Improved <i>In Vivo</i> Performance of Second‐Generation Cryoballoon for Pulmonary Vein Isolation

Coulombe, Nicolas; Paulin, Jaime; Su, Wilber

doi:10.1111/jce.12157

Cited by 97 publications

(77 citation statements)

References 22 publications

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“…Moreover, the recently introduced 2nd-generation CBs provide more uniform and distal cooling than the 1st-generation balloons because of improved cooling of the distal balloon hemisphere. 17 Our finding that the 2nd-generation CB resulted in a more pronounced myocardial injury than RF ablation despite the short application time was in line with the previous reported results.…”

Section: Markers Of Myocardial Injury and Prothrombotic Markerssupporting

confidence: 82%

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies　– Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

Miyazaki

Kuroi

Nakamura

et al. 2016

Circ J

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Section: Markers Of Myocardial Injury and Prothrombotic Markerssupporting

confidence: 82%

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies　– Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

Miyazaki

Kuroi

Nakamura

et al. 2016

Circ J

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“…Our results are in accordance with the recently described broader lesion sets demonstrated in animal studies for CBG2. 10 Nonsignificant trends for increased rates of transient and persistent PNP were observed with CBG2 compared to CBG1. With CBG2, we used more consistently an empirically determined cutoff criterion of −60°C BT when ablating the right superior PV.…”

Section: Discussionmentioning

confidence: 94%

“…Results of a preclinical animal study with 10 dogs are suggestive of equal safety and higher efficacy in lesion generation. 10 Human clinical studies are sparse. Two different centers published their initial experience in roughly 100 patients treated with CBG2 until now.…”

mentioning

confidence: 99%

Comparison of the First and Second Cryoballoon

Straube

Dorwarth

Schmidt

et al. 2014

Circ: Arrhythmia and Electrophysiology

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There were 2 main objectives:1. To compare the procedural efficacy of CBG1 and CBG2 by analyzing rates of acute PVI, time to isolation (TTI), balloon © 2014 American Heart Association, Inc. Original ArticleBackground-Cryoballoon (CB) ablation results in >70% freedom from atrial fibrillation at 1 year. Single-center data of the first (CBG1) and second (CBG2) cryoballoon, recently introduced, were analyzed to compare safety and efficacy. Methods and Results-From March 2011 to December 2012, CB ablation with spiral mapping was performed consecutively in 484 patients with symptomatic atrial fibrillation. CBG1 was used in 364 of 484 (75%) and CBG2 in 120 of 484 (25%) patients. Periprocedural data were analyzed. Acute pulmonary vein (PV) isolation with CB only was achieved in 99.86% and 100% of veins with CBG1 and CBG2, respectively (P=0.43). Number of applications until PV isolation decreased significantly with CBG2 (1.45±0.81 versus 1.28±0.64; P=0.001). Procedural, left atrial, and fluoroscopy time were reduced by −5%, −11%, and −15% (P<0.05), respectively. Two balloons were used less frequently. Time to isolation decreased significantly with 23-mm (48 versus 33 seconds; P<0.0001) and 28-mm CBG2 (76 versus 52 seconds; P<0.0001). Early PV reconduction rarely occurred with CBG2 (2.6% versus 0.42%; P=0.0023). In-hospital atrial fibrillation recurrence rates were similar. Balloon temperatures were significantly warmer with 23-mm CBG2 and a trend for colder balloon temperature with 28-mm CBG2 were observed compared with their predecessors. Comparable low rates of phrenic nerve palsy were recorded (1.1% versus 1.7%; P=0.64). Esophageal temperatures were similar. Major complication rates were low (3.3% versus 3.33%; P=1.0). Conclusions-CBG2 attains high rates of acute PV isolation within a significant faster and less complex procedure. Time to isolation is shorter, and PV isolation is achieved with fewer applications using CBG2. These enhancements were not at the cost of complications. Study PopulationFrom 2007 to November 2012, all patients undergoing CB ablation for catheter ablation of symptomatic AF at our center were prospectively enrolled in a consecutive fashion. Informed consent was obtained from all patients for the observational registry study which was approved by the local ethical committee. Baseline characteristics, periprocedural data, and follow-up during blanking period for procedure-associated complications were assessed prospectively. For this interim analysis, we included only patients undergoing a CB procedure in combination with the Achieve spiral mapping catheter (Medtronic Inc., Minneapolis, MN) introduced in March 2011 as the standard catheter to our laboratory for positioning of the balloon and real-time PV potential recordings. Until May 2012, all patients were treated with the Arctic Front, and afterward, all patients were treated with the Arctic Front Advance. Ablation Procedure and Verification of PVICB procedure was performed with an anatomy-based individualized approach as described before u...

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“…8 Furthermore, more recent clinical 17 and experimental 18 studies showed that single 3-minute freeze techniques, without bonus applications, are effective and acceptable approaches in achieving acute PVI and an AF freedom of >80% at 1-year followup. Longer applications (4 minute×>2 times) allow a high durability of the PVI (91%); however, they lead to a high incidence of serious complications (3/21 patients).…”

Section: Isolation Area After Pv Isolationmentioning

confidence: 99%

“…7 The more recently introduced second-generation CB has exhibited a significantly higher performance than the first-generation CB because of the improved cooling effect. 8,9 However, CB ablation cannot specifically control the left atrial (LA) lesion size, which means that the isolation area is basically defined by the LA and PV anatomy. Although a previous study showed that the isolation area was wide and antral during the acute phase post 28-mm secondgeneration CB ablation, [10][11][12] the data during the chronic phase (after disappearance of tissue edema) has not been reported.…”

mentioning

confidence: 99%

Quantitative Analysis of the Isolation Area During the Chronic Phase After a 28-mm Second-Generation Cryoballoon Ablation Demarcated by High-Resolution Electroanatomic Mapping

Miyazaki

Taniguchi

Hishida

et al. 2016

Circ: Arrhythmia and Electrophysiology

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Background-The post-second-generation cryoballoon (CB) ablation isolation area during the chronic phase has not been described. The aim of this study was to quantitatively evaluate the chronic-phase isolation area after 28-mm secondgeneration CB ablation and compare it to the estimated conventional radiofrequency circumferential pulmonary vein isolation (CPVI) line. Methods and Results-Thirty-two patients with paroxysmal atrial fibrillation underwent pulmonary vein (PV) isolation using second-generation CB. After a median of 6.0 (4.0-9.0) months, the PV isolation area was evaluated using highresolution mapping (1-mm electrode, 2-mm interelectrode spacing; 527±99 points per map) and pacing techniques in all patients (17 with and 15 without arrhythmia recurrence beyond blanking period) and compared with estimated conventional radiofrequency CPVI area. PV reconnections were observed in 34 of 126 PVs (27.0%) among 21 of 32 patients (65.6%), which were eliminated by a median of 1.0 (1.0-3.0) focal radiofrequency application. The left-and right-sided PV antrum isolation area and nonablated posterior wall areas were 9.8±1.7, 8.1±2.3, and 17.0±6.1 cm 2 , respectively. The cryoablated areas were significantly smaller than the estimated conventional radiofrequency CPVI areas in all but the right inferior PV. The difference was highest in the left superior PV. In 2 patients (6.3%), recurrent atrial fibrillation originated from the foci identified at the left superior PV antrum outside the CB isolation area but inside the estimated conventional radiofrequency CPVI line. Conclusions-Although the PV isolation areas during the chronic phase after the second-generation CB ablation were generally wide, they were significantly smaller than the area encircled by the CPVI line except at the right inferior PV antrum. Recurrent atrial fibrillation could originate from the left superior PV antrum and could be isolated by a CPVI but not by a CB. (Circ Arrhythm Electrophysiol. 2016;9:e003879.

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Improved In Vivo Performance of Second‐Generation Cryoballoon for Pulmonary Vein Isolation

Abstract: PV isolation and lesion completeness were improved with Arctic Front Advance, while no unexpected findings were found related to safety.

Cited by 97 publications

References 22 publications

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies　– Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies　– Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

Comparison of the First and Second Cryoballoon

Quantitative Analysis of the Isolation Area During the Chronic Phase After a 28-mm Second-Generation Cryoballoon Ablation Demarcated by High-Resolution Electroanatomic Mapping

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Improved In Vivo Performance of Second‐Generation Cryoballoon for Pulmonary Vein Isolation

Abstract: PV isolation and lesion completeness were improved with Arctic Front Advance, while no unexpected findings were found related to safety.

Cited by 97 publications

References 22 publications

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies – Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies – Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

Comparison of the First and Second Cryoballoon

Quantitative Analysis of the Isolation Area During the Chronic Phase After a 28-mm Second-Generation Cryoballoon Ablation Demarcated by High-Resolution Electroanatomic Mapping

Contact Info

Product

Resources

About

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies　– Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –

Early Recurrence After Pulmonary Vein Isolation of Paroxysmal Atrial Fibrillation With Different Ablation Technologies　– Prospective Comparison of Radiofrequency vs. Second-Generation Cryoballoon Ablation –