Evaluation of the Achieve Mapping Catheter in cryoablation for atrial fibrillation: a prospective randomized trial

Yan, Gang; Gonna, Hanney; Domenichini, Giulia; Sampson, Michael; Aryan, Niloufar; Norman, Mark; Behr, Elijah R.; Zuberi, Zia; Dhillon, Paramdeep S.; Gallagher, Mark M.

doi:10.1007/s10840-015-0092-3

Cited by 7 publications

(7 citation statements)

References 18 publications

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“…The mechanisms of recurrence and knowledge of site-specific pulmonary venous breakthrough may help modify the index procedure to be more robust. In addition, the utility of the Achieve™ (Medtronic, Inc., Minneapolis, MN) has been found to be effective at aiding in acute procedural success [13] and comparable to Lasso catheters [14], but has not been compared with ultrasound-guided roving map catheter technique allowing for direct visualization in real time. Given the lack of rigorous evaluation, the purpose of the study was to evaluate the mechanisms of recurrent atrial fibrillation (AF) after use of the Arctic Front Ablation system.…”

Section: Introductionmentioning

confidence: 99%

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Shah

Adelstein

et al. 2019

Indian Pacing and Electrophysiology Journal

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Background The Arctic Front Cryoballoon System is a technology in which substrate alterations in patients with atrial fibrillation (AF) recurrence have not been well characterized. In this study, we evaluated sites of pulmonary vein (PV) reconnections and the accuracy of the Achieve™ circular mapping catheter in detecting these reconnections after cryoablation. Methods This study included 15 patients undergoing redo AF ablation after a prior single cryoablation procedure . PV reconnection sites were determined by measuring PV signals and high output pacing from 4 vectors of the Achieve catheter. The results were compared with a roving mapping catheter guided by rotational intracardiac echocardiography (ICE) in the left atrium. Results All patients had PV reconnections (2.1 ± 0.8 veins/patient). The left superior PV was most commonly reconnected (n = 11), whereas the right inferior PV was least likely (n = 3). Both carinas (left: n = 11; right: n = 7) and left atrial appendage ridge (n = 11) were also frequently reconnected. Mapping with the Achieve catheter showed a positive predictive value (PPV) 100% and negative predictive value (NPV) 96% when compared with ICE guided mapping. In 2 patients, right superior PV reconnection was not identified by the Achieve. Conclusion During redo AF ablation after index cryoablation, multiple PVs are usually reconnected, with both carinas and left atrial appendage ridge being common sites of reconnection. The Achieve mapping catheter was able to identify reconnection with high positive and negative predictive values.

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Section: Introductionmentioning

confidence: 99%

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Shah

Adelstein

et al. 2019

Indian Pacing and Electrophysiology Journal

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“…In a very early stage cryoballoon ablation of AF was considered a sort of “anatomical procedure”, without the possibility to measure electrophysiological signals during cryoenergy delivery. A significant technical improvement of the cryoballoon technique was the possibility to associate to the single shot balloon ablation technology, the possibility to record electrophysiological signals obtained by means of the ACHIEVE mapping catheter [ [15] , [16] , [17] ]. However, CB2's distal tip design could allow vein signals recording only in a minority of treated veins [ [16] , [17] , [18] ].…”

Section: Discussionmentioning

confidence: 99%

“…This difference may be explained by the higher rates of TTE observation in our CB3 group. A favourable TTE, known to be a good predictor of PV deconnection [ [14] , [15] , [16] , [17] ], allows to reduce the time of erogation. In fact, it's been demonstrated that TTE could be a good parameter to predict an optimal PV deconnection.…”

Section: Discussionmentioning

confidence: 99%

“…However, some procedural predictors, in order to improve the ablative efficacy became popular. The time to achieve the PV de-connection defined as time-to-effect (TTE), appeared to be important in order to increase ablative efficacy and to reduce unuseful cryo application time [ [14] , [15] , [16] , [17] ]. Recently, a new third-generation cryoballoon ablative catheter, the Artic Front Advance ST (CB3), has been produced, with a 40% shorter distal tip ( Fig.…”

Section: Introductionmentioning

confidence: 99%

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Impact of the third generation cryoballoon on atrial fibrillation ablation: An useful tool?

Sciarra

Iacopino

Palamà

et al. 2018

Indian Pacing and Electrophysiology Journal

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BackgroundThird-generation cryoballoon (CB3) is characterized by a 40% shorter distal tip designed to increase the rate of pulmonary veins real-time signal recording in order to measure time necessary to isolate veins, the “Time to effect” (TTE). Few data are currently available on clinical follow up of CB3 treated patients.MethodsSixtyeight consecutive patients (mean age 57.8 ± 9.6 years, 48 male) with paroxysmal or persistent atrial fibrillation (AF) were enrolled. Thirthyfour (25 paroxysmal AF) underwent to a 28 mmCB3 pulmonary veins isolation and were compared to 34 treated (21 paroxysmal AF) with 28 mmCB2.ResultsCB3 use was correlated to significant increase of the possibility to measure TTE in every treated veins (left superior 82,35% vs 23,53%, left inferior 70,59% vs 38,24%, right superior 58,82% vs 14,71%, right inferior 52,94% vs 17,65%). When it is measured, TTE wasn't different between two groups. Higher nadir temperature was observed in CB3 patients (−39.4 ± 5.2 °C vs −43.0 ± 7.2 °C, p = 0.03). CB3 procedures were shorter (91.4 ± 21.7 vs 110.9 ± 31.8 min, p = 0.018), with a significant reduction in cryoenergy delivery time (24.2 ± 8.5 vs 20.3 ± 6.7 min, p < 0.05), and a significant reduction in left atrium dwell time (59.3 ± 9.8 vs 69.3 ± 10.8 min, p = 0.02, p < 0.05). At one year follow up period the Kaplan-Meier curve didn't show any significant difference in AF-free survival (Log p = 0,49).ConclusionsNovel CB3 is a useful tool in order to simplify AF cryoballoon ablation when compared to second generation cryoballoon, as observed in our experience. Follow up data seem confirm a clinical CB3 efficacy at least comparable CB2.

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“…This is particularly a feature of cryoballoon ablation, where some degree of transient phrenic nerve dysfunction occurs in as many as 25% of cases, but clinically important injury occurs in fewer than 1% of cases. [ 17 ]…”

Section: Other Neural Injurymentioning

confidence: 99%

Protecting Against Collateral Damage to Non-cardiac Structures During Endocardial Ablation for Persistent Atrial Fibrillation

Leung

Akhtar

Hayat

et al. 2022

Arrhythm Electrophysiol Rev

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Injury to structures adjacent to the heart, particularly oesophageal injury, accounts for a large proportion of fatal and life-altering complications of ablation for persistent AF. Avoiding these complications dictates many aspects of the way ablation is performed. Because avoidance involves limiting energy delivery in areas of interest, fear of extracardiac injury can impede the ability of the operator to perform an effective procedure. New techniques are becoming available that may permit the operator to circumvent this dilemma and deliver effective ablation with less risk to adjacent structures. The authors review all methods available to avoid injury to extracardiac structures to put these developments in context.

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Evaluation of the Achieve Mapping Catheter in cryoablation for atrial fibrillation: a prospective randomized trial

Cited by 7 publications

References 18 publications

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Characterization of pulmonary vein reconnection post Cryoballoon ablation

Impact of the third generation cryoballoon on atrial fibrillation ablation: An useful tool?

Protecting Against Collateral Damage to Non-cardiac Structures During Endocardial Ablation for Persistent Atrial Fibrillation

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