Verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: Results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance)

Aryana, Arash; Kenigsberg, David N.; Kowalski, Marcin; Koo, Charles; Lim, Hae W.; O’Neill, Padraig Gearoid; Bowers, Mark R.; Hokanson, Robert B.; Ellenbogen, Kenneth A.

doi:10.1016/j.hrthm.2017.06.020

Cited by 119 publications

(138 citation statements)

References 12 publications

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“…Procedural results for the remaining 175 veins (left and right superior and inferior PVs, or LSPV, LIPV, RSPV, and RIPV, respectively) are shown in Figure 2. Roughly one‐third of veins had a single application delivered, and the number of applications was similar in all veins (on average, 2.1 ± 1.2 applications per vein, Figure 2A), comparable with previous studies 5,7,14 . Mean application duration per vein was 420 ± 217 seconds, with similar values in all veins (Figure 2B).…”

Section: Resultssupporting

confidence: 85%

“…Further procedural refinement may be obtained by using the TTVI, which can be useful to guide freezing time in patients undergoing CB ablation 7 . This may shorten the procedure and reduce X‐ray exposure 5 . In our cohort, outcomes were comparable across the range of prolonged freezing time studied, from a minimum of 103 seconds to a maximum of 710 seconds after achieving isolation (range including 95% of postisolation application times in our cohort).…”

Section: Discussionmentioning

confidence: 72%

“…Subsequent studies have reinforced fairly good midterm outcomes in patients submitted to CB ablation. However, the optimal freezing strategy is still under debate 3–7 . Prolonged freezing cycles may achieve more durable PVI at the cost of longer procedures and an increased risk of injury to extracardiac structures (eg, phrenic nerve, esophagus, bronchial tree) 8–10 .…”

Section: Introductionmentioning

confidence: 99%

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Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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Introduction Ablation with second‐generation cryoballoon technology evolves as an effective and safe alternative to radiofrequency for atrial fibrillation ablation procedures. Nevertheless, the optimal freezing strategy remains unknown. Our objective was to identify the procedural cryoablation parameters predicting successful peri‐pulmonary vein (PV) lesions by directly analyzing Postablation gaps in late‐gadolinium‐enhanced cardiac magnetic resonance (LGE‐CMR). Methods and Results Forty‐nine consecutive patients (196 PVs) undergoing ablation with second‐generation cryoballoon at our center were included. The number and duration of cryoballoon application to achieve PV isolation were left to operator discretion. Gap number and length were quantified in all patients with a LGE‐CMR performed 3 months postablation. Application time (420 ± 217 seconds), number of applications (2.1 ± 1.2), application time after electrical isolation (311 ± 194 seconds) and minimum temperature (−45.8 ± 6.5°C) were similar in the 4 PVs. Gaps were observed in 148 PVs (76%), averaging 1.3 ± 1 gaps per vein. Gaps were longer and more frequent in the right PVs (91% vs 59% in left PVs, P < .001). Neither the number, total duration of applications, nor postisolation application time predicted relative length or number of gaps. Conclusions After successful PV isolation was achieved in patients undergoing cryoablation, increasing the number of applications, the total application time or application time postisolation did not result in a reduction in the number or the relative length of gaps.

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Section: Resultssupporting

confidence: 85%

Section: Discussionmentioning

confidence: 72%

Section: Introductionmentioning

confidence: 99%

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Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Trotta

Alarcón

Guasch

et al. 2020

Cardiovasc electrophysiol

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“…A recent publication examined the clinical efficacy of the cryoballoon PVI in an effort to titrate the cryoablation dosing to achieve maximal efficacy. The method used is based on time to PVI plus 120 sec . Presently, many practitioners use one to two 180 sec applications.…”

Section: Discussionmentioning

confidence: 99%

Determination of single cryoablation outcome within 30 to 60 seconds of freezing based on ice impedance

Avitall

Lizama

Kalinski

et al. 2019

Cardiovasc electrophysiol

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BackgroundA direct indicator of effective pulmonary vein isolation (PVI) based on early ice formation is presently lacking.ObjectiveThe initial impedance rise within 30 to 60 seconds (sec) of single cryoablation relating to ice on the distal surface of the cryoballoon could; predict effective PVI with early termination, the need for prolonging the cryoablation, or failure to achieve effective ablation.MethodsImpedance measurements were taken between two ring electrodes, at the anterior balloon surface and at the shaft behind the balloon. Ice covering the anterior ring leads to impedance rise. Single cryoablation (eight animals, 37 veins) was applied for 90 to 180 sec. Cryoapplication was terminated if the impedance reached ≥500 Ω. Impedance levels at ≤60 sec of cryoablation were divided into three groups based on the characteristics of the impedance rise. PVI was confirmed acutely and at 45 ± 9 days recovery by electrophysiology mapping and histopathology.ResultsAt 60 sec of freezing, an impedance rise of 34.1 ± 15.2 Ω (13‐50 Ω) and slope of the impedance rise (measured during 15‐30 sec of cryoapplication) less than 1 Ω/sec resulted in failed PVI. An impedance rise of 104.4 ± 31.5 Ω (76‐159 Ω) and slope of 2 Ω/sec resulted in 100% PVIs. An impedance rise of 130.9 ± 137.8 Ω (40‐590 Ω) and slope of 10 Ω/sec resulted in 100% PVIs with early termination at 90 sec.ConclusionThe efficacy of single cryoablation can be defined within 30 to 60 sec based on ice impedance. Three unique impedance profiles described in this investigation are associated with the uniformity and thickness of the ice buildup on the anterior surface of the balloon. One cryoablation with an adequate impedance rise is needed for successful outcomes.

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“…Aryana et al report using a time-to-isolation parameter as a means of dosing cryoablation for AF. 28 They suggest that this approach has similar results to the conventional approach while decreasing the total amount of cryoablation time, as a time-to-isolation on first application of o 60 seconds only requires a single freeze. Also, Cardosos et al published an important meta-analysis of ablation with uninterrupted novel oral anticoagulant use 29 demonstrating equivalency to uninterrupted warfarin but with a significantly lower risk of major bleeding.…”

Section: Atrial Fibrillation Ablationmentioning

confidence: 96%

Review on Atrial Fibrillation

Doshi

2017

J Innov Cardiac Rhythm Manage

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Verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: Results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance)

Abstract: A novel Cryo-AF dosing algorithm guided by TT-PVI can help individualize the ablation strategy and yield improved procedural endpoints and efficiency as compared to a conventional, nonstandardized approach.

Cited by 119 publications

References 12 publications

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Impact of cryoballoon applications on lesion gaps detected by magnetic resonance after pulmonary vein isolation

Determination of single cryoablation outcome within 30 to 60 seconds of freezing based on ice impedance

Review on Atrial Fibrillation

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