Impact of Cryoballoon Freeze Duration on Long-Term Durability of Pulmonary Vein Isolation

Chen, Shaojie; Schmidt, Boris; Bordignon, Stefano; Perrotta, Laura; Bologna, Fabrizio; Chun, K.R. Julian

doi:10.1016/j.jacep.2019.03.012

Cited by 55 publications

(44 citation statements)

References 33 publications

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“…Hence, we focused on shortening RSPV application, and not RIPV applications, to prevent from PNI. Recently, Chen et al published comparable results where a freeze duration of 240 versus 180 seconds was associated with significantly increased lesion durability, particularly at the left‐sided PVs 17 . Here, the low number of PVs per group in our study should be considered.…”

Section: Discussionmentioning

confidence: 56%

Shorter RSPV cryoapplications result in less phrenic nerve injury and similar 1‐year freedom from atrial fibrillation

Molenaar

Hesselink

Bekke

et al. 2020

Pacing Clinical Electrophis

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Background: In the 123-study, we prospectively assessed, in a randomized fashion, the minimal cryoballoon application time necessary to achieve pulmonary vein (PV) isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) with the aim to reduce complications by shortening the application duration. The first results of this study demonstrated that shortened cryoballoon applications (<2 minutes) resulted in less phrenic nerve injury (PNI) without compromising acute isolation efficacy for the right PVs. We now report the 1-year follow-up results regarding safety and efficacy of shorter cryoballoon applications. Methods: A total of 222 patients with AF were randomized to two applications of 1 min "short," 2 min "medium," or 3 min "long" duration, 74 per group. Recurrence of AF and PV reconduction at 1-year follow-up were assessed. Results: The overall 1-year freedom from AF was 79% and did not differ significantly between the short, medium, and long application groups (77%, 74%, and 85% for short, medium, and long application groups, respectively; P = 0.07). In 30 patients, a redo PVI procedure was performed. For all four PVs, there was no significant difference in reconduction between the three groups. Reconduction was most common in the left superior PV (57%). The right superior PV (RSPV) showed significantly less reconduction (17%) compared to the other PVs. Conclusions: Shortening cryoballoon applications of the RSPV to <2 minutes results in less PNI, while acute success and 1-year freedom from AF are not compromised. Therefore, shorter cryoballoon applications (especially) in the RSPV could be used to reduce PNI.

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Section: Discussionmentioning

confidence: 56%

Shorter RSPV cryoapplications result in less phrenic nerve injury and similar 1‐year freedom from atrial fibrillation

Molenaar

Hesselink

Bekke

et al. 2020

Pacing Clinical Electrophis

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“…Recently, a freeze duration of 180 seconds was suggested which resulted in shorter procedure times along with similar clinical outcome 43). In our recently published ICE-RE study we could demonstrate a greater risk for PV re-conduction if a total freeze duration of 180 seconds instead of 240 seconds was performed 45). Therefore, in our experience TTI based single freeze duration of 240 seconds appears to be preferable if no signs of PN or esophageal damage emerge.…”

Section: Clinical Datamentioning

confidence: 62%

Current Status of Atrial Fibrillation Ablation with Balloon Strategy

et al. 2019

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Catheter ablation of atrial fibrillation (AF) has been established worldwide and is recommended for symptomatic paroxysmal AF patients according to international guidelines. Importantly, the cornerstone of any AF ablation represents pulmonary vein isolation (PVI). Traditional radiofrequency (RF) point by point ablation within a 3D electroanatomic left atrial (LA) map requires profound understanding of LA anatomy and electrophysiology. This ablation strategy can be highly efficient and safe if performed in experienced hands and centers. However, procedural complexity causes a long learning curve and has limited its wide spread utilization. In contrast, balloon based PVI ablation strategies are based on an anatomic principle. Currently, two balloon types (cryoballoon and laserballoon) have been adopted to clinical routine. Both balloons are positioned at the target PV and circumferential energy ablation is enabled. This simplified anatomic approach facilitates reaching the procedural endpoint of PVI and demonstrated less operator dependency. Therefore, balloon PVI appears to be associated with improved procedural reproducibility and safety. Importantly, large scale randomized trials proved non-inferiority of balloon guided AF ablation (cryothermal and laser energy) vs. experienced operators using traditional “gold standard” RF ablation in paroxysmal and persistent AF. Ongoing technological refinements of both balloons as well as the introduction of novel energy dosing strategies and ablation targets may potentially impact the current way of ablating AF in future. This review will summarize current clinical experience of contemporary balloon devices and will look into future developments.

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“…The assessment of durable PV lesions using the CB application has been examined in several reports with regard to various predictors 4,14–19 . However, the efficacy of the CB ablation beyond the PVI in terms of the durability of the lesions has not been fully elucidated.…”

Section: Discussionmentioning

confidence: 99%

Clinical investigation of the durability of the lesions created by left atrial linear ablation with a cryoballoon

Shigeta

Okishige

Nishimura

et al. 2020

Cardiovasc electrophysiol

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Introduction Pulmonary vein isolation (PVI) and linear ablation with a roof line and bottom line on the left atrial (LA) posterior wall (LAPW) can be achieved with a cryoballoon (CB). This study sought to investigate the long‐term durability of these linear lesions. Methods and results Among 290 persistent patients with atrial fibrillation (AF) who had undergone linear ablation with a CB on the roof and bottom line of the LAPW in addition to the PVI, we analyzed those patients who underwent a re‐do AF ablation. Arrhythmia recurrence was confirmed in 70 (24%) out of 290 patients, and 47 (16%) patients underwent re‐do sessions. At the beginning of the re‐do ablation, we examined the reconnection sites of the linear lesions on the LAPW and PVI. Maintenance of the conduction block on the LAPW roof and bottom lines was observed in 35 out of 47 patients (74.5%), and 16 out of 35 patients (45.7%), respectively. The length of the roof line was significantly shorter in patients with preservation of the conduction block on the LAPW roof than in those without (36.2 ± 6.5 mm vs 41.6 ± 4.7 mm, P = .02). Conclusion Durable lesions could be obtained after linear ablation with the CB for the LAPW roof line, especially in those with a relatively short LAPW roof line. However, patients requiring touch‐up ablation with radiofrequency were included, and that was associated with a potential financial implication.

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Impact of Cryoballoon Freeze Duration on Long-Term Durability of Pulmonary Vein Isolation

Cited by 55 publications

References 33 publications

Shorter RSPV cryoapplications result in less phrenic nerve injury and similar 1‐year freedom from atrial fibrillation

Shorter RSPV cryoapplications result in less phrenic nerve injury and similar 1‐year freedom from atrial fibrillation

Current Status of Atrial Fibrillation Ablation with Balloon Strategy

Clinical investigation of the durability of the lesions created by left atrial linear ablation with a cryoballoon

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