The PV-LA voltage on the PV-encircling ablation line and FTI/PV-LA voltage were related to the acute post-PVI PV reconnections. A more durable ablation strategy is warranted for high-voltage zones.

rence, 2,3 and thus might yield improved clinical outcomes in terms of ischemic stroke, heart failure, and death. For patients in whom PVI is truly curative, it should be possible to discontinue oral anticoagulants (OACs) without fear that an AF-related clinical event will occur. Despite A trial fibrillation (AF) affects quality of life and increases the risks of stroke, heart failure, and death. 1 Pulmonary vein isolation (PVI) is reported to be more effective than antiarrhythmic drug (AAD) therapy for relief of symptoms and freedom from AF recur

Although HBA lesions appear to be smaller than CBA lesions, middle-term outcomes are not statistically different between these balloon modalities.

Key Wordsatrial fibrillation, cryoballoon ablation, pulmonary vein isolation, pulmonary vein distension. IntroductionCryothermal energy has emerged as an alternative ablation energy that does not issue in the clot formation and excessive tissue damage that occur with radiofrequency (RF) energy-based catheter ablation. [1] Although cryothermal energy is a milder and safer form of energy than RF energy, pulmonary vein isolation (PVI) performed with a second-generation cryoballoon has been highly successful in cases of paroxysmal atrial fibrillation (AF) and comparable to PVI performed by point by point-based RF ablation [2]-[6] or even contact force (CF)-based RF ablation.[7], [8] Despite the efficacy of cryoballoon ablation (CBA), however, some patients suffer recurrence of the AF, due mainly to PV reconnections or to non-PV triggers.[9], [10] Thus far, the mechanisms explaining durable and non-durable lesion formation around the PV ostium by means of second-generation CBA have not been fully investigated. Because establishing good balloon surface-totissue contact is essential for successful CBA of AF, we investigated, by means of 3-dimensional (3D) geometric imaging, how the inflated balloon surface contacts the 4 PVs. We then characterized lesions created around the PV ostia by CBA and those created by CF-based ablation to clarify the mechanism responsible for the efficacy of CBA. Material and Methods Study PatientsThe study involved 112 consecutive patients treated for AF (symptomatic paroxysmal AF [n=88] or persistent AF [n=24]) at Nihon University Itabashi Hospital between September 2014 and December 2015. The patient series comprised 72 men and 40 women with a mean±SD age of 63.8±7.7 years and median duration of AF of 18 months (interquartile range, 6-48 months). Patients were blindly (but not randomly) assigned to 1 of 2 ablation procedures: PVI performed by means of second-generation CBA (CBA group, n=56) and PVI performed by means of CF-based RF catheter ablation (CF group, n=56). Written informed consent was obtained from all patients. All antiarrhythmic drugs were withdrawn for at least 5 half-lives prior to the procedure. Transesophageal and transthoracic echocardiography were performed 1 day before the ablation procedure with an ACUSON Sequoia C256 echocardiography system (Siemens Medical Solutions USA, Inc., Malvern, PA). LA diameter (LAD) and maximum LA volume (by the prolate ellipsoid method) were determined, and the left ventricular ejection fraction (LVEF) was determined by means of M-mode echocardiography (Teichholz method). Multi-slice computed tomography was performed with a 320-detector row, dynamic volume scanner (Aquilion ONE; Toshiba Medical Systems, Tokyo, Japan) in all patients for 3D reconstruction of the left atrium (LA) and PVs before ablation. Electrophysiologic Study and AblationElectrophysiologic study was performed in all patients under conscious sedation achieved with dexmedetomidine and fentanyl.www.jafib.com Apr-May 2017| Volume 9| Issue 6Abstract Background: The mechanism ex...

Pulmonary vein isolation (PVI) of atrial fibrillation (AF) can reduce the AF burden and, potentially, reduce the long-term risk of strokes and death. However, it remains unclear whether anticoagulants can be stopped after PVI because of post-ablation AF recurrence in some patients. This study aimed to investigate the discontinuation rate of anticoagulants and long-term incidence of strokes after PVI. We enrolled 512 consecutive Japanese patients with AF (mean age, 63.4 ± 10.4 years; 123 women; 234 with non-paroxysmal AF; CHADS2 score/CHA2DS2-VASC score, 1.32 ± 1.12/2.21 ± 1.54) who underwent PVI between 2012 and 2015. During a 28.0 ± 17.1-month follow-up, anticoagulants were terminated in 230 (44.9%) of the 512 patients, AF recurred in 200 (39.1%), and 10 (1.95%) suffered from a stroke. Death occurred in 5 (0.98%) patients. Although the incidence of strokes, by a Kaplan-Meier analysis, was similar, the incidence of death was lower (Hazard ratio 0.37, 95% confidence interval 0.12-0.93, P = 0.041) in the AF ablation group than the control group without ablation after 1:1 propensity score matching (the control data was derived from 2,986 patients in the SAKURA AF Registry, a large-cohort AF registry). Anticoagulants were discontinued in nearly half the patients who underwent AF ablation; of these, 39.1% experienced AF recurrences, 1.95% suffered from strokes, and 0.98% died, but the risk of death after AF ablation appeared to be lower than that in a propensity score-matched control group without ablation during longterm follow-up.

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BackgroundLimited data exist on indicators of durable pulmonary vein isolation (PVI) undergoing cryoballoon ablation (CBA) for atrial fibrillation (AF). We investigated whether balloon temperature and time to PVI can be used to predict early PV reconduction (EPVR), including residual PV conduction and adenosine triphosphate‐induced dormant conduction and the relation between touch‐up ablation of EPVR sites and mid‐term recurrence of AF.MethodsWe obtained procedural and outcome data from the records of 130 consecutive patients who underwent CBA and followed up for 13.4 months.Results EPVR was identified in 86 (17%) PVs of 61 (47%) patients. Balloon temperatures during 30 seconds (−27 ± 5.7°C vs −31 ± 5.5°C), 60 seconds (−36 ± 5.6°C vs −41 ± 5.4°C), and at the nadir point (−41 ± 7.4°C vs −49 ± 7.0°C) were significantly higher, and the time to PVI was longer (90 ± 50 seconds vs 52 ± 29 seconds) in PVs with EPVR than in those without (P < 0.0001 for all). Among PVs without EPVR, the time to PVI was longer and balloon temperature was lower for the left superior pulmonary vein/ right inferior pulmonary vein (LSPV/RIPV) than for the right superior pulmonary vein/left inferior pulmonary vein (RSPV/LIPV) (time: 60 ± 25/73 ± 37 seconds vs 41 ± 31/45 ± 20 seconds, P < 0.0001) (temp: −39.2 ± 11.3/−39.4 ± 8.3°C vs −33.8 ± 10.6/−33.6 ± 6.8°C, P = 0.0023). AF recurrence rates were equivalent between patients with and without EPVR (13% [8/69] vs 15% [9/61], P = 0.845).ConclusionsCryoballoon temperature and time to PVI appear to be useful in predicting durable PVI, that is, prevention of EPVR, but the balloon temperature and time required for PVI differ between PVs. Although EPVR does not predict AF recurrence, high success rates can be expected when touch‐up ablation of EPVR sites is performed.

A trial fibrillation (AF) ablation procedures are generally effective and safe; however, devastating complications occasionally occur. Coronary artery spasms (CASs) have recently been reported as a complication of AF ablation, and some patients develop serious Editorial p ????