Time-to-isolation guided titration of freeze duration in 3rd generation short-tip cryoballoon pulmonary vein isolation – Comparable clinical outcome and shorter procedure duration

Pott, Alexander; Kraft, Christoph; Stephan, Tilman; Petscher, Kerstin; Rottbauer, Wolfgang; Dahme, Tillman

doi:10.1016/j.ijcard.2017.11.039

Cited by 31 publications

(47 citation statements)

References 24 publications

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“…There was variability in ablation protocol including time of freeze and use of time to isolation that may impact ablation outcome. However, previous studies have shown the equivalent efficacy of single 3‐min freeze versus double 4‐min freeze and time to isolation strategy versus fixed ablation strategy . In patients with redo ablations, the high rate of vein reconnection per patient is likely due to selection bias as patients with one or two veins reconnected would have received RF and not been included in our study.…”

Section: Discussionmentioning

confidence: 96%

“…However, previous studies have shown the equivalent efficacy of single 3-min freeze versus double 4-min freeze and time to isolation strategy versus fixed ablation strategy. [45][46][47] In patients with redo ablations, the high rate of vein reconnection per patient is likely due to selection bias as patients with one or two veins reconnected would have received RF and not been included in our study. Many patients did not have continuous rhythm monitoring post-CBA and reliance on scheduled clinic ECGs, short-term Holter monitors, and patient symptoms may underestimate episodes of AF recurrence.…”

Section: Strengths/limitationsmentioning

confidence: 99%

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Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Bavishi

Kaplan

Peigh

et al. 2019

Pacing Clinical Electrophis

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Background While several studies have evaluated predictors for atrial fibrillation (AF) recurrence following catheter ablation, there are limited data specific to cryoballoon ablation (CBA). Methods We analyzed a prospective registry of patients at a single institution who underwent CBA. Recurrence of AF (RAF) was defined as recurrence of AF by 12‐month follow‐up, excluding the 3‐month blanking period. Univariate analysis was performed to evaluate predictors of RAF. Receiver operating characteristic analysis was used to compare and evaluate the performance of various risk scores for discriminating risk of RAF. Results There were 542 patients included in the analysis with mean age 61.3 ± 10.6 years, 67.9% male, and 51.6% paroxysmal AF (PAF). Overall, only left atrial diameter (LAD) > 40 mm and ERAF (early recurrence of AF within 0‐3 month blanking period) were significant predictors of RAF. In the PAF specific subgroup, LAD > 40 mm, AF duration > 12 months, prior stroke or transient ischemic attack, ERAF, and having previously failed an antiarrhythmic drug were significant predictors of RAF. In persistent AF (PeAF) subgroup, obstructive sleep apnea (OSA) and ERAF were significant predictors of RAF. Out of clinical risk scores tested, BASEAF2 had the highest performance with area under the curve of 0.646 (95% confidence interval [0.548, 0.708]; P < .01). Conclusions In this single‐center retrospective study of CBA, we found only LAD > 40 mm and ERAF to be predictors of RAF. We identified OSA as a potential targetable risk factor in PeAF patients undergoing CBA. Out of risk scores tested for discriminating risk of RAF, BASEAF2 had the best performance.

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Section: Discussionmentioning

confidence: 96%

Section: Strengths/limitationsmentioning

confidence: 99%

Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Bavishi

Kaplan

Peigh

et al. 2019

Pacing Clinical Electrophis

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“…The exclusion criteria were long-standing persistent AF, previous left atrial (LA) ablation, LA diameter > 55 mm, uncontrolled heart failure (NYHA class IV), and severe valvular disease. The first 224 patients were treated with a fixed freeze protocol and the last 395 patients were treated with a time to isolation guided freeze protocol [13,14].…”

Section: Study Populationmentioning

confidence: 99%

“…A luminal esophageal temperature of 15-20°C was the cut-off temperature, leading to abortion of the freeze cycle. Phrenic nerve function was monitored by phrenic nerve stimulation and detection of compound motor action potentials (CMAP), as well palpation of diaphragm contractions during ablation of the right sided PVs [13,14].…”

Section: Ablation Proceduresmentioning

confidence: 99%

Impact of re-definition of paroxysmal and persistent atrial fibrillation in the 2012 and 2016 European Society of Cardiology atrial fibrillation guidelines on outcomes after pulmonary vein isolation

Weinmann

Aktolga

Pott

et al. 2020

J Interv Card Electrophysiol

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Purpose In the 2016 European Society of Cardiology (ESC) guidelines for the management of atrial fibrillation (AF), the definition of AF type has been modified compared with the 2010 guidelines and its 2012 focused update. We compared the difference of single procedure outcomes using the definitions before and after 2016 on a cohort of patients with AF undergoing AF ablation. Methods Consecutive AF ablation patients with paroxysmal or persistent AF were retrospectively reclassified applying the 2010, 2012, and 2016 ESC definitions on AF type. Results We included a total of 628 patients. Applying the 2010 ESC AF guidelines definition, 68% of patients were paroxysmal while according to the 2016 ESC AF guidelines, the proportion increased to 87%. Applying the 2010 ESC guidelines definition, recurrence rates of paroxysmal and persistent AF patients differ significantly (log-rank p < 0.001). Applying the 2012 focused update and the 2016 ESC AF guidelines, recurrence rates do not differ significantly. In a cox regression model applying the 2010 guidelines, persistent AF is the only independent predictor of AF recurrence in our cohort. However, when applying the 2016 guidelines, persistent AF is no longer a predictor of AF recurrence. Conclusions The revised definition of AF types in the 2016 ESC AF guidelines leads to a marked shift from persistent to paroxysmal AF. It appears that the old definition provided a better separator to predict rhythm outcome after AF ablation.

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“…56 Recently, several studies have investigated ways to reduce cryotherapy time. 65,66 Pott et al reported that CB ablation with TTI-guided cryoenergy titration could be non-inferior to the fixed CB ablation strategy. 66 Their TTI-guided CB ablation protocol was modified such that freeze duration was 120 s for TTI <30s, and 180 s for TTI 30-60 s, and the fixed CB ablation protocol included of carina regions after CB ablation ( Figure 5).…”

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confidence: 99%

Cryoballoon Ablation for Patients With Paroxysmal Atrial Fibrillation

et al. 2020

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Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in clinical practice and induces cardiac dysfunction and stroke. The development of AF requires a trigger and also an electroanatomic substrate capable of both initiating and perpetuating AF. In the past decade, ectopic beats originating from the pulmonary veins (PV) have been identified as a source of paroxysmal AF. Thus, strategies that target the PV, including the PV antrum, are the cornerstone of most AF ablation procedures. Recently, alternative technologies to radiofrequency catheter ablation for paroxysmal AF such as balloon ablation modalities have been developed. The purpose of this review is to discuss cryoballoon ablation for paroxysmal AF.

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Time-to-isolation guided titration of freeze duration in 3rd generation short-tip cryoballoon pulmonary vein isolation – Comparable clinical outcome and shorter procedure duration

Abstract: TTI-guided cryoenergy titration leads to reduced procedure duration and fluoroscopy time and appears to be as effective as a fixed ablation strategy. A single 2-minute freeze seems to be sufficient in case of short TTI.

Cited by 31 publications

References 24 publications

Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Patient characteristics as predictors of recurrence of atrial fibrillation following cryoballoon ablation

Impact of re-definition of paroxysmal and persistent atrial fibrillation in the 2012 and 2016 European Society of Cardiology atrial fibrillation guidelines on outcomes after pulmonary vein isolation

Cryoballoon Ablation for Patients With Paroxysmal Atrial Fibrillation

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