Reduced incidence of esophageal lesions by luminal esophageal temperature–guided second-generation cryoballoon ablation

Fürnkranz, Alexander; Bordignon, Stefano; Böhmig, Michael; Konstantinou, Athanasios; Dugo, Daniela; Perrotta, Laura; Klopffleisch, Tom; Nowak, Bernd; Dignaß, Axel; Schmidt, Boris; Chun, Julian K R

doi:10.1016/j.hrthm.2014.10.033

Cited by 106 publications

(90 citation statements)

References 20 publications

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“…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. Using the first-generation CB, the rate of electric reconduction was 54%.…”

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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Section: Discussionmentioning

confidence: 99%

Once Isolated, Always Isolated?

Heeger

Wißner

Mathew

et al. 2015

Circ: Arrhythmia and Electrophysiology

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“…Recent research has demonstrated CB2 esophageal lesion rates of 3.2 to 19%, as observed through post procedure endoscopies with the lowest rates (3.2%) reported when a LET cut-off of 12-15°C is used. [24][25][26][27][28] When LET, and other measures are used, damage can be limited to esophageal lesions, which frequently heal in a few weeks. If unmonitored, esophageal damage may result in rare and generally fatal, atrioesophageal (AE) fistulas.…”

Section: Prevention Of Esophageal Injurymentioning

confidence: 99%

Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures

et al. 2015

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“…The intraluminal esophageal temperature cut-off was set at 15°C. 15 During delivery of cryoenergy along the septal PV, Advance Publication by-J-STAGE…”

Section: Ablationmentioning

confidence: 99%