Single-Procedure Outcomes and Quality-of-Life Improvement 12 Months Post-Cryoballoon Ablation in Persistent Atrial Fibrillation

Bovéda, Serge; Metzner, Andreas; Nguyen, Dinh Quang; Chun, K.R. Julian; Goehl, K; Noelker, George; Deharo, Jean‐Claude; Andrikopoulos, George; Dahme, Tillman; Lellouche, Nicolas; Defaye, Pascal

doi:10.1016/j.jacep.2018.07.007

Cited by 87 publications

(79 citation statements)

References 19 publications

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“…6 As PVI is the first-line recommended procedural endpoint in AF ablation, it can be recommended not only for the treatment of PAF but also for persistent AF, as studies using CB in patients with paroxysmal and even with persistent AF have shown a comparable clinical success rate. [14][15][16][17][18] Today, CB-based PVI is an accepted strategy for the treatment of symptomatic, drug-refractory AF and is therefore recommended by the current AF ablation guidelines. 1 Thus, the CB turned out as a tool, which is increasingly utilized in many electrophysiology (EP) laboratories worldwide.…”

Section: Acute Efficacy Of Cb-based Pvimentioning

confidence: 99%

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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Section: Acute Efficacy Of Cb-based Pvimentioning

confidence: 99%

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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“…Again, its value in PerAF is less well documented. Some early studies showed very low success rates in the range of 30-40%, whereas more recent trials reported efficacy exceeding 50% [2][3][4][5] . The rationale for using CB in PerAF is based on the fact that CB not only effectively isolates PV but also affects surrounding atrial tissue, and thus also modifies the substrate for AF [10] .…”

Section: Discussionmentioning

confidence: 99%

“…While the value of RF ablation in PerAF has been examined by several studies [1] the role of CB ablation in these patients is less clear. A few studies have suggested that this technique may be useful in PerAF, reaching an efficacy rate of 59-65% [2][3][4][5] . However, data are limited and come from highvolume and very experienced centres.…”

Section: Introductionmentioning

confidence: 99%

Cryoballoon ablation for persistent atrial fibrillation: real-life results from medium volume centre

Kułakowski¹,

Sikorska²,

Adach³

et al. 2019

Heart Beat

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Introduction. The value of cryoballoon (CB) ablation for paroxysmal atrial fibrillation (AF) has been well established. However, the safety and efficacy of CB ablation in persistent AF (PerAF) are less well known. The aim of the present study was to assess efficacy of CB in PerAF in comparison to RF ablation and to identify predictors of successful CB ablation in PerAF performed in a medium volume centre.Methods. Of 303 AF ablations, 92 (30%) procedures were performed in patients with PerAF: 38 CB (mean age 58±9 years, all first-time procedures) and 54 RF ablations, of which in 18 (33%) patients (mean age 57±12 years) this was the first-time procedure. The patients were prospectively followed (mean 14 ± 7 months) by repeated Holter ECG and outpatient visits.Results. After first-time procedures, recurrences of AF were noted in 15 (40%) patients from the CB group and in 15 (83%)

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“…Over the last decade, cryoballoon ablation (CB‐A) has emerged as an effective alternate strategy to point‐by‐point radiofrequency (RF) ablation, showing similar outcomes in terms of freedom from AF when compared to traditional techniques and also favorable data in terms of total procedural time and reproducibility . Both safety and effectiveness of the CB‐A technology were firstly assessed in patients with documented symptomatic paroxysmal AF, and then, its non‐inferiority to other energy sources was confirmed also in the setting of persistent AF . Although some differences have been described in terms of temperature behavior when CB‐A has been performed in patients with ongoing AF compared to those in sinus rhythm (SR), still this procedure can be performed regardless of the presenting cardiac rhythm, solely aimed at electrically isolating the pulmonary veins (PVs) from the left atrium (LA).…”

Section: Introductionmentioning

confidence: 99%

“…4 Both safety and effectiveness of the CB-A technology were firstly assessed in patients with documented symptomatic paroxysmal AF, 5 and then, its non-inferiority to other energy sources was confirmed also in the setting of persistent AF. 6,7 Although some differences have been described in terms of temperature behavior when CB-A has been performed in patients with ongoing AF compared to those in sinus rhythm (SR), 8 still this procedure can be performed regardless of the presenting cardiac rhythm, solely aimed at electrically isolating the pulmonary veins (PVs) from the left atrium (LA). Since in the stepwise RF ablation approach, 9,10 whose main goal is the intra-procedural AF termination achieved by different and sequential ablation approaches, conversion of AF to SR has then been demonstrated to be a strong predictor for single-procedure success, 11 restoration of SR during CB-A PVI might also correlate with the clinical outcome.…”

Section: Introductionmentioning

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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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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Single-Procedure Outcomes and Quality-of-Life Improvement 12 Months Post-Cryoballoon Ablation in Persistent Atrial Fibrillation

Cited by 87 publications

References 19 publications

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

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

Cryoballoon ablation for persistent atrial fibrillation: real-life results from medium volume centre

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

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