The Permanency of Pulmonary Vein Isolation Using a Balloon Cryoablation Catheter

Ahmed, Babur; Neužil, Petr; Škoda, J.; d’Ávila, André; Donaldson, David M.; Laragy, C B S Margaret; Reddy, Vivek Y.

doi:10.1111/j.1540-8167.2009.01703.x

Cited by 73 publications

(57 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…15 A diagnostic catheter was used to evaluate the status of isolation or reconnection per vein. To define successful treatment of a patient, all 8 segments needed to be gap free.…”

Section: Follow-up Procedures At 3 Monthsmentioning

confidence: 99%

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Neužil

Reddy

Kautzner

et al. 2013

Circ: Arrhythmia and Electrophysiology

Self Cite

413

363

View full text Add to dashboard Cite

Background-Pulmonary vein isolation is the most prevalent approach for catheter ablation of paroxysmal atrial fibrillation.Long-term success of the procedure is diminished by arrhythmia recurrences occurring predominantly because of reconnections in previously isolated pulmonary veins. The aim of the EFFICAS I multicenter study was to demonstrate the correlation between contact force (CF) parameters during initial procedure and the incidence of isolation gaps (gap) at 3-month follow-up. Method and Results-A radiofrequency ablation catheter with integrated CF sensor (TactiCath, Endosense, Geneva, Switzerland) was used to perform pulmonary vein isolation in 46 patients with paroxysmal atrial fibrillation. During the ablation procedure, the operator was blinded to CF information. At follow-up, an interventional diagnostic procedure was performed to assess gap location as correlated to index procedure ablation parameters. At follow-up, 65% (26/40) of patients showed ≥1 gaps. Ablations with minimum Force-Time Integral (FTI) <400 gs showed increased likelihood for reconnection (P<0.001). Reconnection correlated strongly with minimum CF (P<0.0001) and minimum FTI (P=0.0007) at the site of gap. Gap occurrence showed a strong trend with lower average CF and average FTI. CF and FTI are generally higher on the right side, although the left anterior segment presents a unique challenge to achieve stable position with good CF. Conclusions-Minimum

show abstract

“…15 A diagnostic catheter was used to evaluate the status of isolation or reconnection per vein. To define successful treatment of a patient, all 8 segments needed to be gap free.…”

Section: Follow-up Procedures At 3 Monthsmentioning

confidence: 99%

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Neužil

Reddy

Kautzner

et al. 2013

Circ: Arrhythmia and Electrophysiology

Self Cite

413

363

View full text Add to dashboard Cite

show abstract

“…13 Although novel ablation devices such as the cryoballoon (CB; Arctic Front Advance TM , Medtronic) and the laser balloon (LB; HeartLight TM , CardioFocus) have shown favorable rates of acute and durable PVI, data on the area of isolated atrial antral myocardium following a balloonbased PVI approach are scarce. 14- 16 We therefore investigated the size of the isolated antral surface area (IASA) Antral Lesion Size After PVI LB-Guided PVI In the LB group, the sizeable balloon (HeartLight TM , CardioFocus, MA, USA) was navigated to the individual PV by the steerable sheath and inflated to obtain optimal PV occlusion. Ablation lesions were deployed in a contiguous fashion under visual guidance, titrating the energy from 5.5 to 12 W (20-30 s ablation time) according to the degree of tissue exposure.…”

mentioning

confidence: 99%

What Is the Acute Antral Lesion Size After Pulmonary Vein Isolation Using Different Balloon Ablation Technologies?

Perrotta

Konstantinou

Bordignon

et al. 2017

Circ J

View full text Add to dashboard Cite

Background: Clinical outcome after pulmonary vein isolation (PVI) may be linked to both durability of PVI and the antral lesion size. Data on balloon-guided technologies are scarce. We investigated the size of the isolated surface area (ISA) acutely after PVI achieved by cryoballoon (CB) or laser balloon (LB), both using voltage mapping. Methods and Results:In 40 patients (73% male, mean age 66±9 years), a bipolar voltage map before and after PVI in sinus rhythm was acquired to delineate the isolated antral surface area (IASA, contiguous area of low voltage <0.5 mV) and the ISA (relative size of the low-voltage area in relation to the whole antral surface area including the posterior wall). IASA (CB: 57±14 cm 2 vs. LB: 42±15 cm 2 ; P=0.002) as well as ISA (65±8% vs. 54±10%; P=0.001) were significantly larger in the CB than in the LB group. No periprocedural complications occurred. During a mean follow-up of 326±142 days, 4/20 and 5/20 patients experienced an AF/AT recurrence in the CB and LB groups, respectively. No differences in clinical outcome were observed between patients with a large (≥55%) or small (<55%) ISA. Conclusions:Balloon-guided PVI is associated with antral lesion formation. CB-guided PVI is associated with the largest ISA as compared with LB procedures. ISA size did not correlate with clinical outcome after a single procedure in the present study population.

show abstract

“…In contrast to the relatively high rate of procedural reconnection observed in studies of RF-based AF ablation (up to 50% in some series), the rate of acute reconnection post CBA appears to be low. In studies employing waiting periods of up to 60 minutes, the pooled rate of acute recurrence among the 749 treated PVs was <1% [40,43,46-48]. Moreover, in contrast to RF-based ablation, the use of adjunctive pharmacologic agents such as adenosine and/or isoproterenol does not appear to provide additional prognostic information in patients undergoing CBA [40,49,50].…”

Section: How To Perform Cryoballoon Ablationmentioning

confidence: 99%

Cryoballoon Ablation for Atrial Fibrillation

Andrade

Dubuc

Guerra

et al. 2012

Indian Pacing and Electrophysiology Journal

View full text Add to dashboard Cite

Focal point-by-point radiofrequency catheter ablation has shown considerable success in the treatment of paroxysmal atrial fibrillation. However, it is not without limitations. Recent clinical and preclinical studies have demonstrated that cryothermal ablation using a balloon catheter (Artic Front©, Medtronic CryoCath LP) provides an effective alternative strategy to treating atrial fibrillation. The objective of this article is to review efficacy and safety data surrounding cryoballoon ablation for paroxysmal and persistent atrial fibrillation. In addition, a practical step-by-step approach to cryoballoon ablation is presented, while highlighting relevant literature regarding: 1) the rationale for adjunctive imaging, 2) selection of an appropriate cryoballoon size, 3) predictors of efficacy, 4) advanced trouble-shooting techniques, and 5) strategies to reduce procedural complications, such as phrenic nerve palsy.

show abstract

The Permanency of Pulmonary Vein Isolation Using a Balloon Cryoablation Catheter

Abstract: Cryoballoon ablation allows for durable PV isolation with the use of a single balloon. With maintained chronic isolation in most PVs, it may represent a significant step toward consistent and lasting ablation procedures.

Cited by 73 publications

References 30 publications

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

Electrical Reconnection After Pulmonary Vein Isolation Is Contingent on Contact Force During Initial Treatment

What Is the Acute Antral Lesion Size After Pulmonary Vein Isolation Using Different Balloon Ablation Technologies?

Cryoballoon Ablation for Atrial Fibrillation

Contact Info

Product

Resources

About