Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: A comparison between the first- and second-generation balloon

Casado-Arroyo, Rubén; Chierchia, Gian‐Battista; Conte, Giulio; Levinstein, Moisés; Sieira, Juan; Rodríguez‐Mañero, Moisés; Giovanni, Giacomo Di; Baltogiannis, Yannis; Wauters, Kristel; Asmundis, Carlo de; Sarkozy, Andrea; Brugada, Pedro

doi:10.1016/j.hrthm.2013.07.005

Cited by 121 publications

(77 citation statements)

References 14 publications

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“…8,9 The incidence of PN palsy during second-generation cryoballoon-based PVI was reported as high as 19.5%. 6 At our center, the rate is 3.5% 7 and thus comparable to the first-generation cryoballoon. 3 In our electrophysiology laboratories, only the 28-mm cryoballoon is used because of 2 reasons: first, our rate of acute PVI using only the 28-mm cryoballoon is 99%; second, the 28-mm cryoballoon is usually bigger than a normal-sized PV.…”

Section: Figurementioning

confidence: 57%

“…Initial acute and mid-term clinical results have been published, reporting an improvement in efficacy compared with the first-generation cryoballoon. 4,5 Furthermore, the rate of phrenic nerve (PN) palsy 6,7 and esophageal thermal injury 8,9 has been described. However, 1-year clinical outcome after PVI using the secondgeneration 28-mm cryoballoon has not yet been reported.…”

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confidence: 99%

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One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

Metzner

Reißmann

Rausch

et al. 2014

Circ: Arrhythmia and Electrophysiology

202

145

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Section: Figurementioning

confidence: 57%

mentioning

confidence: 99%

One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

Metzner

Reißmann

Rausch

et al. 2014

Circ: Arrhythmia and Electrophysiology

202

145

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“…4,7,16 However, better cooling characteristics and clinical efficacy may in turn be associated with a higher incidence of damage to extracardiac structures, such as the esophagus or the phrenic nerve. 9,10,17,18 Recently reported endoluminal esophageal temperature cutoffs have resulted in a significant reduction in thermal esophageal injury, whereas the development and evaluation of multiple safety algorithms to prevent phrenic nerve palsy, such as compound motoric activation potential pacing or the double-stop technique, have further improved the safety profile of the second-generation CB. 11,17,19,20 It had yet to be evaluated whether the greater clinical efficacy of the second-generation CB is because of a higher rate of permanently isolated PVs.…”

Section: Discussionmentioning

confidence: 99%

Once Isolated, Always Isolated?

Heeger

Wißner

Mathew

et al. 2015

Circ: Arrhythmia and Electrophysiology

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The regular TS was exchanged over a guidewire for a 12F steerable TS (Flexcath Advance, Medtronic Inc., Minneapolis, MN). The © 2015 American Heart Association, Inc. Original ArticleBackground-The second-generation cryoballoon delivers effective pulmonary vein isolation (PVI) associated with superior 1-year clinical outcome. However, data on reconduction of previously isolated PV are sparse. Methods and Results-A total of 421 patients underwent second-generation 28-mm cryoballoon-based PVI in 2 centers (St.George's hospital and Harburg hospital, Hamburg, Germany) between June 2012 and May 2015. Sixty-six of 421 (16%) patients (39/66, 59% women; mean age, 63±10 years, mean left atrium diameter, 45±6 mm) with a history of paroxysmal (40/66, 61%) or persistent atrial fibrillation and atrial tachyarrhythmia recurrences despite previous successful secondgeneration 28-mm cryoballoon-based PVI were included in this analysis. During the index PVI, the standard freeze cycle duration was 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 15 of 66 (23%) patients, whereas no bonus freeze cycle was applied in the remaining patients. Repeat procedures were performed after a median of 205 (131-357) days following the index ablation. Electric reconduction was assessed for all PVs, and reablation was performed using radiofrequency energy. Persistent electric isolation was noted in 178 of 258 (69%) PVs. In 17 of 66 (26%) patients, all previously targeted PVs remained isolated. A significant difference toward highest reconduction rate for the posteroinferior segment of the right inferior PV was found (P=0.0002). Conclusions-The second-generation cryoballoon ablation is associated with a high rate of persistent PVI. The posteroinferior segment of the right inferior PV showed the highest reconduction rate and seems to be a predilection site for PV reconduction.

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“…The dominant such device is the cryoballoon 87 , now on its second iteration, with circular RF ablation catheters and a laser balloon also available 88 . While these technologies are easy to use, and have been shown in small trials to be at least as efficacious as point-by-point ablation, they may increase the prevalence of complications such as phrenic nerve injury 89 and asymptomatic cerebral emboli 90 , and their effects involve more tissue destruction 91 . Mechanistically, whether these devices produce more durable PV isolation is being tested in the Fire and Ice trial (NCT01490814).…”

Section: Evolving Technical Aspects Of Ablation: Less Is Morementioning

confidence: 99%

Ablation of Atrial Fibrillation

2017

Fogoros' Electrophysiologic Testing

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Ablation is increasingly used to treat AF, since recent trials of pharmacological therapy for AF have been disappointing. Ablation has been shown to improve maintenance of sinus rhythm compared to pharmacological therapy in many multi center trials, although success rates remain suboptimal. This review will discuss several trends in the field of catheter ablation, including studies to advance our understanding of AF mechanisms in different patient populations, innovations in detecting and classifying AF, use of this information to improve strategies for ablation, technical innovations that have improved the ease and safety of ablation, and novel approaches to surgical therapy and imaging. These trends are likely to further improve results from AF ablation in coming years as it becomes an increasingly important therapeutic option for many patients.

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Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: A comparison between the first- and second-generation balloon

Cited by 121 publications

References 14 publications

One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon

Once Isolated, Always Isolated?

Ablation of Atrial Fibrillation

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