Left atrial roof ablation in patients with persistent atrial fibrillation using the second-generation cryoballoon: benefit or wasted time?

Ablation of Atrial Fibrillation in Patients with Hypertension—An Analysis from the German Ablation Registry

“…Of 626 patients included in this study, HTN had been diagnosed in 386 patients. The majority of patients in both groups were male, similar to previous AF cohorts [ 21 , 22 , 23 ]. Patients with HTN were older and more often suffered from other cardiac comorbidities, in particular coronary artery disease and previous myocardial infarction ( Table 1 ).…”

“…Patients with HTN undergoing AF ablation were older than patients without HTN, however, age-distribution was still comparable to typical AF cohorts from previous studies focusing on AF-ablation [ 21 , 22 ]. HTN was associated with a higher prevalence of diabetes and renal insufficiency as additional cardiovascular risk factors.…”

Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: Best practices III

“…4,5 Based on available data, myocardial cells are rendered electrically dormant (ie, reversible ion channel block) at 120 C to 125 C with irreversible, lethal effects achieved at temperatures of -20 C to -50 C. 6,7 Although PV occlusion likely augments the "magnitude of the freeze," optimal tissue contact and not necessarily PV occlusion, which in itself implies the same, is quintessential for creating durable cryolesions. This notion is further supported by finite element modeling data 8 and clinically corroborated when performing nonocclusive cryoballoon ablation (NOCA) to target large-sized PVs in a segmental approach, as in the case of large, common PV ostia 9 and the left atrial (LA) roof (NOCAROOF) [10][11][12][13] and posterior wall (PW) (NOCALAPW). [14][15][16][17][18] In fact, PV occlusion using currently available, fixed-diameter cryoballoons (23/28 mm) is more likely to yield suboptimal results (ie, an ostial level PVI) when treating large-sized PVs or patients with persistent/long-standing persistent AF who typically exhibit large LA and PV antra.…”

“…14 In several studies, this approach, when performed using the cryoballoon in conjunction with PVI, has been shown to offer favorable outcomes in patient with persistent AF. [10][11][12][13] This location is also the site of the main autonomic ganglionic plexi related to the LA dome (ie, superior LA ganglionated plexus), which is believed to modulate extrinsic cardiac innervation and facilitate the occurrence of AF in a hyperactive autonomic state. 39 As such, catheter ablation at this site is believed to greatly attenuate the input of these plexi to the PVs and interrupt vagosympathetic input to the ligament of Marshall and inferior left ganglionated plexus, which both are highly implicated in the pathogenesis of AF.…”

Pulmonary vein isolation treats symptomatic AF in a patient with Lamin A/C mutation: case report and review of the literature

“…Despite the fact that mid-to long-term effects of PVI is still missing in our patient, it is nevertheless important to communicate the need for further case studies and randomized-trials in specialized centers to assess the time course of atrial remodeling and the long-term effects of AF ablation in this highly arrhythmogenic patient collective. Numerous patients have undergone PVI procedures as in recent ablation registries and studies [17][18][19][20][21][22][23][24][25][26][27][28][29] and it can be assumed that laminopathy patients have been included without knowing or including their genetic background. It may be worthwhile to re-analyze existing data of ablation registries regarding the existence of laminopathies.…”