Practical Techniques in Cryoballoon Ablation: How to Isolate Inferior Pulmonary Veins

Chen, Shaojie; Schmidt, Boris; Bordignon, Stefano; Bologna, Fabrizio; Nagase, Takahiko; Perrotta, Laura; Chun, K.R. Julian

doi:10.15420/aer.2018;1;2

Cited by 23 publications

(13 citation statements)

References 40 publications

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“…Of note, and in contrast to some previous reports of persistent PVI, [17,18] the right inferior PV had the highest isolation rates in our series, yet Westra et al [19]. A possible explanation could be the routine use of the "hockey stick" and "pull-down" techniques during CB ablation, which was also used in our series of patients, particularly helpful in isolating inferior pulmonary veins [20].…”

Section: Pv Reconnection Patterns After Cb Pvicontrasting

confidence: 72%

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Wieczorek

Sassani²,

Hoeltgen³

2020

BMC Cardiovasc Disord

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Background: Pulmonary vein isolation (PVI) using phased radiofrequency (RF) energy has been shown to be effective in the treatment of atrial fibrillation (AF). Methods: We characterize and compare pulmonary vein (PV) reconnection at repeat ablation in patients with AF after initially successful PVI using phased RF technology (PVAC) or 2nd generation cryoballoon (CB). Eighty five patients undergoing redo PVI using multielectrode PVAC phased RF catheter and 66 patients after CB PVI were enrolled 9.7 ± 3.4 months after the initial ablation procedure. Results: The percentage of patients with PV reconnection(s) was comparably high between both groups (93% PVAC and 92% CB). However, 75% of all PVs and left common trunks (CTs) isolated with PVAC were reconnected, compared with 52% reconnections after CB PVI (p < 0.001). A mean of 2.79 ± 1.2 PVs and CTs/patient were reconnected after PVAC PVI compared with 1.97 ± 0.8 in CB patients, p < 0.0001. No patients in the CB group had 4 reconnected PVs, while this pattern of reconnection was observed in 33% in the PVAC group (p < 0.0001). The percentage of patients in the PVAC group with ≥3 reconnected PVs was significantly higher compared with CB patients (56 patients (66%) vs. 17 patients (26%), p < 0.0001), while the percentage of patients with no PV reconnection was comparably low in PVAC and CB patients (7 and 8%, respectively). CTs were most frequently reconnected after PVAC PVI (94%) and left superior PVs after CB ablation (67%), respectively. Conclusions: The number of patients with recurrent AF and PV reconnection(s) at redo PVI was comparably high between both groups. However, the extent and distribution of PV reconnections was different in many aspects, indicating more stable atrial lesions after CB PVI compared with PVAC technology.

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Section: Pv Reconnection Patterns After Cb Pvicontrasting

confidence: 72%

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Wieczorek

Sassani²,

Hoeltgen³

2020

BMC Cardiovasc Disord

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“…Cryoballoon ablation has emerged as a novel ablation strategy in patients with PAF 7 . By single energy release for lesions encircling the pulmonary vein (PV) 8 , the efficacy of cryoballoon ablation for AF has been confirmed in previous studies 9 . However, for some AF patients (15% 10 and 28% 11 according to previous studies), unrecognized incomplete PVI may persist despite the application of a standardized protocol for cryoablation and the use of a circular mapping catheter to record the LA-PV potential connections.…”

Section: Introductionmentioning

confidence: 79%

Effects of different ablation strategies on long-term left atrial function in patients with paroxysmal atrial fibrillation: a single-blind randomized controlled trial

You

Yao

Zhou

et al. 2019

Sci Rep

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Restoration of sinus rhythm in atrial fibrillation (AF) by radiofrequency catheter ablation (RFCA) is associated with a transient stunning of left atrial (LA) function. However, the long-term effects of different ablation strategies on LA function remain undetermined. We performed randomized controlled trial to evaluate the effects of RFCA, cryoablation, and 3D mapping-guided cryoablation on LA function of proximal AF patients within 1 year. The 3D mapping-guided cryoablation was defined as a maximum of two cryoablation procedures for each pulmonary vein accompanied by RFCA for additional points until complete pulmonary vein isolation was achieved. Conventional and speckle tracking echocardiographic analyses were performed to evaluate LA function. Among the 210 patients (70 in each group) included, a trend of decreasing LA systolic and diastolic function was observed in all groups, as evidenced by decreases in peak A-wave velocity, the global LA peak systolic strain, the peak strain rate, the peak early diastolic strain rate, and the peak late diastolic strain rate within 7 days to 3 months after ablation followed by gradual recovery thereafter. However, the temporal changes in the above four strain parameters among the three groups did not differ significantly within 1 year after ablation (all p > 0.05). Parameters of the LA emptying fraction and LA dimensions were not significantly affected. These results suggested that stunning of LA function occurred within 7 days to 3 months after ablation, and different strategies of AF ablation did not differentially affect the temporal changes in LA function up to 1 year after ablation.

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“…As discussed previously, a “pull‐down” CB maneuver gives the operators an opportunity for segmentally circumferential isolation of the targeted PV . In this study, a “pull‐down” (or “pull‐away”) CB maneuver in addition to direct approach (illustrated in Figure ) was performed aiming for (1) better contact between CB and caudal segment of the LAA ostium (lesion quality); (2) increasing the distance between CB and left PN during freeze (reducing risk of left PN injury).…”

Section: Discussionmentioning

confidence: 98%

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

Chen

Schmidt

Bordignon

et al. 2019

Cardiovasc electrophysiol

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Introduction: Pulmonary vein isolation (PVI) is the cornerstone ablation strategy for treatment of atrial fibrillation (AF). Ablation outside the PVs is sometimes needed particularly in persistent or longstanding AF. This study reported left atrial appendage isolation (LAAI) using cryoballoon (CB) focusing on technical data and short-term clinical follow-up.Methods and results: Patients with recurrent persistent AF after multiple AF procedures were enrolled. LAAI was performed using the second generation CB guided by compound motor action potential (CMAP) and 240 seconds plus bonus freeze (ICE-B) protocol. Ten patients were included, median age was 69.5 (56-73) years, CHA 2 DS 2 -VASc score was 3 (1.8-4), LA diameter was 44 (38.8-46.5) mm. All patients had a mean of three AF procedures before the LAAI procedure. All patients were under successful CMAP guidance. During the CB LAAI procedure, the median time to LAA isolation was 100 (76-270) seconds, minimal freeze temperature was −50 (−57 to −47)°C. A "pull-down (or pull-away)" CB maneuver was performed in all patients. Median fluoroscopic time was 4.8 (3.4-6.8) minutes and acute LAAI success rate was 100%. No phrenic nerve injury or other major complications were observed.At 6-week follow-up, remapping of the LAA showed durable isolation of all PVs (100%), all patients were scheduled for LAA occlusion. Six-month follow-up showed that 80% of patients were free from AF/AT recurrence. Conclusion: CMAP plus ICE-B guided LAAI using cryo-technology appears feasible and safe, results in durable LAAI, and shows promising clinical results in patients with recurrent persistent AF. K E Y W O R D S ablation, atrial fibrillation, cryoballoon, left atrial appendage, pulmonary vein isolation J Cardiovasc Electrophysiol. 2019;30:272-283. wileyonlinelibrary.com/journal/jce 272 |

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Practical Techniques in Cryoballoon Ablation: How to Isolate Inferior Pulmonary Veins

Cited by 23 publications

References 40 publications

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Comparison of pulmonary vein reconnection patterns after multielectrode phased radiofrequency- and cryoballoon ablation of atrial fibrillation

Effects of different ablation strategies on long-term left atrial function in patients with paroxysmal atrial fibrillation: a single-blind randomized controlled trial

Compound motor action potential guided 240 seconds plus bonus freeze for safe and durable left atrial appendage isolation in patients with recurrent persistent atrial fibrillation: How to isolate the appendage with cryoballoon (the CMAP guided ICE‐B protocol)

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