Hot Balloon Versus Cryoballoon Ablation for Atrial Fibrillation

Nagashima, Koichi; Okumura, Yasuo; Watanabe, Ichiro; Nakahara, Shiro; Iso, Kazuki; Watanabe, Ryuta; Arai, M.; Wakamatsu, Yuji; Kurokawa, Syuhei; Matsubara, Hiroaki; Nakai, Toshiko; Ohkubo, Kimie; Hirayama, Atsushi

doi:10.1161/circep.117.005861

Cited by 49 publications

(26 citation statements)

References 15 publications

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“…13 Nowadays, there has been a report regarding the method of using the CB at areas besides the PVs. 3 In the present study, we performed a LAPW isolation with the CB, because the lesions created by the CB were relatively large 14 and durable. 15…”

Section: Rationale For Utilizing the Cb For The Isolation Of The Lapwmentioning

confidence: 99%

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Shigeta

Okishige

Aoyagi

et al. 2019

Pacing Clinical Electrophis

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Background The cryoballoon (CB) can be utilized for extra pulmonary vein (PV) ablation such as for a left atrial (LA) posterior wall (LAPW) isolation. However, scrutiny of the esophageal injuries during the LAPW isolation has never been performed. We sought to thoroughly investigate the esophageal lesions (ELs) and gastric hypomotility (GH) caused by an LAPW isolation using a CB. Methods A total of 101 persistent atrial fibrillation patients who underwent an LAPW isolation using a CB were enrolled. The CB was applied on the roof and bottom area of the LAPW after a PV isolation. The luminal esophageal temperature (LET) was monitored by a thermistor probe during the CB applications. When the LET reached 15°C, the freezing application was prematurely interrupted. Esophagogastroscopy was performed on the next day following the ablation. Results All PVs were successfully isolated in all patients. A successful LAPW isolation solely with CB ablation was performed in 72 (71.3%) patients. Cryofreezing applications were prematurely interrupted due to low LETs in 49 (48.5%) patients predominantly during the LA bottom line ablation. ELs and GH were observed in 11 (10.9%) and 16 patients (15.8%), respectively. The nadir LET tended to be lower in patients with ELs and GH than in those without (ELs: 14.8 ± 4.5°C vs 17.4 ± 6.0°C, P = 0.17; GH: 15.5 ± 4.5°C vs 17.5 ± 6.1°C, P = 0.23, respectively). Conclusions Esophageal complications such as ELs and GH occur during the LAPW isolation with a CB. There was no reliable predictor of those adverse events.

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Section: Rationale For Utilizing the Cb For The Isolation Of The Lapwmentioning

confidence: 99%

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Shigeta

Okishige

Aoyagi

et al. 2019

Pacing Clinical Electrophis

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“…Balloon-based ablation modalities such as the cryoballoon (CB) and hot balloon (HB) have been developed to simplify pulmonary vein (PV) isolation, with favorable outcomes. 1 , 2 , 3 Nonetheless, a left common PV trunk (LCPV) of the superior and inferior PVs is not rare and the incidence has been reported to be 9%–83%. 4 , 5 The balloon adaptability to this anatomic variation is challenging, especially in CB-based ablation because of its fixed balloon size.…”

Section: Introductionmentioning

confidence: 99%

“…HB ablation details have been previously described. 2 In brief, SATAKE Hot Balloon (Toray Industries, Inc, Tokyo, Japan) with an inner lumen and J-tip guidewire was inflated at each PV ostium through a 13F deflectable guiding sheath (Treswaltz, Toray Industries) via a transseptal approach. PV occlusion was achieved by inflating the HB to 26–33 mm in diameter with 10–20 mL of contrast medium diluted 1:2 with saline, and was confirmed by venography.…”

Section: Introductionmentioning

confidence: 99%

Single-shot antral isolation of a common pulmonary vein by the hot balloon

Wakamatsu

Nagashima

Watanabe

et al. 2019

HeartRhythm Case Reports

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“…4 Thus, the HotBalloon ablation system has been applied in the clinical setting for paroxysmal and persistent AF ablation. [4][5][6] However, a recent multicenter study also demonstrated that the incidence of severe PV stenosis (>70%) has increased to 5.2%. 5 These findings suggest that a more antral side of energy delivery using the HotBalloon (e.g., HotBalloon-based wide antral ablation [HBWA]) is desirable to avoid unpredictable vein stenosis, but this methodology may cause an increase in the creation of residual conduction gaps between the PV and left atrium (LA), because of the loss of balloon flexibility for obliterating the loon.…”

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confidence: 99%

Characterization of Residual Conduction Gaps After HotBalloon-Based Antral Ablation of Atrial Fibrillation　― Evidence From Ultra-High-Resolution 3-Dimensional Mapping ―

Fukuda

Nakatani

Kobayashi

et al. 2019

Circ J

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Background: The electrophysiological characteristics of residual conduction gaps between the left atrium (LA) and pulmonary veins (PVs) after HotBalloon-based wide antral ablation (HBWA) of atrial fibrillation (AF) remain incompletely understood. This study aimed to characterize the residual gaps by means of ultra-high-resolution mapping. Methods and Results: A total of 55 AF patients underwent HBWA by a predetermined protocol (6-shot total-based antral approach). LA-PV maps were created using 64-electrode minibasket catheters. In total, 55 residual gaps were identified among 26 (47%) patients. Residual gaps included 33 left superior (LS: 60%), 10 left inferior (18%), 6 right superior (11%), and 6 right inferior (11%) PVs. Those gaps demonstrated both extremely lower bipolar amplitudes (0.11 [interquartile range: 0.06-0.27] mV) and conduction velocities (0.75±0.27 m/s); however, the length was confined (10.3±4.1 mm) except for the LSPV anterior carina (12.2±2.4 mm) region. Among the carina regions, all gaps had far-field potentials consistently added to the PV potentials. Left atrial appendage pacing to split the far-field activity identified confined gap regions (6.7±1.9 mm). Touch-up ablation eliminated the residual PV potentials in all cases. Conclusions: HBWA resulted in a certain degree of residual gap conduction in particular antral regions. These gaps exhibited narrow lengths with lower amplitudes, and often had far-field recordings from the left atrial appendage. Combined with pacing maneuvers, ultra-high-resolution activation maps could both visualize all confined gaps and ensure a bare minimum of touch-up ablations in all patients with gap conduction.

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Hot Balloon Versus Cryoballoon Ablation for Atrial Fibrillation

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

Cited by 49 publications

References 15 publications

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Single-shot antral isolation of a common pulmonary vein by the hot balloon

Characterization of Residual Conduction Gaps After HotBalloon-Based Antral Ablation of Atrial Fibrillation　― Evidence From Ultra-High-Resolution 3-Dimensional Mapping ―

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Hot Balloon Versus Cryoballoon Ablation for Atrial Fibrillation

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

Cited by 49 publications

References 15 publications

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Clinical investigation of esophageal injury from cryoballoon ablation of persistent atrial fibrillation

Single-shot antral isolation of a common pulmonary vein by the hot balloon

Characterization of Residual Conduction Gaps After HotBalloon-Based Antral Ablation of Atrial Fibrillation ― Evidence From Ultra-High-Resolution 3-Dimensional Mapping ―

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Characterization of Residual Conduction Gaps After HotBalloon-Based Antral Ablation of Atrial Fibrillation　― Evidence From Ultra-High-Resolution 3-Dimensional Mapping ―