On the Quest for the Best Freeze

Abstract

Background— The second-generation cryoballoon is effective in achieving acute pulmonary vein isolation (PVI) and favorable clinical outcome. To date, no data are available on factors affecting late PV reconnection after second-generation cryoballoon ablation. Methods and Results— A total of 29 consecutive patients (25 male, 86.2%; mean age 57.8±13.8 years) underwent a repeat procedure, after a mean 11.6±4.5 months (range, 3.5–19.7 months), after index ablation using the 28-mm second-generation cryoballoon. All repeat ablations were performed using a 3-dimensional electroanatomical mapping system. Among all 115 PVs, including 1 left common ostiums (LCOs), 25 (21.7%) showed a PV reconnection in 20 patients (1.25 per patient). Persistent PVI could be documented in 90 of 115 PVs (78.2%). In 9 of 29 patients (31%), all PVs were electrically isolated. In the multivariable analysis, time to PVI ( P =0.03) and failure to achieve −40°C within 60 s ( P =0.05) independently predicted late PV reconnection. At receiver-operator curve analysis, time to PVI <60 s identified the absence of PV reconduction (sensitivity, 86.7%; specificity, 86.2%; positive predictive value, 59.1%; and negative predictive value, 96.4%; area under the curve, 0.85; confidence interval, 0.73–0.97; P <0.001). Conclusions— The rate of late PV reconnection after second-generation cryoballoon ablation is low (1.25 PVs/patient). Faster time to isolation and achievement of −40°C within 60 s independently predict durable PVI. In addition, 60-s cut-off for time to PVI indicates persistent isolation with 96.4% negative predictive value. These parameters might guide the operator whether to perform further applications to ensure a long-lasting PVI.

Complications in the setting of percutaneous atrial fibrillation ablation using radiofrequency and cryoballoon techniques: A single-center study in a large cohort of patients

“…Although in our study no significant differences in TIA/stroke have been found between RF and CB ablation procedures, cryoenergy applications have been reported to activate platelets and the coagulation cascade to a lesser degree than RF ablation and lead to a minimal endocardial surface disruption hypothetically resulting in less thrombogenic lesions than those produced with RF energy [30]. Moreover, in our laboratory, cryoballoon ablation procedures are carried out with a significantly shorter LA time than RF ablation procedures [22,25]. The arterial approach might also noticeably contribute to higher rates of vascular adverse events in AF ablation procedures.…”

“…Complication rates similarly decreased over time in both RF and CB groups. study periods); however, in the latter, the decrease of procedural and fluoroscopy times might also be related to the different cryoapplication strategy of a single 3 minute freeze adopted in the last 366 procedures [22]. No significant differences were observed both in complication rates and in procedural/fluoroscopy times between different operators.…”

Does Size Matter? Cryoballoon-Based Pulmonary Vein Isolation Using a Novel 25-mm Circular Mapping Catheter

“…12- 14 The consistent application of these TTI-guided ablation protocols, however, is hampered by a limited real-time verification of PV isolation (PVI) when using currently available 15-or 20-mm diameter circular mapping catheters with 8 electrodes. [11][12][13][14] continuous PN pacing was performed using a diagnostic catheter positioned in the superior vena cava (6F; Inquiry TM , St. Jude Medical). PN capture was monitored by tactile feedback of diaphragmatic contraction when the operator's hand was placed on the patient's abdomen.…”

“…First studies evaluating mapping technologies in conjunction with the hot-balloon, however, are currently under investigation. The TTI independently predicts recovered PV-LA conduction 11 and thereby directly affects arrhythmiafree survival. 12, 18 The direct feedback on freeze cycle efficacy enables the operator to anticipate ineffective freeze cycles, which should result in premature discontinuation of the respective application.…”

Predictors of sustained isolation of pulmonary vein ostia with cryoballoon ablation using a second-generation cryoballoon Arctic Front Advance

“…Как показало наше исследование, частота устойчивой ИЛВ после криоизоляции ЛВ с применением баллона второго поколения достаточно высокаяоколо 70%, что хорошо коррелирует с результатами раннее опубликованных исследований [9][10][11]. В исследовании Ciconte G, et al время до изоляции <60 сек и достижение температуры -40° C в течение 60 сек являлись независимыми предикторами устойчивой ИЛВ [9], а в исследовании Aryana A, et al, выполненного на базе 2 клиник [10], наиболее сильными предикторами оказались время до изоляции ≤60 сек и время до размораживания 0° C ≥10 сек (время до ИЛВ ≤60 сек -ОШ: 1,13 (95% ДИ 1,08-1,19); p<0,001, время до размораживания 0° C -ОШ: 0,62 (95% ДИ 0,49-0,79); p<0,001). В нашем исследовании гипотеза о наличии статистически достоверной разницы для показателя времени до ИЛВ (<60 сек) между группами иЛВ и вЛВ не подтвердилась (ОШ: 1,55 (95% ДИ 0,48-4,97); p=0,459), но возможность контроля регистрации электрической ИЛВ в группе устойчивой иЛВ была значимо больше (ОШ: 3,502 (95% ДИ 1,682-7,289); p=0,001).…”