Keeping it Simple

Maurer, Tilman; Schlüter, Michael; Kuck, Karl‐Heinz

doi:10.1016/j.jacep.2020.08.041

Cited by 15 publications

(12 citation statements)

References 104 publications

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“…Both systems consist of a CB catheter (POLARx™ / AFAP™), a steerable sheath (POLARSHEATH™ / FlexCath Advance™), a mapping catheter (POLARMAP™ / Achieve Advance™) and a console (SMARTFREEZE™ / CryoConsole™). Differences to the AFAP are mainly found in the steerable sheath, which offers a slightly greater angle of maximal deflection (155° in POLARSHEATH™ vs. 135° in FlexCath Advance™) 18 . The POLARx was designed to maintain stable pressure during all ablation phases aiming to prevent dislodgement of the CB 18 .…”

Section: Methodsmentioning

confidence: 99%

Procedural performance between two cryoballoon systems for ablation of atrial fibrillation depends on pulmonary vein anatomy

Menger

Frick

Sharif-Yakan

et al. 2023

Journal of Arrhythmia

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Background: Cryoballoon ablation is a first-line therapy for atrial fibrillation. We compared the efficacy and safety of two ablation systems and addressed the influence of pulmonary vein (PV) anatomy on performance and outcome. Methods:We consecutively enrolled 122 patients who were planned for first-time cryoballoon ablation. Patients were assigned 1:1 for ablation with the POLARx or the Arctic Front Advance Pro (AFAP) system and followed-up for 12 months. Procedural parameters were recorded during the ablation. Before the procedure, a magnetic resonance angiography (MRA) of the PVs was generated and diameter, area, and shape of each PV ostium were assessed. We applied an evaluated PV anatomical scoring system on our MRA measurement data ranging from 0 (best anatomical combination) to 5.Results: Procedures performed with POLARx were associated with shorter time to balloon temperature −30°C (p < .001), lower balloon nadir temperature (p < .001), and longer thawing time till 0°C (p < .001) in all PVs, however, time to isolation was similar.We observed a decreasing performance with each increase in the score for the AFAP, whereas the POLARx performed constant regardless of the score. At 1 year, AF recurred in 14 of 44 patients treated with AFAP (31.8%) and in 10 of 45 patients treated with POLARx (22.2%) (hazard ratio, 0.61; 95% CI 0.28 to 1.37; p = .225). There was no significant correlation between PV anatomy and clinical outcome. Conclusion:We found significant differences in cooling kinetics, especially when anatomical conditions are difficult. However, both systems have a comparable outcome and safety profile.

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Section: Methodsmentioning

confidence: 99%

Procedural performance between two cryoballoon systems for ablation of atrial fibrillation depends on pulmonary vein anatomy

Menger

Frick

Sharif-Yakan

et al. 2023

Journal of Arrhythmia

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“…8 Therefore, interest in a simple, fast, effective, and safe AFCA technology has been increasing to reduce the numerical burden of AF patients. 9 Reducing the procedure time has become an important factor for the operator and patient when opting for an AFCA procedure. Cryoballoon ablation is a 1-shot technology that ablates a large volume of the pulmonary vein (PV) ostial tissue by contacting the entire PV orifice with a balloon.…”

mentioning

confidence: 99%

Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

Pak

Park

Yang

et al. 2021

Circ: Arrhythmia and Electrophysiology

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Background: The efficacy of cryoballoon pulmonary vein isolation (Cryo-PVI) is equivalent to that of radiofrequency pulmonary vein isolation in patients with paroxysmal atrial fibrillation (AF). We aimed to compare the efficacy and safety profile of Cryo-PVI and high-power, short-duration (HPSD) radiofrequency catheter ablation (RFCA) in patients with AF. Methods: We prospectively randomized 314 patients with paroxysmal AF (men, 71.3%; 59.9±10.9 years old) to either the Cryo-PVI group (n=156) or HPSD-RFCA group (n=158). Cavotricuspid isthmus ablation and linear ablation from the superior vena cava to the right atrial septum in addition to pulmonary vein isolation were carried out in the majority of patients in the HPSD-RFCA group. The primary end point was AF recurrence after a single procedure; secondary end points were the recurrence pattern, cardioversion rate, follow-up heart rate variability, and response to antiarrhythmic drugs. Results: After a mean follow-up of 9.8±5.1 months, the clinical recurrence rate did not significantly differ between the two groups (log-rank P =0.840). The rate of recurrence as atrial tachycardia ( P >0.999), cardioversion ( P =0.999), and 3-month heart rate variability (high frequency; P =0.506) did not significantly differ. During the final follow-up, sinus rhythm was maintained without antiarrhythmic drugs in 70.5% of the Cryo-PVI group and 73.4% of the HPSD-RFCA group ( P =0.567). No significant difference was found in the major complication rate between the two groups (3.8% versus 0.6%; P =0.066), but total procedure time was significantly shorter in the Cryo-PVI group (78.5±20.2 versus 124.5±37.1 minutes; P <0.001). Conclusions: In patients with paroxysmal AF, the Cryo-PVI is an effective rhythm-control strategy with a shorter procedure time compared with the HPSD-RFCA. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03920917.

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“…The efficacy of PFA in improving outcomes for AF remains uncertain. CBA being the most commonly employed single‐shot technology, serves as the benchmark against which PFA is compared 9 . This study aims to compare PFA with CBA systems regarding their effectiveness, safety profile, efficiency, and release of cardiac and neuronal biomarkers in patients with AF.…”

Section: Introductionmentioning

confidence: 99%

Meta‐analysis of pulsed‐field ablation versus cryoablation for atrial fibrillation

Zhang,

et al. 2024

Pacing Clinical Electrophis

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PurposeThe available data on the treatment strategy of pulsed field ablation (PFA) for patients with atrial fibrillation (AF) is limited. This study aims to provide a comparative analysis of the efficacy, safety, and procedural efficiency between PFA and cryoballoon ablation (CBA) for AF.MethodsWe conducted a comprehensive search of the EMBASE, PubMed, Cochrane Library, and ClinicalTrials.gov databases to identify trials comparing PFA with CBA for AF from their inception until December 2023. The odds ratio (OR) and mean difference (MD), along with a 95% confidence interval (CI), were utilized as measures of treatment effect.ResultsThe analysis included 15 eligible trials with a total enrollment of 1880 patients. No significant differences were found in recurrent atrial arrhythmia (OR 0.83, 95% CI 0.64, 1.07) or periprocedural complications (OR 0.78, 95% CI 0.46, 1.30) between the two ablation techniques examined in this study. However, the PFA technique demonstrated a significantly shorter procedure time (MD ‐7.17, 95% CI ‐13.60, ‐0.73), but a longer fluoroscopy time (MD 2.53, 95% CI 0.87, 4.19). Similarly, PFA was found to be significantly associated with a decreased incidence of phrenic nerve palsy (OR 0.20, 95% CI 0.07, 0.59), but an increased incidence of cardiac tamponade (OR 4.07, 95% CI 1.15, 14.39). Moreover, there was a significantly higher release of troponin with PFA compared to CBA (MD 470.28, 95% CI 18.89, 921.67), while the increase in S100 protein and heart rate was significantly lower with PFA than with CBA (MD ‐64.41, 95% CI ‐105.46, ‐17.36), (MD ‐8.76, 95% CI ‐15.12, ‐2.40).ConclusionThe utilization of PFA provides a safer, time‐saving, and tissue‐specific procedure compared to CBA, while maintaining comparable success rates. This has the potential to enhance procedural efficiency and optimize resource utilization in clinical practice. These findings underscore the feasibility and promise of PFA as an alternative technique for PVI in patients with AF.

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Keeping it Simple

Cited by 15 publications

References 104 publications

Procedural performance between two cryoballoon systems for ablation of atrial fibrillation depends on pulmonary vein anatomy

Procedural performance between two cryoballoon systems for ablation of atrial fibrillation depends on pulmonary vein anatomy

Cryoballoon Versus High-Power, Short-Duration Radiofrequency Ablation for Pulmonary Vein Isolation in Patients With Paroxysmal Atrial Fibrillation

Meta‐analysis of pulsed‐field ablation versus cryoablation for atrial fibrillation

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