Visualization of pulmonary vein–left atrium lesions using delayed-enhancement magnetic resonance imaging after cryothermal balloon catheter ablation: A case report

Morita

et al. 2019

Journal of Arrhythmia

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Background Although late gadolinium enhancement magnetic resonance imaging ( LGE ‐ MRI ) allows the identification of lesions and gaps after a cryothermal balloon ( CB ) ablation of paroxysmal atrial fibrillation ( PAF ), the accuracy has not yet been well established. Methods The subjects consisted of 10 consecutive patients who underwent a second ablation procedure among our cohort of 80 patients who underwent LGE ‐ MRI after the CB ablation of PAF . LGE ‐ MRI scar regions were compared with electroanatomical mapping during the second procedure. In the analysis, the unilateral pulmonary vein ( PV ) antrum was divided into 7 regions. Results The gap characterization analysis was performed in 140 regions around 40 PV s in total. There were 16 LGE ‐ MRI gaps around 11 PV s (mean 1.6 ± 1.4 gaps/patient) in 7 patients and 14 electrical gaps around 10 PV s in 8 patients (mean 1.4 ± 1.1 gaps/patient). The locations of 13 electrical gaps were well matched to that on the LGE ‐ MRI , whereas the remaining 1 electrical gap had not been predicted on the LGE ‐ MRI . Compared to the electrical gaps in the second procedure, the sensitivity and specificity of the LGE ‐ MRI gaps were 93% (13 LGE ‐ MRI gaps of 14 electrical gaps) and 98% (123 LGE ‐ MRI scars out of 126 electrical scars), respectively. Conclusion LGE ‐ MRI can accurately localize the lesion gaps after CB ablation of PAF .

Section: Introductionmentioning

confidence: 99%

Feasibility of late gadolinium enhancement magnetic resonance imaging to detect ablation lesion gaps in patients undergoing cryoballoon ablation of paroxysmal atrial fibrillation

Mishima

Morita

et al. 2019

Journal of Arrhythmia

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“…The details have been described in our previous work [14] . In brief, delayed-enhancement MRI will be performed 1–2 months after discharge using a 1.5-T scanner (MAGNETOM Sonata, Siemens, Erlangen, Germany) with a 6-channel body array coil.…”

Section: Methodsmentioning

confidence: 99%

A multicenter study of the need of additional freezing for cryoballoon ablation in patients with atrial fibrillation: The AD‐Balloon study

Doi

Amaya

et al. 2016

Journal of Arrhythmia

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BackgroundPulmonary vein isolation (PVI) is a cornerstone of catheter ablation in patients with paroxysmal atrial fibrillation (PAF), and balloon-based ablation has been recently performed worldwide. Ablation using the second-generation cryoballoon (CB2) (Arctic Front AdvanceTM, Medtronic, MN, USA) is useful for PVI; however, there is some debate concerning the optimal freezing time and number of cycles after PVI is achieved.MethodsThe AD-Balloon study was designed as a prospective, multicenter, randomized clinical trial to evaluate the optimal strategy (freezing cycles) of CB2 ablation (UMIN Clinical Trials Registry UMIN000020130). The main objective of this study is to investigate the need for an additional freezing cycle after PVI in patients treated with CB2 ablation. Patients will be randomly assigned in a 1:1 ratio to treatment with additional freezing (AD group) or without additional freezing (non-AD group). In the AD group, 3 min of additional freezing time will be applied in all pulmonary veins after PVI is confirmed at the previous freezing cycle. In the non-AD group, no additional freezing will be applied in all pulmonary veins after PVI is confirmed. The primary endpoint of this study is the occurrence of atrial tachyarrhythmias within a 1-year follow-up period. We will enroll 110 consecutive patients with PAF. We will also investigate the usefulness of delayed-enhancement magnetic resonance imaging to assess the ablation lesions caused by CB2 ablation.ResultsThe results of this study are currently under investigation.ConclusionThe AD-Balloon study would assess the need for an additional freezing cycle after PVI is achieved. Our findings may contribute to further improvement of the CB2 ablation procedure.

Multicenter Study of the Validity of Additional Freeze Cycles for Cryoballoon Ablation in Patients With Paroxysmal Atrial Fibrillation

Circ: Arrhythmia and Electrophysiology

Doi

Hasegawa

et al. 2019

Background: Pulmonary vein isolation (PVI) is a cornerstone of catheter ablation in patients with paroxysmal atrial fibrillation, and balloon-based ablation has been recently performed worldwide. The second-generation cryoballoon (CB2) ablation has proven to be highly effective in achieving freedom from paroxysmal atrial fibrillation. However, there are some debatable questions, including the ideal number of freeze cycles. Methods: The AD-Balloon study (Multicenter Study of the Validity of Additional Freeze Cycles for Cryoballoon Ablation) was designed as a prospective, multicenter, and randomized clinical trial for investigation of the optimal strategy of freeze cycles for the CB2 ablation. One hundred and ten consecutive patients (aged 64±11 years) were randomly assigned to 2 groups after achieving a PVI by the CB2 ablation: 3-minute freeze cycles were added to each pulmonary vein (AD group: n=55) or not (non-AD group: n=55). Delayed-enhancement magnetic resonance imaging was also performed 1 to 2 months after the PVI to assess the ablation lesions. Results: The patient characteristics did not differ between the 2 groups. A complete PVI was achieved in all patients. The total number of freeze cycles and durations for all pulmonary veins were significantly shorter in the non-AD group than in the AD group (5.7±1.6 versus 9.1±1.6 cycles, P <0.0001, and 932±244 versus 1483±252 seconds, P <0.0001). The cumulative freedom from any atrial tachyarrhythmia at 1 year was 87.3% in the AD group and 89.1% in the non-AD group (log-rank test P =0.78). There was no significant difference in the frequency of gaps on the PVI lines in the delayed-enhancement magnetic resonance imaging (46% in the AD group versus 36% in the non-AD group; P =0.38). Conclusions: No benefit was found in the patients receiving additional 3-minute freeze cycles after the complete PVI with the CB2 ablation, suggesting that an insurance freeze after achieving a PVI with the CB2 may be unnecessary and time consuming.