Second-generation cryoballoon ablation in the setting of left common pulmonary veins: Procedural findings and clinical outcome

Ströker, Erwin; Takarada, Ken; Asmundis, Carlo de; Abugattas, Juan-Pablo; Mugnai, Giacomo; Velagić, Vedran; Regibus, Valentina De; Coutiño, Hugo-Enrique; Choudhury, Rajin; Iacopino, Saverio; Greef, Yves De; Tanaka, Kaoru; Brugada, Pedro; Chierchia, Gian‐Battista

doi:10.1016/j.hrthm.2017.06.019

Cited by 44 publications

(49 citation statements)

References 16 publications

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“…Previously, our group conducted a matched study (146 LCPV+ versus 146 LCPV− patients) in patients who underwent CB‐A ablation. With a mean follow‐up of 19 ± 10 months, no significant difference was noted in terms of clinical outcome between both groups . All these patients underwent preprocedural cardiac CT scan with selection of LCPV patients based on the same definition used as in this study.…”

Section: Discussionmentioning

confidence: 99%

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Coutiño

Ströker

Takarada

et al. 2019

Pacing Clinical Electrophis

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Background A left common pulmonary vein (LCPV) accounts as the most frequent pulmonary vein (PV) variation. Our aim was to compare the performance of radiofrequency (RF) versus second‐generation cryoballoon (CB‐A) ablation in patients with atrial fibrillation (AF) and LCPVs. Methods In a total cohort of 716 patients undergoing PV isolation with preprocedural CT‐scanning, LCPV+ patients were selected with measurement of PV ostial area and trunk distance. All LCPV+ patients were matched between RF and CB‐A group in a 1:1 ratio based on propensity scores, and compared for outcome. Results Left common pulmonary veins were found in 31% (88/283) RF versus 34% (146/433) CB‐A patients, respectively, (P = .44). In the matched population of 83 LCPV+ patients in each group, electrical isolation could be achieved in all left‐sided PVs. No significant difference was noted for the rate of AF/left atrial tachyarrhythmia (LAT) recurrence between RF and CB‐A group (30% vs 28%, P = .86), with similar AF/LAT‐free survival (log rank, P = .71). There were 48 patients with AF/LAT recurrence (29%) during the follow‐up. Recurrence rate between paroxysmal versus persistent AF was 27/120 (22.5%) versus 21/46 (46%), P = .004. Cox proportional regression analysis withheld LA volume and persistent AF as independent variables to predict AF/LAT recurrence. No increased hazard for AF/LAT recurrence was observed for patients with a long (>15 mm) vs short (5‐15 mm) LCPV trunk (OR 1.14, 95% CI 0.6‐2.2, P = .7). Conclusions In our study, equal efficacy and outcome was noted in LCPV+ patients between RF and CB‐A technology.

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Section: Discussionmentioning

confidence: 99%

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Coutiño

Ströker

Takarada

et al. 2019

Pacing Clinical Electrophis

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“…Presence of an LCPV ostium was defined as a coalescence of the inferior and superior PV of >5 mm before the insertion into the LA. A short common PV trunk was defined as a distance from the ostium to the bifurcation of 5-15 mm, and a long common trunk as a distance of >15 mm [7]. A strictly perpendicular plane to the ostium was used to measure the maximal and minimal diameters, and the cross-sectional area, as previously described [12,13] (Fig.…”

Section: Ct Scanning and Measurementsmentioning

confidence: 99%

“…high procedural performance [5,6], however, the data on patients with LCPVs are conflicting [7][8][9][10]. Moreover, to date, no data comparing the CB and RF ablation in patients with an LCPV are available.…”

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confidence: 99%

Pulmonary vein isolation in patients with a left common pulmonary vein: Comparison between second-generation cryoballoon and radiofrequency ablation

Yoshizumi

Miyazaki

Kajiyama

et al. 2019

Journal of Cardiology

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“…Specifically, a short common PV trunk was defined when the distance from the ostium to the bifurcation was 5-15 mm, and a long common trunk when this distance was >15 mm. 12 During the procedure, full occlusion and acute isolation could be achieved in all LCPVs without additional focal tip ablation.…”

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confidence: 99%

“…8,9 This translated in significantly better clinical outcomes, 10 probably due to a higher rate of permanent PV isolation in the long term. 11 Recently, Ströker et al 12 analysed the impact of an LCPV on clinical outcome in patients undergoing CB-Adv ablation as an index procedure. In a total of 476 patients, 146 presenting LCPV (study cohort; LCPV+) and 287 with normal PV drainage pattern (control group; LCPV-), were matched in a 1:1 ratio based on propensity scores, which resulted in two balanced groups of 146 patients each.…”

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confidence: 99%

Cryoballoon Ablation in Today’s Practice: Can the Left Common Ostium Be Ablated and Injury to the Right Phrenic Nerve Avoided?

Chierchia¹,

Iacopino

Asmundis³

2017

Arrhythmia &Amp; Electrophysiology Review

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Access at: www.AERjournal.com Pulmonary vein (PV) isolation is currently an established treatmentfor drug-resistant AF.1 A left common PV (LCPV) is present in 9-83 % of the patients, depending on the definition used, 2,3 and counts as the most frequent PV variation, followed by a right accessory middle vein. In recent years, cryoballoon (CB) ablation has emerged as a valid alternative to traditional point-by-point radiofrequency ablation. 4,5However, mainly due to its geometrical shape the use of the CB in the setting of LCPVs is still under evaluation. In fact, a successful ablation with the CB is tightly related to an optimal occlusion. In addition, one might advocate that in the setting of a LCPV the CB might create a distal lesion leaving the antrum largely unablated.Although, initial experiences with the first-generation CB (Arctic AbstractCryoballoon ablation is rapidly gaining popularity among electrophysiologists in the setting of pulmonary vein isolation for the treatment of AF. The first part of the following review focuses on the feasibility and clinical outcome of this technique in patients exhibiting a left common ostium. In the second part, we discuss how to predict and prevent the most common complication related to cryoballoon ablation: right phrenic nerve palsy.

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Second-generation cryoballoon ablation in the setting of left common pulmonary veins: Procedural findings and clinical outcome

Cited by 44 publications

References 16 publications

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Radiofrequency versus cryoballoon ablation for atrial fibrillation in the setting of left common pulmonary veins

Pulmonary vein isolation in patients with a left common pulmonary vein: Comparison between second-generation cryoballoon and radiofrequency ablation

Cryoballoon Ablation in Today’s Practice: Can the Left Common Ostium Be Ablated and Injury to the Right Phrenic Nerve Avoided?

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