Single freeze per vein strategy with the second-generation cryoballoon for atrial fibrillation: a propensity score-matched study between 180- and 240-s application time in a large cohort of patients

Regibus, Valentina De; Abugattas, Juan-Pablo; Iacopino, Saverio; Mugnai, Giacomo; Storti, Cesare; Conte, Giulio; Auricchio, Angelo; Ströker, Erwin; Coutiño, Hugo Enrique; Takarada, Ken; Salghetti, Francesca; Lusoc, Ian; Capulzini, Lucio; Brugada, Pedro; Asmundis, Carlo de; Chierchia, Gian Battista

doi:10.1093/europace/eux279

Cited by 13 publications

(12 citation statements)

References 24 publications

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“…Before ablation, for each PVs, the ILMC was positioned at a proximal site in the PV ostium, in order to record baseline pulmonary vein potentials (PVPs). PVs occlusion was considered optimal when selective iodine contrast injection showed total contrast retention, without any backflow into the LA; once occlusion was documented, the cryo‐application was started delivering initially two applications and then from April 2013 with a single freeze‐thaw cycle of 240 first and 180 seconds then for each vein . Our usual ablation sequence was treating the left superior PV (LSPV) first, followed by the left inferior (LIPV), right inferior (RIPV), and right superior (RSPV).…”

Section: Methodsmentioning

confidence: 99%

“…PVs occlusion was considered optimal when selective iodine contrast injection showed total contrast retention, without any backflow into the LA; once occlusion was documented, the cryo-application was started delivering initially two applications and then from April 2013 with a single freeze-thaw cycle of 240 first and 180 seconds then for each vein. 13 Our usual ablation sequence was treating the K E Y W O R D S atrial fibrillation, cardioversion, catheter ablation, cryoablation, pulmonary vein isolation left superior PV (LSPV) first, followed by the left inferior (LIPV), right inferior (RIPV), and right superior (RSPV). During ablation, if PVPs were visible during energy delivery, time to isolation was recorded when PVPs completely disappeared or were dissociated from LA activity.…”

Section: Cb-a Proceduresmentioning

confidence: 99%

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Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

Maj

Borio

Osório

et al. 2020

Journal of Arrhythmia

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Background The prevalence and the clinical impact of conversion of atrial fibrillation (AF) to sinus rhythm (SR) during cryoballoon ablation (CB‐A) are unknown. Objective The purpose of this study was to evaluate the prevalence of restoration of SR during CB‐A and the clinical impact of this phenomenon. Methods Between January 2012 and September 2018, all patients who experienced conversion of AF to SR during CB‐A were included. This group was subsequently matched for gender, age, type of AF, diagnosis‐to‐ablation time, and left atrial size with patients who underwent CB‐A and did not experienced conversion of AF to SR. After discharge, patients were scheduled for follow‐up visits at 1, 3, 6, and 12 months and 24 hours Holter recordings were obtained at each follow‐up visit. All documented AF episodes of >30 seconds were considered as recurrence. A 3 month post‐procedural blanking period (BP) was applied. Results A total of 1559 patients underwent pulmonary veins isolation by CB‐A between January 2012 and September 2018; among them, 58 patients (3.7%) experienced restoration of SR during CB‐A. In total, 53 patients (41 males [77.3%], mean age 61.4 ± 13.3 years) were included in the case group. During CB‐A, restoration of SR occurred more frequently during right‐side PVs applications (right inferior pulmonary vein 39.6%, right superior pulmonary vein 30.2%). If considering a BP, at 2 year follow‐up, freedom from recurrences was 86.5% in the case group and 68.0% in the control group (P = .036). Conclusion Conversion of AF to SR is a favorable and relatively frequent phenomenon during cryoballoon pulmonary vein isolation ablation.

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Section: Methodsmentioning

confidence: 99%

Section: Cb-a Proceduresmentioning

confidence: 99%

Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

Maj

Borio

Osório

et al. 2020

Journal of Arrhythmia

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“…For PaAF patients, a 4 min CBA has been associated with increased rates of PVI durability, particularly for left-sided PV, without increasing complications when compared to 3 min CBA, whereas the outcomes for two groups have been similar [31,32]. In PaAF and PeAF patients, a 3 min freeze protocol is similarly safe and effective as a 4 min freeze time, and it is associated with 78.6%-85.6% of patients remaining sinus arrhythmia-free compared to 67%-87% success rates during the short-and midterm follow-ups [33,34]. One study with a long-term follow-up of more than 3 years showed that a single 3 min freeze strategy is effective, and it can be successful in 72.8% of PaAF patients and 59.1% of PeAF patients [35].…”

Section: Longer Time Is Futile To Recurrencementioning

confidence: 96%

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

Huang

Wang

Song

2020

BioMed Research International

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Atrial fibrillation (AF) is a common arrhythmia contributing to severe outcomes, including cardiac dysfunction and stroke, and it has drawn great attention around the world. Drug therapies have been available for many years to terminate AF and control heart rate. However, the results from clinical studies on drug therapies have been discouraging. Mounting evidence indicates that radiofrequency catheter ablation (RFCA) is a safe and effective method to maintain sinus rhythm, especially in patients who are drug intolerant or for whom the drugs are ineffective, although it is a technically demanding and complex procedure. Fortunately, a novel application, cryoballoon ablation (CBA), with outstanding characteristics has been widely used. Great outcomes based on CBA have manifested its significant role in the treatment of AF. However, how to improve the safety and efficacy of CBA is a question that has not been well-answered. Would it be helpful to develop a different generation of cryoballoon? Is bonus freezing beneficial, or not? Is it better to prolong freezing time? Dose CBA combined with RFCA bring higher success rates? In this review, we comprehensively summarized useful applications for improving outcomes of CBA in AF patients.

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“…Cryoballoon ablation is an effective single‐shot technique for the treatment of paroxysmal atrial fibrillation (AF) and is noninferior to radiofrequency catheter ablation . Several ablation protocols for cryoballoon ablation have been proposed . Optimizing the ablation duration to obtain durable ablation lesions without causing extracardiac complications is crucial.…”

Section: Introductionmentioning

confidence: 99%

Optimizing ablation duration using dormant conduction to reveal incomplete isolation with the second generation cryoballoon: A randomized controlled trial

Keçe

Riva

Naruse

et al. 2019

Cardiovasc electrophysiol

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IntroductionEfficacy of cryoballoon ablation depends on balloon‐tissue contact and ablation duration. Prolonged duration may increase extracardiac complications. The aim of this study is to determine the optimal additional ablation duration after acute pulmonary vein isolation (PVI).MethodsConsecutive patients with paroxysmal AF were randomized to three groups according to additional ablation duration (90, 120, or 150 seconds) after acute PVI (time‐to‐isolation). Primary outcome was reconnection/dormant conduction (DC) after a 30 minutes waiting period. If present, additional 240 seconds ablations were performed. Ablations without time‐to‐isolation <90 seconds, esophageal temperature <18°C or decreased phrenic nerve capture were aborted. Patients were followed with 24‐hour Holter monitoring at 3, 6, and 12 months.ResultsSeventy‐five study patients (60 ± 11 years, 48 male) were included. Reconnection/DC per vein significantly decreased (22%, 6% and 4%) while aborted ablations remained stable (respectively 4, 5, and 7%) among the 90, 120, and 150 seconds groups. A shorter cryo‐application time, longer time‐to‐isolation, higher balloon temperature and unsuccessful ablations predicted reconnection/DC. Freedom of atrial fibrillation was, respectively, 52, 56, and 72% in 90, 120, and 150 seconds groups ( P = 0.27), while repeated procedures significantly decreased from 36% to 4% ( P = 0.041) in the longer duration group compared to shorter duration group (150 seconds vs 90 seconds group). In multivariate Cox‐regression only reconnection/DC predicted recurrence.ConclusionProlonging ablation duration after time‐to‐isolation significantly decreased reconnection/DC and repeated procedures, while recurrences and complications rates were similar. In a time‐to‐isolation approach, an additional ablation of 150 seconds ablation is the most appropriate.

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Single freeze per vein strategy with the second-generation cryoballoon for atrial fibrillation: a propensity score-matched study between 180- and 240-s application time in a large cohort of patients

Abstract: There is no difference in acute success, rate of complications, and freedom from atrial fibrillation recurrences during the follow-up between 3-min and 4-min per vein freeze strategies. The procedural and fluoroscopy times were significantly shorter in 3-min per vein strategy.

Cited by 13 publications

References 24 publications

Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

Optimizing ablation duration using dormant conduction to reveal incomplete isolation with the second generation cryoballoon: A randomized controlled trial

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