Dissociated pulmonary vein activity after cryoballoon ablation and radiofrequency ablation for atrial fibrillation: a propensity score-matched analysis

2017 ◽  
Vol 33 (5) ◽  
pp. 529-536
Author(s):  
Kenichi Tokutake ◽  
Michifumi Tokuda ◽  
Seiichiro Matsuo ◽  
Ryota Isogai ◽  
Kenichi Yokoyama ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Pulmonary Vein ◽  
Cryoballoon Ablation

scholarly journals Procedural Patterns and Safety of Atrial Fibrillation Ablation

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Zak Loring ◽  
DaJuanicia N. Holmes ◽  
Roland A. Matsouaka ◽  
Anne B. Curtis ◽  
John D. Day ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Contact Force ◽  
De Novo ◽  
Class I ◽  
Cryoballoon Ablation ◽  
Af Ablation ◽  
Life Threatening

Background: Catheter ablation is an increasingly used treatment for symptomatic atrial fibrillation (AF). However, there are limited prospective, nationwide data on patient selection and procedural characteristics. This study describes patient characteristics, techniques, treatment patterns, and safety outcomes of patients undergoing AF ablation. Methods: A total of 3139 patients undergoing AF ablation between 2016 and 2018 in the Get With The Guidelines-Atrial Fibrillation registry from 24 US centers were included. Patient demographics, medical history, procedural details, and complications were abstracted. Differences between paroxysmal and patients with persistent AF were compared using Pearson χ 2 and Wilcoxon rank-sum tests. Results: Patients undergoing AF ablation were predominantly male (63.9%) and White (93.2%) with a median age of 65. Hypertension was the most common comorbidity (67.6%), and patients with persistent AF had more comorbidities than patients with paroxysmal AF. Drug refractory, paroxysmal AF was the most common ablation indication (class I, 53.6%) followed by drug refractory, persistent AF (class I, 41.8%). Radiofrequency ablation with contact force sensing was the most common ablation modality (70.5%); 23.7% of patients underwent cryoballoon ablation. Pulmonary vein isolation was performed in 94.6% of de novo ablations; the most common adjunctive lesions included left atrial roof or posterior/inferior lines, and cavotricuspid isthmus ablation. Complications were uncommon (5.1%) and were life-threatening in 0.7% of cases. Conclusions: More than 98% of AF ablations among participating sites are performed for class I or class IIA indications. Contact force-guided radiofrequency ablation is the dominant technique and pulmonary vein isolation the principal lesion set. In-hospital complications are uncommon and rarely life-threatening.

scholarly journals Safety and outcome of cryoballoon ablation versus radiofrequency catheter ablation of the pulmonary veins in patients with paroxysmal atrial fibrillation

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
O H M A Riad ◽  
T Wong ◽  
A N Ali ◽  
M T Ibrahim ◽  
M A Abdelhamid ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
The Mean

Abstract Background Pulmonary vein isolation (PVI) has become the mainstay of catheter ablation of atrial fibrillation (AF). There are two commonly used methods to isolate the pulmonary veins, either point-by-point delivery of circumferential lesion sets around ipsilateral pulmonary veins using radiofrequency energy, or the application of the cryoballoon to the pulmonary vein antrum with occlusion of the vein ostium. The cryoballoon has proven to be a reliable alternative to radiofrequency ablation in acute and long-term freedom from AF. We describe our results using both modalities. Aim and Objectives to compare the safety and efficacy of cryoballoon (CB) ablation and radiofrequency (RF) ablation in treatment of paroxysmal atrial fibrillation. Patients and Methods Forty-four consecutive patients having paroxysmal AF underwent PVI using the second generation cryoballoon were compared to a retrospective cohort of 69 patients who had radiofrequency induced PVI, either by conventional RF catheter (n = 32), or a contact-force sensing-catheter (n = 37). The study took place at Ain Shams university hospitals and Royal Brompton & Harefield NHS trust. Patient data, procedural data and follow up data- at 3, 6 and 12 months- were collected and analysed. Recurrence was defined as documented AF or atrial arrhythmias with duration exceeding 30 seconds, either by 12 lead ECG or an ambulatory monitoring device. Results A total of 113 patients were studied. The mean age was 53.84 ± 15.01 for the CB group and 55.78 ± 14.84 for the RF group and females representing 40.9% vs 34.8% respectively. The mean procedural times in minutes were significantly less in the CB group (94.37 ± 39.32 vs 184.57 ± 88.19, p < 0.0001), while the median fluoroscopy times were similar [30 (11.04 - 40) vs 37.25 (14.2 - 70), p = 0.172]. Procedural complications were comparable between the two groups (p = 0.06) with 1 patient (2.3%) having long term phrenic nerve paresis. At 1 year follow up, after an initial 90-day blanking period, recurrence rate of CB was similar to RF (27.3% vs 30.4% respectively, p = 0.719), the Kaplan Meier estimates of AF- free survival for a period of 1 year were comparable between both groups (log rank test, p = 0.606). Conclusion Cryoballoon is a feasible method for pulmonary vein isolation with similar success rates to radiofrequency ablation. Cryoballoon ablation is safe with shorter duration of the procedure.

VP122 Cryoballoon Versus Radiofrequency Ablation For Atrial Fibrillation

2017 ◽  
Vol 33 (S1) ◽  
pp. 204-205
Author(s):  
Gongru Wang ◽  
Yingyao Chen ◽  
Lizheng Shi ◽  
Danni Chen ◽  
Hui Sun
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Cryoballoon Ablation ◽  
Complication Rates ◽  
Procedure Time ◽  
Isolation Rate

INTRODUCTION:Pulmonary vein isolation (PVI) is a new effective treatment for atrial fibrillation (AF) (1). The standard of care for ablation methods using radiofrequency (RF) is time-consuming and technically challenging (2), and restricted to a few specialized centers, which causes the limited availability of ablation therapy (3). Therefore, cryoballoon (CB) ablation has been developed to shorten and simplify the procedure. The objective of this systematic literature review and meta-analysis was to compare the effectiveness of cryoballoon ablation (CBA) with radiofrequency ablation (RFA) for the treatment of AF.METHODS:We searched the Cochrane Library and PubMed from 2009 to October 2016 to screen the eligible literature according to the inclusion and exclusion criteria. The effectiveness measures were the acute pulmonary vein (PV) isolation rate, procedure time, complications and the proportion of patients free from AF (follow-up > 3 months). Meta-analysis and descriptive statistics were used in this study.RESULTS:A total of seventeen articles with 5,806 cases (2,288 from CBA group, 3,518 from RFA group) from seven different countries were reviewed and analyzed. Pooled analyses indicated that CBA was more beneficial in terms of procedural time (Standard mean difference, SMD = -.501; 95%CI: -.893– -.109; P<.05) for RFA; but the acute PV isolation rate (Odds ratio, OR = .06; 95 percent Confidence Interval, CI: .03–.13; P < .05) in RFA was higher than for CBA; also, after median follow-up of 14 months (range 9–28 months), the proportion of patients free from AF (OR = .965; 95 percent CI:.859—1.085; P = .554) and the total complication rates (OR = .937; 95 percent CI:.753–1.167; P = .562) were not significantly different between CBA and RFA.In the four randomized controlled trials (RCTs) of the seventeen studies, the proportion of patients free from AF (OR = .951; 95 percent CI:.752–1.202; P = .672) and the complications (OR = 1.521; 95 percent CI:.570–4.058; P = .402) were not significantly different between CBA and RFA.CONCLUSIONS:Overall, compared with RFA for the treatment of patients with AF, CBA had similar clinical effectiveness on the proportion of people free from AF and the number of complications, and yet greater improvement in total procedure time referred for CBA and higher acute PVI rate referred for RFA.

Abstract 16580: Safety and Efficacy of Cryoballoon Ablation in Patients With Congestive Heart Failure

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Roger Tseng ◽  
Muhanad Al-Zubaidi ◽  
Alexander Homer ◽  
Kelly DanCanay ◽  
Wilber Su
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Congestive Heart Failure ◽  
Radiofrequency Ablation ◽  
Success Rate ◽  
Pulmonary Vein ◽  
Systolic Heart Failure ◽  
Cryoballoon Ablation ◽  
Atrial Fibrillation Burden ◽  
Procedural Success

Background: Irrigated radiofrequency ablation of atrial fibrillation (AF) is challenging in patient with severe systolic congestive heart failure due to large fluid load. The use of cryoballoon ablation in patients with low ejection fraction (EF) and NYHA class II-IV congestive heart failure has not been well described, and may benefit from the lack of fluid bolus and restoration of sinus rhythm. Method: To evaluate the efficacy and safety of cryoballoon ablation for systolic heart failure patients with atrial fibrillation (AF). Single center retrospective review of 832 patients with AF ablation using Arctic Front Advance Cryoballoon (Medtronic, Minneapolis, MN) was performed, and 188 patients has EF less than 35% (24 paroxysmal, 122 persistent, and 42 long-standing persistent, average EF 28%) was analyzed. Procedural tolerance, complications, and impact on congestive heart failure were reviewed over a 12 months follow up. Results: All 188 patients (Average age 68, LA size 5.8 cm) with systolic CHF and atrial fibrillation underwent successful pulmonary vein (PV) isolation and extra-pulmonary vein lesions sets applied using cryoballoon. Non-irrigated radiofrequency ablation was used in (22%) for cavo-tricuspid isthmus flutter ablation. Acute procedural success rate was 100% with length of hospitalization of 1.1 days. Average procedural time was 2.6 hours, and fluid infusion of 0.3 liters, no significant complications was noted. Atrial fibrillation burden was monitored by implantable pacemaker or defibrillator in 118 of 188 patients (63%), and others were monitoring via wearable looping recorders every 3 months. Significant AF burden (<10% atrial high rate burden) was observed in over 67% of the patients, and improvement CHF symptoms were reported in all of the patients with reduction of atrial fibrillation burden. Conclusions: Cryoballoon of AF in systolic CHF population is well tolerated with high procedural success rate and low complication rate. Significant clinical improvement of CHF class was observed in patient with reduction of atrial fibrillation burden. Ongoing collection of data is needed to quantify long-term benefit.

Adenosine testing during cryoballoon ablation and radiofrequency ablation of atrial fibrillation: A propensity score–matched analysis

Heart Rhythm ◽  
2016 ◽  
Vol 13 (11) ◽  
pp. 2128-2134 ◽  
Author(s):  
Michifumi Tokuda ◽  
Seiichiro Matsuo ◽  
Ryota Isogai ◽  
Goki Uno ◽  
Kenichi Tokutake ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Propensity Score ◽  
Cryoballoon Ablation

scholarly journals Results and Implications of the FIRE AND ICE Trial

2016 ◽  
Vol 02 (02) ◽  
pp. 55
Author(s):  
Karl-Heinz Kuck ◽  
Michael Schlüter ◽  
◽  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Vein Isolation ◽  
Paroxysmal Atrial Fibrillation ◽  
Gold Standard ◽  
Cryoballoon Ablation ◽  
Clinical Failure

Whilst radiofrequency ablation is widely considered the “gold standard” for pulmonary-vein isolation, cryoballoon ablation is considered easier to perform. The aim of the randomised, multicentre FIRE AND ICE trial was to demonstrate, in patients with paroxysmal atrial fibrillation, the non-inferiority of cryoballoon ablation with respect to the time to a first documented clinical failure within 1 year outside a 90-day “blanking period” after the index ablation. This editorial gives an overview of the trial and its findings.

scholarly journals Pulmonary veins reconnection pattern differences after failed radiofrequency ablation and cryoballoon ablation for atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Antoun ◽  
B Sihdu ◽  
A Mavilakandy ◽  
L Merzaka ◽  
P Stafford ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Funding Sources ◽  
Mapping System ◽  
The Right ◽  
Electrocardiogram Ecg

Abstract   Point-by-point radiofrequency ablation (RF) and one-shot cryoballoon ablation (CRYO) electrically isolate pulmonary veins (PVs) in atrial fibrillation (AF) using different techniques and energies. This study aimed to examine differences in PVs reconnection pattern and ablation lesions required to re-isolate PVs after failed RF and failed CRYO. Methods Twenty-four patients who had their repeat ablation between January 2017-December 2020 were studied with six months of learning curve for CRYO. Fourteen patients had paroxysmal atrial fibrillation (PAF). Failed first ablations were defined by electrocardiogram (ECG) documented AF within twelve months following three months blanking period. Repeat ablations were performed using CARTO3® mapping system, which was utilized to locate ablation lesions and impedance drop details. Results 2,260 lesions were collected from 63 reconnected PVs (31 isolated after RF vs 32 isolated veins after CRYO). 849 lesions were targeted towards triggers. Repeat ablation procedure time was similar between both cohorts. However, repeat ablation after failed CRYO had longer fluoroscopy time (19.8±2 vs 12.4±2.1 minutes, P=0.019). The right lower pulmonary vein (RLPV) was reconnected after failed CRYO for AF in 92% of patients and 100% in PAF patients. Although PV reconnection pattern was similar between both cohorts, RLPV and left upper pulmonary vein (LUPV) required more ablation lesions after failed CRYO. Left lower pulmonary vein (LLPV) and right upper pulmonary vein (RUPV) required more ablation lesions after failed RF. Impedance drop was similar in both cohorts. Conclusion After failed CRYO for PAF, RLPV was reconnected in all patients. RUPV and LLPV required more ablation lesions after failed RF, while RLPV and LLPV required more ablation lesions after failed CRYO. FUNDunding Acknowledgement Type of funding sources: None. PVs reconnection pattern Lesions number and percentage comparison

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