Time-to-Effect–Based Dosing Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation

Ferrero-de-Loma-Osorio, Ángel; García-Fernández, Amaya; Castillo-Castillo, Jesús; Izquierdo-de-Francisco, Maite; Ibáñez-Críado, Alicia; Moreno‐Arribas, José; Martínez, Ángel Plaza; Bertomeu-González, Vicente; López-Mases, Patricia; Ajo‐Ferrer, María; Núñez, Carlos Navarro; Bondanza-Saavedra, Lourdes; Sánchez-Gómez, Juan Miguel; Martínez-Martínez, Juan Gabriel; Chorro‐Gascó, Francisco J.; Ruiz‐Granell, Ricardo

doi:10.1161/circep.117.005318

Cited by 56 publications

(66 citation statements)

References 23 publications

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“…Procedural results for the remaining 175 veins (left and right superior and inferior PVs, or LSPV, LIPV, RSPV, and RIPV, respectively) are shown in Figure 2. Roughly one‐third of veins had a single application delivered, and the number of applications was similar in all veins (on average, 2.1 ± 1.2 applications per vein, Figure 2A), comparable with previous studies 5,7,14 . Mean application duration per vein was 420 ± 217 seconds, with similar values in all veins (Figure 2B).…”

Section: Resultssupporting

confidence: 85%

“…Of note, our results should be interpreted within the range of application times assessed in our study: 95% of the applications lasted between 180 and 950 seconds. Further procedural refinement may be obtained by using the TTVI, which can be useful to guide freezing time in patients undergoing CB ablation 7 . This may shorten the procedure and reduce X‐ray exposure 5 .…”

Section: Discussionmentioning

confidence: 99%

“…Subsequent studies have reinforced fairly good midterm outcomes in patients submitted to CB ablation. However, the optimal freezing strategy is still under debate 3–7 . Prolonged freezing cycles may achieve more durable PVI at the cost of longer procedures and an increased risk of injury to extracardiac structures (eg, phrenic nerve, esophagus, bronchial tree) 8–10 .…”

Section: Introductionmentioning

confidence: 99%

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Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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Introduction Ablation with second‐generation cryoballoon technology evolves as an effective and safe alternative to radiofrequency for atrial fibrillation ablation procedures. Nevertheless, the optimal freezing strategy remains unknown. Our objective was to identify the procedural cryoablation parameters predicting successful peri‐pulmonary vein (PV) lesions by directly analyzing Postablation gaps in late‐gadolinium‐enhanced cardiac magnetic resonance (LGE‐CMR). Methods and Results Forty‐nine consecutive patients (196 PVs) undergoing ablation with second‐generation cryoballoon at our center were included. The number and duration of cryoballoon application to achieve PV isolation were left to operator discretion. Gap number and length were quantified in all patients with a LGE‐CMR performed 3 months postablation. Application time (420 ± 217 seconds), number of applications (2.1 ± 1.2), application time after electrical isolation (311 ± 194 seconds) and minimum temperature (−45.8 ± 6.5°C) were similar in the 4 PVs. Gaps were observed in 148 PVs (76%), averaging 1.3 ± 1 gaps per vein. Gaps were longer and more frequent in the right PVs (91% vs 59% in left PVs, P < .001). Neither the number, total duration of applications, nor postisolation application time predicted relative length or number of gaps. Conclusions After successful PV isolation was achieved in patients undergoing cryoablation, increasing the number of applications, the total application time or application time postisolation did not result in a reduction in the number or the relative length of gaps.

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Section: Resultssupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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“…After becoming a widely accepted technology, cryoballoon ablation continues to be refined. In a prospective study, 19 140 patients with paroxysmal AF undergoing cryoablation were randomized to a conventional strategy of 180-second cryoapplications per vein with a bonus freeze or to a shorter-time application protocol, with 1 application that lasted the time required for conduction block (time-to-effect) plus 60 seconds and a 120-second bonus freeze. The time-to-effect-based cryotherapy dosage led to shorter cryotherapy and procedure times, with comparable safety, and 1-year freedom from arrhythmia recurrences, compared with the conventional approach.…”

Section: Cryoablation and Laser Balloon Ablationmentioning

confidence: 99%

Year in Review in Cardiac Electrophysiology

Tzou

Hussein

Madhavan

et al. 2018

Circ: Arrhythmia and Electrophysiology

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1 In the past year, there have been key advances in our understanding of arrhythmia mechanisms and diagnosis and important new therapies. We have seen advances in basic cardiac electrophysiology with demonstration of optogenetic targeting of atrial fibrillation (AF) rotors, induced pluripotent stem cell-based biological pacemakers, small-conductance Ca 2+ -activated K + (SK) channels as targets for AF treatment, and reductions in inward rectifier potassium current in promoting ventricular fibrillation. Hand-held ECG devices and implantable loop recorders have been shown to detect subclinical AF. Catheter ablation of AF in patients with left ventricular dysfunction improves outcomes compared with medical therapy. Both hybrid thoracoscopic surgical and catheter ablation procedures and off-pump surgery for AF have demonstrated efficacy. Anticoagulation with uninterrupted dabigatran had a lower major bleeding rate compared with uninterrupted warfarin after AF ablation. Studies have examined optimizing access to automatic external defibrillators by identifying optimal locations for placement and possibility of using a drone delivery network. In long-QT syndrome, there are advances in understanding of ECG predictors of arrhythmic events, the role of the role of gene variants in conferring arrhythmic risk, and effect of age and sex on QTc interval. There are numerous advances in the treatment of ventricular tachycardia, including noninvasive cardiac radiation. Catheter ablation and implantable devices continue to demonstrate effectiveness in patients with congenital heart disease.In the past year, there have been numerous ground-breaking discoveries and observations that illustrate the vibrancy and promise of our field. In this review, we have tried to capture articles published in the year 2017 of particular interest to cardiac electrophysiologists. Although we have focused on articles from our journal, we have captured many of the most impactful articles in numerous other journals. We apologize for omitting a large number of other important articles that cannot be included in this review because of space limitations. We have placed some of these in our Data Supplement. BASIC ELECTROPHYSIOLOGY BradyarrhythmiasThe search for new biological therapies for bradycardia met with recent progress as human keratinocytes genetically reprogrammed into electrically unstable cardiomyocytes were shown to persist and provide continued catecholaminergic-responsive pacing for 13 weeks after subepicardial injection into immunosuppressed dogs at the time of atrioventricular (AV) node ablation.1 Although only 40% to 80% of the beats matched the site of cell injection, this is first study to test a human induced pluripotent stem cell-based biological pacemaker in a large animal model of heart block and represents an important step forward in biological pacing.

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“…(2) Time to PVI has been reported as a marker for the estimation of AF recurrence after cryoballoon PVI . (3) Cryotherapy and procedure time are shortened when freezing duration is changed based on time to PVI …”

Section: Discussionmentioning

confidence: 99%

A decapolar 25‐mm‐diameter circular mapping catheter with improved detection of pulmonary vein potential disappearance in cryoballoon ablation

Matsuda

Masuda

Asai

et al. 2019

Journal of Arrhythmia

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Background Disappearance of pulmonary vein ( PV ) potentials is an important indicator of successful PV isolation during cryoballoon ablation. Conventional octapolar 20‐mm‐diameter circular PV mapping catheters occasionally fail to identify persistent PV potentials. A new decapolar 25‐mm‐diameter circular PV mapping catheter has been introduced to improve the detection of PV potentials and their elimination. We compared the detection rates of PV potential disappearance between the decapolar and the octapolar PV mapping catheters. Methods and Results A total of 44 consecutive patients (175 PV s) undergoing initial cryoballoon ablation for atrial fibrillation were included. The decapolar catheter was used for 79 (45%) PV s in 20 (45%) patients. There was no difference in left atrial diameter or PV diameter in patients mapped with the two catheters. The decapolar mapping catheter demonstrated a significantly higher detection rate of PV potential disappearance than the octapolar catheter. The need for touch‐up ablation was similar between the two groups (5% vs 8%, P = 0.39). When PV potentials were identified, the decapolar catheter detected significantly higher‐amplitude PV potentials than the octapolar catheter. In multivariate analysis, use of the decapolar catheter was an independent predictor of the detection of PV potential disappearance. Conclusions The decapolar PV mapping catheter demonstrated improved detection of PV potential disappearance in cryoballoon PV isolation.

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Time-to-Effect–Based Dosing Strategy for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation

Abstract: URL: https://clinicaltrials.gov. Unique identifier: NCT02789358.

Cited by 56 publications

References 23 publications

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Year in Review in Cardiac Electrophysiology

A decapolar 25‐mm‐diameter circular mapping catheter with improved detection of pulmonary vein potential disappearance in cryoballoon ablation

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