Influence of energy source on early atrial fibrillation recurrences: a comparison of cryoballoon vs. radiofrequency current energy ablation with the endpoint of unexcitability in pulmonary vein isolation

Gunawardene, Melanie; Hoffmann, Boris; Schaeffer, Benjamin; Chung, Da‐Un; Moser, Julia; Akbulak, Ruken Ö.; Jularic, Mario; Nuehrich, Jana; Meyer, Christian; Willems, Stephan

doi:10.1093/europace/euw307

Cited by 25 publications

(48 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…RFC and CB are both routine techniques to perform an index PVI in clinical practice 1 . However, although utilizing the newest technologies such as contact–force‐guided RFC ablation and the use of uniform cooling of the second‐generation CB, AF and/or AT may recur 8 . AF recurrence is frequently associated with PV reconnection, as shown previously and in the present study 3,4,14‐16 .…”

Section: Discussionsupporting

confidence: 75%

“…Catheter ablation and periprocedural management of patients at our institution have been reported before 8 . After the transseptal puncture, a sequential left atrial reconstruction was performed using a circumferential mapping catheter in combination with a three‐dimensional (3D) mapping system (CARTO 3, Biosense Webster or EnSite Precision, Abbott).…”

Section: Methodsmentioning

confidence: 99%

“…PVI with the second‐generation CB has been reported before 8 . After a single transseptal puncture (BRK‐1; St Jude, Medical, St Paul, MN), the 28 mm CB (Arctic Front Advance; Medtronic Inc, Minneapolis, MN) was introduced into the LA via a 12 F steerable sheath (FlexCath; Medtronic).…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Gunawardene

Akbulak

Jularic

et al. 2020

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

Introduction:The aim of this study was to investigate electrophysiological findings in patients with arrhythmia recurrence undergoing a repeat ablation procedure using ultra-high-density (UHDx) mapping following an index procedure using either contact-force (CF)-guided radiofrequency current (RFC) pulmonary vein isolation (PVI) or second-generation cryoballoon (CB) PVI for treatment of atrial fibrillation (AF). Methods and Results: Fifty consecutive patients with recurrence of AF and/or atrial tachycardia (AT) following index CF-RFC PVI (n = 21) or CB PVI (n = 29) were included. A 64-pole mini-basket mapping catheter in combination with an UHDxmapping system-guided ablation was used. RFC was applied using a catheter tip with three incorporated mini-electrodes. PV reconnection rates were higher after CF-RFC PVI (CF-RFC: 2.5 ± 1.3 PVs vs CB: 1.4 ± 0.9 PVs; P = .0025) and left PVs were more frequently reconnected (CF-RFC: 64% PVs vs CB: 35% PVs; P = .0077).Fractionated signals along the antral index ablation line (FS) were found in 30% of CB-PVI patients (CF-RFC: 9.5% vs CB:30%; P = .098) targeted for ablation. In five cases, FS were a critical part of maintaining consecutive AT. The main AT mechanism found during reablation (n = 45 ATs) was macroreentry (80% [36/45], CF-RFC: 78.9% vs CB: 80.8%; P = 1.0) with a variety of circuits throughout both atria.Conclusion: UHDx mapping is sensitive in detecting conduction gaps along the index ablation line. Left PVs are more frequently reconnected after initial CF-RFC PVI. FS are a common finding after CB PVI and can maintain certain forms of ATs. ATs after index PVI are mostly macroreentries with a broad spectrum of entities. K E Y W O R D Satrial fibrillation, contact-force radiofrequency catheter ablation, cryoballoon ablation, pulmonary vein isolation, ultra-high-density mapping

show abstract

Section: Discussionsupporting

confidence: 75%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Gunawardene

Akbulak

Jularic

et al. 2020

Cardiovasc electrophysiol

Self Cite

View full text Add to dashboard Cite

show abstract

“…All patients underwent catheter-based PVI as described before [21]. Deep sedation was achieved by continuous propofol infusion and fentanyl bolus administration throughout the procedure.…”

Section: Catheter Ablationmentioning

confidence: 99%

Respiratory sinus arrhythmia is reduced after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Jungen¹,

Alken²,

Scherschel³

et al. 2020

aoms

Self Cite

View full text Add to dashboard Cite

Introduction: Respiratory sinus arrhythmia (RSA) describes heart rate (HR) changes in synchrony with respiration. It is relevant for exercise capacity and mechanistically linked with the cardiac autonomic nervous system. After pulmonary vein isolation (PVI), the current therapy of choice for patients with paroxysmal atrial fibrillation (AF), the cardiac vagal tone is often diminished. We hypothesized that RSA is modulated by PVI in patients with paroxysmal AF. Material and methods: Respiratory sinus arrhythmia, measured by using a deep breathing test and heart rate variability parameters, was studied in 10 patients (64 ±3 years) with paroxysmal AF presenting in stable sinus rhythm for their first catheter-based PVI. Additionally, heart rate dynamics before and after PVI were studied during sympathetic/parasympathetic coactivation by using a cold-face test. All tests were performed within 24 h before and 48 h after PVI. Results: After PVI RSA (E/I difference: 7.9 ±1.0 vs. 3.5 ±0.6 bpm, p = 0.006; E/I ratio: 1.14 ±0.02 vs. 1.05 ±0.01, p = 0.003), heart rate variability (SDNN: 31 ±3 vs. 14 ±3 ms, p = 0.006; RMSSD: 17 ±2 vs. 8 ±2 ms, p = 0.002) and the HR response to sympathetic/parasympathetic coactivation (10.2 ±0.7% vs. 5.7 ±1.1%, p = 0.014) were diminished. The PVI-related changes in RSA correlated with the heart rate change during sympathetic/parasympathetic coactivation before vs. after PVI (E/I difference: r = 0.849, p = 0.002; E/I ratio: r = 0.786, p = 0.007). One patient with vagal driven arrhythmia experienced AF recurrence during follow-up (mean: 6.5 ±0.6 months). Conclusions: Respiratory sinus arrhythmia is reduced after PVI in patients with paroxysmal AF. Our findings suggest that this is related to a decrease in cardiac vagal tone. Whether and how this affects the clinical outcome including exercise capacity need to be determined.

show abstract

“…Among them, CB ablation is the widest used and recommended in the current guidelines as an alternative to point-by-point RF [1]. Several randomized trials have compared the effectiveness and safety of RF and CB catheters [20][21][22][23][24][25]; however, of these published studies, few have included advanced catheter ablation technologies [21,25]. Furthermore, the FIRE AND ICE study, which included some advanced catheter ablation technologies, was not balanced in terms of use of advanced technologies.…”

Section: Comparison Between Rf and Cbmentioning

confidence: 99%

Treatment of Atrial Fibrillation Using Ablation Index-Guided Contact Force Ablation: A Matching-Adjusted Indirect Comparison to Cryoballoon Ablation

et al. 2019

View full text Add to dashboard Cite

show abstract

Influence of energy source on early atrial fibrillation recurrences: a comparison of cryoballoon vs. radiofrequency current energy ablation with the endpoint of unexcitability in pulmonary vein isolation

Abstract: ERAF rates were equal among groups; however, they occurred earlier in the initial phase after RFC ablation when compared with CB-G2. PVI utilizing cryoablation is associated with shorter procedure durations but extended fluoroscopy time while being similarly secure.

Cited by 25 publications

References 20 publications

Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Ultra–high‐density mapping of conduction gaps and atrial tachycardias: Distinctive patterns following pulmonary vein isolation with cryoballoon or contact–force‐guided radiofrequency current

Respiratory sinus arrhythmia is reduced after pulmonary vein isolation in patients with paroxysmal atrial fibrillation

Treatment of Atrial Fibrillation Using Ablation Index-Guided Contact Force Ablation: A Matching-Adjusted Indirect Comparison to Cryoballoon Ablation

Contact Info

Product

Resources

About