.30-4.58, p < 0.006). However, there exists significant heterogeneity for each indicator, and a slight publication bias was observed. Conclusions:Our study suggests that early recurrence in the blanking period, increased left atrial size, a long duration of AF before ablation and persistent AF are independent predictors of late recurrence after cryoballoon ablation.

show abstract

“…8 Furthermore, more recent clinical 17 and experimental 18 studies showed that single 3-minute freeze techniques, without bonus applications, are effective and acceptable approaches in achieving acute PVI and an AF freedom of >80% at 1-year followup. Longer applications (4 minute×>2 times) allow a high durability of the PVI (91%); however, they lead to a high incidence of serious complications (3/21 patients).…”

Section: Isolation Area After Pv Isolationmentioning

confidence: 99%

Quantitative Analysis of the Isolation Area During the Chronic Phase After a 28-mm Second-Generation Cryoballoon Ablation Demarcated by High-Resolution Electroanatomic Mapping

Miyazaki

Taniguchi

Hishida

et al. 2016

Circ: Arrhythmia and Electrophysiology

View full text Add to dashboard Cite

Background-The post-second-generation cryoballoon (CB) ablation isolation area during the chronic phase has not been described. The aim of this study was to quantitatively evaluate the chronic-phase isolation area after 28-mm secondgeneration CB ablation and compare it to the estimated conventional radiofrequency circumferential pulmonary vein isolation (CPVI) line. Methods and Results-Thirty-two patients with paroxysmal atrial fibrillation underwent pulmonary vein (PV) isolation using second-generation CB. After a median of 6.0 (4.0-9.0) months, the PV isolation area was evaluated using highresolution mapping (1-mm electrode, 2-mm interelectrode spacing; 527±99 points per map) and pacing techniques in all patients (17 with and 15 without arrhythmia recurrence beyond blanking period) and compared with estimated conventional radiofrequency CPVI area. PV reconnections were observed in 34 of 126 PVs (27.0%) among 21 of 32 patients (65.6%), which were eliminated by a median of 1.0 (1.0-3.0) focal radiofrequency application. The left-and right-sided PV antrum isolation area and nonablated posterior wall areas were 9.8±1.7, 8.1±2.3, and 17.0±6.1 cm 2 , respectively. The cryoablated areas were significantly smaller than the estimated conventional radiofrequency CPVI areas in all but the right inferior PV. The difference was highest in the left superior PV. In 2 patients (6.3%), recurrent atrial fibrillation originated from the foci identified at the left superior PV antrum outside the CB isolation area but inside the estimated conventional radiofrequency CPVI line. Conclusions-Although the PV isolation areas during the chronic phase after the second-generation CB ablation were generally wide, they were significantly smaller than the area encircled by the CPVI line except at the right inferior PV antrum. Recurrent atrial fibrillation could originate from the left superior PV antrum and could be isolated by a CPVI but not by a CB. (Circ Arrhythm Electrophysiol. 2016;9:e003879.

show abstract

Single 3-minute freeze for second-generation cryoballoon ablation: One-year follow-up after pulmonary vein isolation

Cited by 173 publications

References 19 publications

Once Isolated, Always Isolated?

Once Isolated, Always Isolated?

Predictors of late atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation: a meta-analysis

Quantitative Analysis of the Isolation Area During the Chronic Phase After a 28-mm Second-Generation Cryoballoon Ablation Demarcated by High-Resolution Electroanatomic Mapping

Contact Info

Product

Resources

About