Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon

Chierchia, Gian‐Battista; Mugnai, Giacomo; Ströker, Erwin; Velagić, Vedran; Hünük, Burak; Moran, Darragh; Hacioğlu, Ebru; Poelaert, Jan; Verborgh, Christian; Umbrain, Vincent; Beckers, Stefan; Ruggiero, Diego; Brugada, Pedro; Asmundis, Carlo de

doi:10.1093/europace/euv452

Cited by 24 publications

(15 citation statements)

References 20 publications

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“…The significant improvement in TTE detection was observed in all veins. These results confirm previously published data regarding the third-generation CB (CB3, Arctic Front Advance ST, Medtronic, Inc.) that was withdrawn from the commercial market due to higher balloon nadir temperatures probably caused by a more proximal positioning of the intra-balloon thermocouple [13][14][15]. In our population, the main reason for failure to obtain TTE recordings was the distal placement of the Achieve in order to guarantee balloon stability, especially in the right inferior PV (TTE displayed CB2 vs CB4, 19% vs 58%, respectively; P = .002).…”

supporting

confidence: 90%

Acute outcome after a single cryoballoon ablation: Comparison between Arctic Front Advance and Arctic Front Advance PRO

Moltrasio

Sicuso

Fassini

et al. 2019

Pacing Clinical Electrophis

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Background:The novel fourth-generation cryoballoon (CB4) potentially allows for enhanced catheter maneuverability and more frequent capture of pulmonary vein (PV) potentials which can be used to monitor real-time PV isolation (PVI). The aim of our study is to compare the acute procedural endpoints between the CB4 and second-generation cryoballoon (CB2). Methods:A single-center retrospective chart review was used to examine 50 consecutive patients with drug-refractory atrial fibrillation undergoing CB4-based PVI. Procedural data and acute success of these patients were compared to 50 propensity-matched controls who underwent cryoballoon ablation procedure using CB2. Results:Procedures performed with the CB4 showed significant shorter fluoroscopy time (14.8 ± 5.5 vs 18.0 ± 6.5 minutes, P = .04), shorter procedure time (58.3 ± 15.7 vs 65.3 ± 21 minutes, P = .13), and shorter total ablation time (10.8 ± 1.5 vs 13.8 ± 1.9 minutes, P = .42). The real-time PVI visualization rate was 33.3% in the CB2 group and 74.7% in the CB4 group (P < .001). CB4 was correlated to significant increase of acute real-time recordings with regard to all the single PV (left superior PV: 58% vs 84%, P = .02; left inferior PV: 26% vs 71%, P = .001; right superior PV 29% vs 61%, P = .01; and right inferior PV 19% vs 58%, P = .002). Conclusion:The CB4 was more often able to capture real-time recordings of PV potentials and the subsequent acute PV isolation. K E Y W O R D Satrial fibrillation, catheter ablation, cryoablation, cryoballoon catheter, pulmonary vein isolation INTRODUCTIONAs a cornerstone technique, pulmonary vein isolation (PVI) is the primary target for catheter ablation in patients with drug-refractory symptomatic paroxysmal and persistent atrial fibrillation (AF). 1 Furthermore, the cryoballoon (CB) catheter is a well-described tool that has achieved good procedural results with a freedom from AF recurrence that is similar to radiofrequency ablation catheters. 2 Particularly, since 2012, the second-generation CB (CB2, Artic Front Advance, Medtronic, Inc., Minneapolis, MN, USA) has been described as a catheter with a high procedural success rate and durability of clini-cal outcomes in the treatment of patients with AF. [3][4][5][6][7] Recent technical changes were completed to improve the CB catheter in terms of maneuverability and pulmonary vein (PV) signal recordings during PVI.The resulting fourth-generation CB (CB4, Artic Front Advance PRO, Medtronic, Inc.) is characterized by a shorter tip (8-mm distal tip versus 13.5-mm tip of the traditional balloon, a 40% reduction) that can potentially facilitate better visualization of PV signals (Figure 1).The real-time visualization of PV potentials allows for a patienttailored ablation strategy. Specifically, the visualization of timeto-effect (TTE; defined as the duration of freeze until acute circumferential cellular electrical dormancy is achieved) can be 890

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supporting

confidence: 90%

Acute outcome after a single cryoballoon ablation: Comparison between Arctic Front Advance and Arctic Front Advance PRO

Moltrasio

Sicuso

Fassini

et al. 2019

Pacing Clinical Electrophis

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“…19 The third-generation CB with a short tip has been developed to improve the visualisation of real-time PVI recording; the rate of real-time PVI recording during cryoablation ranges from 74 % to 89.2 % in third-generation CB studies. [20][21][22][23] In the ICE-T trial using second-generation CBs, real-time PVI was recorded in 80 % of PVs. 18 Practical Techniques in Cryoballoon Ablation PN function can be monitored via manual palpation to determine the strength of the diaphragmatic excursion during PN pacing or by monitoring the diaphragmatic compound motor action potential (CMAP) during PN pacing (sensitive, early detection).…”

Section: Real-time Pulmonary Vein Isolationmentioning

confidence: 99%

Practical Techniques in Cryoballoon Ablation: How to Isolate Inferior Pulmonary Veins

Chen

Schmidt

Bordignon

et al. 2018

Arrhythmia &Amp; Electrophysiology Review

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Catheter ablation is the most effective treatment option for patients suffering from symptomatic atrial fibrillation. Electrical isolation of the pulmonary veins is the procedural cornerstone. Point-by-point radiofrequency current energy ablation in combination with a 3D electro-anatomical mapping system is the established approach to ablation. In contrast, cryoballoon ablation uses a single-shot approach to facilitate pulmonary vein isolation. However, fixed cryoballoon diameters (28 mm or 23 mm) and non-balloon compliance can lead to technical difficulties in isolating variable pulmonary vein anatomies. This review focuses on key procedural aspects and illustrates practical techniques in cryoballoon pulmonary vein isolation to shorten the learning curve without compromising safety and efficacy. It has a special emphasis on inferior pulmonary veins.

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“…Further technological advances may provide better means to guide the procedure and produce more durable lesions, but also apply the cryoballoon ablation to isolate extrapulmonary sources of AF triggers, like those emanating from the superior vena cava and other sites. Already a new version of the cryoballoon recently has been introduced, with a 40% shortened tip length compared with the previous devices, in an attempt to improve visualization of real‐time recordings of PV potentials during the cryoablation procedure and thus more readily assess time‐to‐PVI, which is an important predictor of successful and durable PVI . Further randomized controlled studies with longer follow‐up, such as the ongoing Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation (CABANA) trial, are needed to evaluate the long‐term success of these ablative procedures in the large AF population.…”

Section: Resultsmentioning

confidence: 99%

Cryoballoon ablation of atrial fibrillation: a practical and effective approach

Georgiopoulos¹,

Tsiachris²,

Manolis³

2016

Clinical Cardiology

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Medical management of atrial fibrillation (AF), the most common arrhythmia in the general population, has had modest efficacy in controlling symptoms and restoring and maintaining sinus rhythm. Since the seminal observation in 1998 that pulmonary veins host the triggers of AF in the majority of cases, electrical isolation of all pulmonary veins constitutes the cornerstone of ablation in patients with symptomatic AF. However, due to the elaborate and tedious technique of the conventional point-by-point method with radiofrequency ablation guided by electroanatomical mapping, newer, more versatile single-shot techniques, such as cryoballoon ablation, have been sought and developed over recent years and are progressively prevailing.Cryoballoon ablation appears to be the most promising practical and effective approach, and we review it here by presenting all available relevant data from the literature as well as from our own experience in an attempt to apprise colleagues of the significant progress made over the last several years in this important field of electrophysiology. K E Y W O R D Satrial fibrillation, catheter ablation, radiofrequency, cryoballoon, cryoablation, pulmonary vein isolation 1 | INTRODUCTION Atrial fibrillation (AF) is the most common cardiac arrhythmia, afflicting 1% to 2% of the general population, with an age-dependent incidence reaching~10% in individuals age >80 years. In the United States, its prevalence was estimated to range from~2.7 million to 6.1 million in 2010, predicted to rise to 12.1 million in 2030. 1 In the European Union, the prevalence of AF in adults age >55 years was estimated to be 8.8 million in 2010, projected to rise to 17.9 million in 2060. 2 AF increases morbidity, mainly related to stroke and heart failure (HF), as well as overall mortality. It is therefore clear that it constitutes a growing major public-health burden, with considerable socioeconomic impact. As medical management has had modest efficacy in controlling this arrhythmia, over the last several years hope has been rekindled with the advent of more-effective ablation techniques.Since the seminal observation of pulmonary-vein triggers in AF, 3 there has been a significant increase in the number of AF patients submitted to pulmonary vein (PV) isolation (PVI), which constitutes the cornerstone of ablation in patients with symptomatic, drugrefractory AF. 4,5 However, due to the elaborate and tedious technique of the initial point-by-point method with radiofrequency (RF) ablation guided by electroanatomical mapping, penetration of this conventional approach was slow. Most recently, the advent of single-shot techniques, such as cryoballoon ablation, has ushered in a new era in the management of AF patients. 6,7 | AF MECHANISMSDespite the significant progress made in understanding the complex pathophysiology of AF, the precise mechanisms underlying its onset and persistence remain elusive. In brief, AF requires both a trigger and a susceptible substrate. 8 The trigger for initiation and maintenance of AF seem...

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Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon

Abstract: The rate of visualization of RT recordings is significantly high during third-generation CB-ST ablation. Real-time recordings can be visualized in ∼87.1% of veins with this novel cryoballoon.

Cited by 24 publications

References 20 publications

Acute outcome after a single cryoballoon ablation: Comparison between Arctic Front Advance and Arctic Front Advance PRO

Acute outcome after a single cryoballoon ablation: Comparison between Arctic Front Advance and Arctic Front Advance PRO

Practical Techniques in Cryoballoon Ablation: How to Isolate Inferior Pulmonary Veins

Cryoballoon ablation of atrial fibrillation: a practical and effective approach

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