The feasibility and safety of substrate modification on the left atrial roof area using a cryoballoon in atrial fibrillation ablation

Miyazaki, Shinsuke; Sekihara, Takayuki; Hasegawa, Kanae; Mukai, Moe; Aoyama, Daisetsu; Nodera, Minoru; Tada, Hiroshi

doi:10.1016/j.ijcard.2021.12.039

Cited by 7 publications

(5 citation statements)

References 22 publications

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“…Accumulating evidence have demonstrated that RL ablation in addition to PVI reduce AF recurrence significantly 6, 7, 14 . The area modified by ablation was extremely larger in cryoballoon than radiofrequency ablation 15, 16 .…”

Section: Discussionmentioning

confidence: 99%

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Cryoballoon Ablation of RooF line combined with pulmonary vein Isolation for persistent atrial fibrillation (The CARFI-PerAF Randomized Clinical Trial)

Huang,

Zhao,

et al. 2023

Preprint

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Background The limited effectiveness of pulmonary vein isolation (PVI) alone using cryoballoon ablation (CBA) led to addictive ablation in procedures of persistent atrial fibrillation (AF) ablation. Roof line (RL) ablation in addition to PVI hold great promise for reduction of AF recurrence after CBA. The randomized controlled CARFI-PerAF trial aimed to prospectively investigate the efficacy of a novel CBA strategy for block of RL and reduction of AF recurrence. Methods One hundred and ten patients who were diagnosed with persistent AF were randomized into PVI group and PVI+RL group. 'Quarter balloon ablation technique' and 'roof distortion technique' were used to improve quality of RL ablation. Conduction block of RL was confirmed by both voltage mapping and upper right atrial septum pacing. Primary effectiveness was freedom from AF or atrial tachycardia absent class I/III antiarrhythmic drugs through 12-month follow-up according to ECGs collected by portable device and 24-hour Holter. Results There was no significant difference in AF recurrence between PVI group and PVI+RL group (63.5% vs 76.2%, P = 0.296) after 532.7 ± 171.0 days of follow-up. However, blocked RL was associated with a significant reduction in risk of AF recurrence in the PVI+RL group (84.0% vs 45.5%, P = 0.025). The shape of RL was the only factor affecting the success rate of RL block. Patients with 'Regular' shape of RL predicted a higher rate of RL block than other types (89.7% vs 56.3%, P = 0.014). Conclusions Blocked roof line ablation was associated with a significant reduction in risk of atrial fibrillation recurrence after cryoballoon ablation. Patients with 'Regular' shape of roof line may benefit more from roof line ablation.

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Section: Discussionmentioning

confidence: 99%

“…However, the limited effectiveness of PVI alone for persistent AF ablation led to addictive ablation to reduce AF recurrence 5 . Roof line (RL) ablation in addition to PVI hold great promise for intervention of atrial electrophysiological and structural substrates [6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

Cryoballoon Ablation of RooF line combined with pulmonary vein Isolation for persistent atrial fibrillation (The CARFI-PerAF Randomized Clinical Trial)

Huang,

Zhao,

et al. 2023

Preprint

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“…To conclude, there is a tendency to use RF for second ablation procedures because it is more flexible for the evaluation and treatment of PVs (i.e., PV reconnection), as well as for the analysis of new arrhythmogenic substrates or placement of the necessary ablation lines. However, several observational studies and one randomized study found no significant differences in arrhythmia recurrence after repeat ablation with CB and RF procedures [ 23 , 24 ]. Therefore, it is possible that CB is currently an underused technique for repeat ablation procedures.…”

Section: Discussionmentioning

confidence: 99%

Reablation in Atrial Fibrillation Recurrence and Pulmonary Vein Reconnection: Cryoballoon versus Radiofrequency as Index Ablation Procedures

Molina-Ramos

Ruíz-Salas

Medina-Palomo

et al. 2022

JCM

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Pulmonary vein (PV) isolation is a well-established rhythm control therapy in atrial fibrillation (AF). Currently, there is no consensus on which ablation technique to use for the first procedure, cryoballoon (CB) or radiofrequency (RF). A retrospective cohort study was conducted on 1055 patients who underwent a first ablation, to assess both techniques based on the need for reablation. Patients with CB (n = 557) and RF (n = 498) ablations were clinically characterized and the need for reablation during a 30-month follow-up was used as the primary endpoint. Independent variables were analyzed to identify potential predictors. The need for reablation was significantly lower in the CB group than in the RF group (hazard ratio = 0.45 and 95% confident interval = 0.32–0.61; p < 0.001); in both paroxysmal and persistent AF, using a full-adjusted regression Cox model by age, sex, smoking, hypertension, diabetes mellitus, dyslipidemia, severe obstructive sleep apnea, dilated left atrium, persistent AF and early recurrence. RF ablation, dilated left atrium, persistent AF and early recurrence were identified as independent predictors of reablation. In addition, the CB-redo subgroup had a lower PV reconnection than the RF-redo subgroup. In conclusion, CB ablation suggests a reduction in the need for reablation and lower PV reconnection during the follow-up than RF ablation.

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“…The first CB application was performed in proximity to the balloon during the RSPV isolation. Sequential freezes were applied every 180 s along the LA roof in an overlapping manner with a target of −40°C until the original balloon position for the isolation of the LSPV was reached anatomically on the fluoroscopic guidance 13,14 . If the freezing temperature did not reach −40°C, the duration of the CB application was extended up to a maximum of 240 s. Right ventricular burst pacing was performed to cool the balloon temperature sufficiently in all cases during freezing 15 .…”

Section: Methodsmentioning

confidence: 99%

“…Sequential freezes were applied every 180 s along the LA roof in an overlapping manner with a target of −40°C until the original balloon position for the isolation of the LSPV was reached anatomically on the fluoroscopic guidance. 13,14 If the freezing temperature did not reach −40°C, the duration of the CB application was extended up to a maximum of 240 s. Right ventricular burst pacing was performed to cool the balloon temperature sufficiently in all cases during freezing. 15 When the LET reached 15°C during CB application, the CB freezing was immediately stopped by the "double-stop maneuver" to avoid esophageal complications.…”

Section: La Roof Line Ablationmentioning

confidence: 99%

Raise‐up technique for the creation of left atrial roof lesion: A useful technique with cryoballoon for persistent atrial fibrillation

Kujiraoka,

Suzuki,

Kawaguchi

et al. 2024

Cardiovasc electrophysiol

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IntroductionRecent studies have reported the efficacy of the cryoballoon (CB)‐guided left atrial roof block line (LARB) creation in patients with persistent atrial fibrillation (AF). However, it can be technically challenging to attach the balloon to the left atrial (LA) roof due to its anatomical variations. We designed a new procedure called the “Raise‐up Technique,” which may facilitate the firm adhesion of the CB to the LA roof during freezing. This study aimed to evaluate the efficacy of the Raise‐up technique in LARB creation.Methods and ResultsIn total, 100 consecutive patients with persistent AF who underwent CB‐LARB creation were enrolled. Fifty‐seven patients underwent LARB creation using the Raise‐up technique (Raise‐up group), and the remaining 43 did not use it (control group). The Raise‐up technique was performed as follows: An Achieve catheter was inserted as deeply as possible into the upper branch of the right superior pulmonary vein to anchor the CB. The balloon was placed below the targeted site on the LA roof and frozen. When the temperature of the CB reached approximately −10°C and the CB was easier to attach to the LA tissue, the CB was raised and pressed against the LA roof immediately by sheath advancement. Then the balloon could be in firm contact with the target site on the roof. If necessary, additional sheath advancement after sufficient freezing (−20°C to −30°C) was allowed the CB to have more firm and broad contact with the target site. LARB creation without touch‐up ablation was achieved in 54 of 57 patients (94.7%) in the Raise‐up group and 33 of 43 patients (76.7%) in the control group (p < .05). The lesion size of the LARB in the Raise‐up group was significantly larger than that in the control group (15.2 cm2 vs. 12.8 cm2, p < .05). Moreover, the width of the LARB lesion in the Raise‐up group was wider than that in the control group (32.0 mm vs. 26.6 mm, p < .05).ConclusionThe Raise‐up technique enabled the creation of seamless and thick LARB lesions with a single stroke. In addition, the CB‐LARB lesions created using the Raise‐up technique tended to be large, resulting in extensive debulking of the LA posterior wall arrhythmia substrates. In CB ablation for persistent AF, the Raise‐up technique can be considered one of the key strategies for LARB creation.

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The feasibility and safety of substrate modification on the left atrial roof area using a cryoballoon in atrial fibrillation ablation

Cited by 7 publications

References 22 publications

Cryoballoon Ablation of RooF line combined with pulmonary vein Isolation for persistent atrial fibrillation (The CARFI-PerAF Randomized Clinical Trial)

Cryoballoon Ablation of RooF line combined with pulmonary vein Isolation for persistent atrial fibrillation (The CARFI-PerAF Randomized Clinical Trial)

Reablation in Atrial Fibrillation Recurrence and Pulmonary Vein Reconnection: Cryoballoon versus Radiofrequency as Index Ablation Procedures

Raise‐up technique for the creation of left atrial roof lesion: A useful technique with cryoballoon for persistent atrial fibrillation

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