Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation

Conte, Giulio; Soejima, Kyoko; Asmundis, Carlo de; Chierchia, Gian‐Battista; Badini, Matteo; Miwa, Yosuke; Caputo, Maria Luce; Özkartal, Tardu; Maffessanti, Francesco; Sieira, Juan; Degreef, Yves; Ströker, Erwin; Regoli, François; Moccetti, Tiziano; Brugada, Pedro; Auricchio, Angelo

doi:10.1016/j.ijcard.2018.05.135

Cited by 14 publications

(7 citation statements)

References 15 publications

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“…As there was no adenosine challenge during PV mapping, concealed reconnection might remain undetected in some cases which could have affected the presented PV reconnection patterns in both groups. Further, the reported PV reconnection rates at redo PVI in our study may have been overestimated, as there exist some data about the inaccuracy of PVAC and Achieve mapping catheter to falsely classify some reconnected PVs as isolated [25,26].…”

Section: Study Limitationsmentioning

confidence: 69%

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Wieczorek

Sassani²,

Hoeltgen³

2020

BMC Cardiovasc Disord

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Background: Pulmonary vein isolation (PVI) using phased radiofrequency (RF) energy has been shown to be effective in the treatment of atrial fibrillation (AF). Methods: We characterize and compare pulmonary vein (PV) reconnection at repeat ablation in patients with AF after initially successful PVI using phased RF technology (PVAC) or 2nd generation cryoballoon (CB). Eighty five patients undergoing redo PVI using multielectrode PVAC phased RF catheter and 66 patients after CB PVI were enrolled 9.7 ± 3.4 months after the initial ablation procedure. Results: The percentage of patients with PV reconnection(s) was comparably high between both groups (93% PVAC and 92% CB). However, 75% of all PVs and left common trunks (CTs) isolated with PVAC were reconnected, compared with 52% reconnections after CB PVI (p < 0.001). A mean of 2.79 ± 1.2 PVs and CTs/patient were reconnected after PVAC PVI compared with 1.97 ± 0.8 in CB patients, p < 0.0001. No patients in the CB group had 4 reconnected PVs, while this pattern of reconnection was observed in 33% in the PVAC group (p < 0.0001). The percentage of patients in the PVAC group with ≥3 reconnected PVs was significantly higher compared with CB patients (56 patients (66%) vs. 17 patients (26%), p < 0.0001), while the percentage of patients with no PV reconnection was comparably low in PVAC and CB patients (7 and 8%, respectively). CTs were most frequently reconnected after PVAC PVI (94%) and left superior PVs after CB ablation (67%), respectively. Conclusions: The number of patients with recurrent AF and PV reconnection(s) at redo PVI was comparably high between both groups. However, the extent and distribution of PV reconnections was different in many aspects, indicating more stable atrial lesions after CB PVI compared with PVAC technology.

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Section: Study Limitationsmentioning

confidence: 69%

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Wieczorek

Sassani²,

Hoeltgen³

2020

BMC Cardiovasc Disord

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“…In the present study, residual potential within the PV-LA junction was found in 5.7% (17/296) PVs after high-density mapping. Yokoyama et al ( 13 ) demonstrated that PV antral remapping after PVI without the use of the 3D mapping system could reveal residual PV potential in 4.3% of PVs. Because the isolation line of CB-PVI is sometimes located in the inner regions for a large PV, residual PV potential may be recorded at the proximal antrum after complete PV ostium (distal) isolation ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

“…However, data for the mapping system in CB-A are limited and sometimes controversial in nature. Some have argued that voltage mapping after standard confirmation of PVI yields no reduction in AF recurrence ( 11 , 12 ), while others have demonstrated that the detection of incomplete ablation yields promising results ( 9 , 13 ).…”

Section: Introductionmentioning

confidence: 99%

One-year outcomes of wide antral cryoballoon ablation guided by high-density mapping vs. conventional cryoballoon ablation for atrial fibrillation: a propensity score–matched study

Chen,

Wang,

Xuan

et al. 2024

Front. Cardiovasc. Med.

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BackgroundPulmonary vein isolation with wide antral ablation leads to better clinical outcomes for the treatment of atrial fibrillation, but the isolation lesion is invisible in conventional cryoballoon ablation. In this study, we aim to investigate the efficacy of the wide pulmonary vein isolation technique that includes the intervenous carina region, guided by high-density mapping, compared with pulmonary vein isolation alone without the mapping system.MethodsWe conducted a propensity score–matched comparison of 74 patients who underwent a wide cryoballoon ablation guided by high-density mapping (mapping group) and 74 controls who underwent conventional cryoballoon ablation in the same period (no-mapping group). The primary outcome was a clinical recurrence of documented atrial arrhythmias for >30 s during the 1-year follow-up.ResultsOf 74 patients in the mapping group, residual local potential in the pulmonary vein antrum was found in 30 (40.5%) patients, and additional cryothermal applications were performed to achieve a wide pulmonary vein isolation. Compared with the no-mapping group, the use of the mapping system in the mapping group was associated with a longer fluoroscopic time (26.97 ± 8.07 min vs. 23.76 ± 8.36 min, P = 0.023) and greater fluoroscopic exposure [339 (IQR181–586) mGy vs. 224 (IQR133–409) mGy, P = 0.012]. However, no significant differences between the two groups were found in terms of procedural duration and left atrial dwell time (104.10 ± 18.76 min vs. 102.45 ± 21.01 min, P = 0.619; 83.52 ± 17.01 min vs. 79.59 ± 17.96 min, P = 0.177). The rate of 12-month freedom from clinical atrial arrhythmia recurrence was 85.1% in the mapping group and 70.3% in the no-mapping group (log-rank P = 0.029).ConclusionVoltage and pulmonary vein potential mapping after cryoballoon pulmonary vein isolation can identify residual potential in the pulmonary vein antrum, and additional cryoablation guided by mapping leads to improved freedom from atrial arrhythmias compared with conventional pulmonary vein isolation without the mapping system.Clinical Trial Registration NumberChiCTR2200064383.

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“…In previous studies, an 8-pole circular catheter used in combination with a short-tip balloon was compared with a basket catheter (Orion™ catheter). The 8-pole catheter missed PV potentials in 24% of cases in which an older-generation balloon was used and in 1.4% of procedures done with a fourth-generation balloon ( 11 , 12 ). In our study, the discordance between the new POLARx™ circular catheter used in combination with a short-tip balloon and the Orion basket catheter was only 0.9%.…”

Section: Discussionmentioning

confidence: 99%

“…Only one study, involving 8 patients, has evaluated acute lesion characteristics after PVI with the POLARx™; this showed a large antral lesion and ablation of 50% of the posterior wall ( 10 ). The use of high-resolution mapping during CB ablation is useful not only in order to characterize the tissue, but also to detect incomplete PVI unrecognized by means of conventional circular mapping catheter mapping ( 11 – 13 ). A new map analysis tool (Lumipoint™, Boston Scientific) automatically identifies fragmented potentials and continuous activation, and seems to detect residual antral potentials after PVI better than other tools ( 14 ).…”

Section: Introductionmentioning

confidence: 99%

Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

Spera

Narducci²,

Bencardino³

et al. 2022

Front. Cardiovasc. Med.

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IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair, respectively (p = 0.0068). The mean posterior wall (PW) area was 22.9 ± 2 cm2 and, following PV isolation, 44.8 ± 6% of the PW area was ablated. After CB ablation, complete isolation of each PV was documented by the POLARMap™ catheter in all patients. By contrast, confirmatory UHDM and the Lumipoint™ tool unveiled PV signals in 1 out of 114 of the PVs (0.9%). Over 30-day follow-up, no major procedure-related adverse events were reported. After a mean follow-up of 333 days, 89.7% of patients were free from arrhythmia recurrence.ConclusionThe lesion extension achieved by the new CB ablation system involved the PV antrum, with less than 50% of the PW remaining untouched. The new system, with short tip and circular mapping catheter, failed to achieve PV isolation in only 0.9% of all PVs treated.Clinical trial registration[http://clinicaltrials.gov/], identifier [NCT03793998].

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Value of high-resolution mapping in optimizing cryoballoon ablation of atrial fibrillation

Cited by 14 publications

References 15 publications

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

One-year outcomes of wide antral cryoballoon ablation guided by high-density mapping vs. conventional cryoballoon ablation for atrial fibrillation: a propensity score–matched study

Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation

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