Cryoballoon temperature predicts acute pulmonary vein isolation

Fürnkranz, Alexander; Köster, Ilka; Chun, K.R. Julian; Metzner, Andreas; Mathew, Shibu; Konstantinidou, Melanie; Ouyang, Feifan; Kuck, Karl Heinz

doi:10.1016/j.hrthm.2011.01.044

Cited by 73 publications

(77 citation statements)

References 15 publications

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“…It gives reliable information about balloontissue contact, explaining the association of low temperatures with ablation efficiency. 13,14 As demonstrated in our series, a late PV reconnection was more frequent in those veins with a warmer nadir temperature and a delayed time to isolation. Interestingly, these findings are in agreement with previous studies, showing that a minimal temperature ≤51°C predicted successful isolation and no acute resumption of PV conduction.…”

Section: Predictors Of Late Pv Reconnectionssupporting

confidence: 57%

“…Interestingly, these findings are in agreement with previous studies, showing that a minimal temperature ≤51°C predicted successful isolation and no acute resumption of PV conduction. 13,15 However, the multivariable analysis showed that time to PVI and failure to achieve −40°C within the first minute of cryoenergy application are independent predictors of late PV reconnections. In addition, a faster time to PVI is usually achieved with the CB-Adv when compared with its predecessor.…”

Section: Predictors Of Late Pv Reconnectionsmentioning

confidence: 96%

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On the Quest for the Best Freeze

Ciconte

Mugnai

Sieira

et al. 2015

Circ: Arrhythmia and Electrophysiology

116

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Background— The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation. Methods and Results— A total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13.8 years) underwent a repeat procedure, after a mean 11.6±4.5 months (range, 3.5–19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI ( P =0.03) and failure to achieve −40°C within 60 s ( P =0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73–0.97; P <0.001). Conclusions— The rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of −40°C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.

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Section: Predictors Of Late Pv Reconnectionssupporting

confidence: 57%

Section: Predictors Of Late Pv Reconnectionsmentioning

confidence: 96%

On the Quest for the Best Freeze

Ciconte

Mugnai

Sieira

et al. 2015

Circ: Arrhythmia and Electrophysiology

116

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“…In the absence of a clinical rationale to provide a bonus lesion (such as a late time to isolation or a relatively warm ablation temperature), it was our preference to proceed with no bonus lesions. 10,11 The end point of the procedure was complete isolation of all PVs, as assessed by entrance and exit block.…”

Section: Pulmonary Isolation Proceduresmentioning

confidence: 99%

Clinical Experience With a Novel Electromyographic Approach to Preventing Phrenic Nerve Injury During Cryoballoon Ablation in Atrial Fibrillation

Mondésert

Andrade

Khairy

et al. 2014

Circ: Arrhythmia and Electrophysiology

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Background-Phrenic nerve palsy remains the most frequent complication associated with cryoballoon-based pulmonary vein (PV) isolation. We sought to characterize our experience using a novel monitoring technique for the prevention of phrenic nerve palsy. Methods and Results-Two hundred consecutive cryoballoon-based PV isolation procedures between October 2010and October 2013 were studied. In addition to standard abdominal palpation during right phrenic nerve pacing from the superior vena cava, all patients underwent diaphragmatic electromyographic monitoring using surface electrodes. Cryoablation was terminated on any perceived reduction in diaphragmatic motion or a 30% decrease in the compound motor action potential (CMAP). During right-sided ablation, a ≥30% reduction in CMAP amplitude occurred in 49 patients (24.5%). Diaphragmatic motion decreased in 30 of 49 patients and was preceded by a 30% reduction in CMAP amplitude in all. In 82% of cases, this reduction in CMAP amplitude occurred during right superior PV isolation. The baseline CMAP amplitude was 946.5±609.2 mV and decreased by 13.8±13.8% at the end of application. This decrease was more marked in the 33 PVs with a reduction in diaphragmatic motion than in those without (40.9±15.3% versus 11.3±10.5%; P<0.001). In 3 cases, phrenic nerve palsy persisted beyond the end of the procedure, with all cases recovering within 6 months. Despite the shortened application all veins were isolated. At repeat procedure the right-sided PVs reconnected less frequently than the left-sided PVs in those with phrenic nerve palsy. Conclusions-Electromyographic phrenic nerve monitoring using the surface CMAP is reliable, easy to perform, and offers an early warning to impending phrenic nerve injury. (Circ Arrhythm Electrophysiol. 2014;7:605-611.)

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“…Cryoballoon temperatures are generally lower in the superior PVs when compared with inferior PVs, most likely due to passive warming of the proximal thermocouple by blood flow from the superior PVs [42]. A minimal cryoballoon temperature at the end of freezing of <-51ºC has been reported to predict PVI with 100% specificity for both superior and inferior PVs.…”

Section: How To Perform Cryoballoon Ablationmentioning

confidence: 99%

Cryoballoon Ablation for Atrial Fibrillation

Andrade

Dubuc

Guerra

et al. 2012

Indian Pacing and Electrophysiology Journal

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Focal point-by-point radiofrequency catheter ablation has shown considerable success in the treatment of paroxysmal atrial fibrillation. However, it is not without limitations. Recent clinical and preclinical studies have demonstrated that cryothermal ablation using a balloon catheter (Artic Front©, Medtronic CryoCath LP) provides an effective alternative strategy to treating atrial fibrillation. The objective of this article is to review efficacy and safety data surrounding cryoballoon ablation for paroxysmal and persistent atrial fibrillation. In addition, a practical step-by-step approach to cryoballoon ablation is presented, while highlighting relevant literature regarding: 1) the rationale for adjunctive imaging, 2) selection of an appropriate cryoballoon size, 3) predictors of efficacy, 4) advanced trouble-shooting techniques, and 5) strategies to reduce procedural complications, such as phrenic nerve palsy.

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Cryoballoon temperature predicts acute pulmonary vein isolation

Cited by 73 publications

References 15 publications

On the Quest for the Best Freeze

On the Quest for the Best Freeze

Clinical Experience With a Novel Electromyographic Approach to Preventing Phrenic Nerve Injury During Cryoballoon Ablation in Atrial Fibrillation

Cryoballoon Ablation for Atrial Fibrillation

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