Pressure-Guided cryoablation of pulmonary veins in atrial fibrillation: A fast and effective strategy

Raizada, Amol; Gedela, Maheedhar; Shaikh, Kashif; Apte, Nachiket; DeHaan, Max; Stanton, Christopher

doi:10.1016/j.ihj.2016.11.330

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…Other pilot and small observational studies showed that additional pressure curve monitoring significantly reduced the contrast volume utilization (23 and 8 mL) as compared to the conventional strategy in the first-generation CB-PVI. 7,8 The present study had three major differences from the prior studies. 4,7,8 First, our strategy was a "pure" pressure-guided strategy, i.e.…”

Section: Discussionmentioning

confidence: 79%

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Pressure‐guided second‐generation cryoballoon pulmonary vein isolation: Prospective comparison of the procedural and clinical outcomes with the conventional strategy

Hasegawa

Miyazaki

Kaseno

et al. 2019

Cardiovasc electrophysiol

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Background: The utility of pressure waveform analyses to assess pulmonary vein (PV) occlusions has been reported in cryoballoon PV isolation (CB‐PVI) using first‐generation CBs. This prospective randomized study compared the procedural and clinical outcomes of pressure‐guided and conventional CB‐PVI. Methods and Results: Sixty patients with paroxysmal atrial fibrillation underwent CB‐PVI with 28‐mm second‐generation CBs. PV occlusions were assessed either by real‐time pressure waveforms without contrast utilization (pressure‐guided group) or contrast injections (conventional group) and randomly assigned. Before the randomization, 24 patients underwent pressure‐guided CB‐PVIs. In the derivation study, a vein occlusion was obtained in 88/96 (91.7%) PVs among which 86 (97.7%) were successfully isolated by the application. In the validation study, the nadir balloon temperature and total freezing time did not significantly differ per PV between the two groups. The positive predictive value of the vein occlusion for predicting successful acute isolations was similar (93 of 103 [90.2%] and 89 of 98 [90.8%] PVs; P = 1.000), but the negative predictive value was significantly higher in pressure‐guided than angiographical occlusions (14 of 17 [82.3%] vs 7 of 22 [31.8%]; P = .003). Both the procedure (57.7 ± 14.2 vs 62.6 ± 15.8 minutes; P = .526) and fluoroscopic times (16.3 ± 6.4 vs 20.1 ± 6.1; P = .732) were similar between the two groups, however, the fluoroscopy dose (130.6 ± 97.7 vs 353.2 ± 231.4 mGy; P < .001) and contrast volume used (0 vs 17.5 ± 7.7 mL; P < .001) were significantly smaller in the pressure‐guided than conventional group. During 27.8 (5‐39) months of follow‐up, the single procedure arrhythmia freedom was similar between the two groups (P = .438). Conclusions: Pressure‐guided second‐generation CB‐PVIs were similarly effective and as safe as conventional CB‐PVIs. This technique required no contrast utilization and significantly reduced radiation exposure more than conventional CB‐PVIs.

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Section: Discussionmentioning

confidence: 79%

“…7,8 The present study had three major differences from the prior studies. 4,7,8 First, our strategy was a "pure" pressure-guided strategy, i.e. the utilized contrast volume was zero.…”

Section: Discussionmentioning

confidence: 79%

Pressure‐guided second‐generation cryoballoon pulmonary vein isolation: Prospective comparison of the procedural and clinical outcomes with the conventional strategy

Hasegawa

Miyazaki

Kaseno

et al. 2019

Cardiovasc electrophysiol

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“… 9 A reduction in fluoroscopy has also been achieved with the use of continuous-wave pressure monitoring (CWPM) as a hemodynamic measure of vein occlusion. 10 – 13 The aim of this proof-of-concept study was to show that, by employing imaging with ICE and hemodynamic measures with CWPM, fluoroscopy use during CB procedures can be safely and effectively eliminated. We present the first proof-of-concept, case–control study comparing the use of traditional fluoroscopic methods of CB ablation with a completely fluoroless approach.…”

Section: Introductionmentioning

confidence: 99%

Acute Safety and Efficacy of Fluoroless Cryoballoon Ablation for Atrial Fibrillation

Alyesh¹,

Venkataraman²,

A³

et al. 2020

J Innov Cardiac Rhythm Manage.

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Pulmonary vein isolation (PVI) is widely used for the ablation of atrial fibrillation, with prior reports suggesting good efficacy. Due to the widespread use of three-dimensional electroanatomic mapping systems and advances in intracardiac echocardiography, fluoroless ablation has been made possible. Fluoroless ablation with a cryoballoon (CB), however, has not been widely performed because of the need to prove occlusion of the vein with contrast dye and fluoroscopy. The objective of this study is to show that CB ablation can be performed safely and effectively without fluoroscopy. A dual-center, case–control study was performed of patients undergoing CB PVI with a fluoroless approach and a control group with traditional fluoroscopic techniques. The absence of color-flow Doppler signals around the periphery of the CB on intracardiac echocardiography and an increase in mean pressure by 5 mmHg, loss of the A-wave, and an increase in the V-wave as measured with continuous-wave pressure monitoring were adopted as indicators of vein occlusion in the absence of fluoroscopy. Temperature at 30 seconds, minimum temperature, time to isolation, procedure length, and complications were evaluated. During the study period of November 15, 2018 to November 15, 2019, a total of 100 patients underwent CB PVI at the participating centers. A total of 50 patients were enrolled in the fluoroless arm [35 men (70%), mean age: 64.9 ± 12 years, mean left atrium size: 44.2 ± 16 mL/m 2 , left ventricular ejection fraction: 61% ± 5%], while 50 patients were enrolled in the control arm with similar characteristics. Four hundred forty-one 441 PVs were evaluated in the study cohort compared to 339 PVs in the control arm. When comparing fluoroless and traditional techniques, the mean temperature at 30 seconds was −31.7°C ± 6°C versus −32.8°C ± 5°C (p = 0.037), the minimum temperature was −47.4°C ± 6°C versus −47.7°C ± 9°C (p = 0.677), the time to isolation was 56.8 ± 28 seconds versus 74.8 ± 45 seconds (p = 0.212), and the procedure time was 102.2 ± 27.3 seconds versus 104.5 ± 16.9 seconds (p = 0.6436). Ultimately, t his proof-of-concept study revealed that fluoroless ablation can be performed with success and efficiency outcomes similar to those of a traditional ablation approach. This suggests that the ablation of atrial fibrillation with CB can be performed safely and effectively without the use of fluoroscopy by experienced operators.

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“…The authors need to be applauded for having shown the value of this alternative technique, only described elsewhere in a anecdotal fashion or small clinical studies. [2][3][4] A total of 24 patients were included in the validation study, proving that the pressure-wave is an effective technique to achieve a high rate of PV occlusion, and, therefore, promote vein isolation. Furthermore, in the derivation study, including 60 patients, the comparison between the two techniques revealed no significant differences in the total procedural time or the fluoroscopic time; however, the fluoroscopic and the contrast doses were significantly reduced in the pressure-wave guided patients than the conventional group.More importantly, over the follow-up, freedom from any atrial arrhythmia recurrences was similar in the two groups of patients.Cryoballoon PV ablation is already a well-established strategy of ablation of paroxysmal atrial fibrillation (AF) and it has become a standard approach in clinical practice in several laboratories worldwide, based on the high acute and midterm success rates.…”

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confidence: 99%

Dye or not dye, the cryoablation dilemma

Tondo

2019

Cardiovasc electrophysiol

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Pressure-Guided cryoablation of pulmonary veins in atrial fibrillation: A fast and effective strategy

Abstract: Pressure-guided PVI is an effective method for cryoablation of AF. This method not only significantly reduces the volume of contrast used but also decreases the fluoroscopy without compromising the success of PVI.

Cited by 6 publications

References 9 publications

Pressure‐guided second‐generation cryoballoon pulmonary vein isolation: Prospective comparison of the procedural and clinical outcomes with the conventional strategy

Pressure‐guided second‐generation cryoballoon pulmonary vein isolation: Prospective comparison of the procedural and clinical outcomes with the conventional strategy

Acute Safety and Efficacy of Fluoroless Cryoballoon Ablation for Atrial Fibrillation

Dye or not dye, the cryoablation dilemma

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