Technical and procedural comparison of two different cryoballoon ablation systems in patients with atrial fibrillation

Abstract Purpose The aim was to report procedural and technical differences of a novel cryoballoon (NCB) ablation catheter for pulmonary vein isolation (PVI) compared to the standard cryoballoon (SCB) catheter. Methods Consecutive patients with atrial fibrillation (AF) undergoing PVI using the NCB and the SCB were included. Procedural parameters, technical differences, acute efficacy, and safety are reported. Results Eighty patients (age 66 ± 10 years, ejection fraction 57 ± 10%, left atrial volume index 40 ± 6 ml/m2) were studied. With the NCB, 156 of 158 PVs (99%) were isolated compared to isolation of 159 of 159 PVs (100%) with the SCB. The median number of freezes in the NCB and the SCB group was 6 (IQR 5–8) and 5 (IQR 4–7), respectively (p = 0.051), with 73% and 71% of the PVs isolated with a single freeze, respectively. Nadir temperature and temperature at isolation were − 59 ± 6 °C and − 45 ± 17 °C in the NCB group and − 46 ± 7 °C and − 32 ± 23 °C in the SCB group, respectively (both p < 0.001) with no difference in time to isolation (TTI). Procedural differences were observed for the total procedure time (84 ± 29 min in the NCB group and 65 ± 17 min in the SCB group, p = 0.003). There was a peri-procedural stroke in one patient in the NCB group. Differences in catheter design were observed that may account for the differences in temperature recordings and ice cap formation. Conclusions Acute efficacy and TTI were similar with the NCB compared to the SCB. Measured temperatures were lower with the NCB, most likely due to differences in catheter design.

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Cryoballoon Ablation of Atrial Fibrillation Without Demonstration of Pulmonary Vein Occlusion—The Simplify Cryo Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.664538 ◽

2021 ◽

Vol 8 ◽

Author(s):

Michael Kühne ◽

Sven Knecht ◽

Florian Spies ◽

Stefanie Aeschbacher ◽

Philip Haaf ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Left Atrial Volume ◽

Volume Index ◽

Standard Group ◽

Cryoballoon Ablation ◽

Left Atrial Volume Index ◽

Dose Area Product ◽

Total Procedure Time ◽

Area Product

Background: The demonstration of pulmonary vein (PV) occlusion is routinely performed and considered a prerequisite for successful cryoballoon (CB) ablation of atrial fibrillation (AF). The purpose of this study was to assess the feasibility and impact on procedural parameters and outcome of a standardized procedural protocol without demonstrating PV occlusion.Methods and Results: Consecutive patients undergoing CB pulmonary vein isolation (PVI) were studied. After cMRI assessment, patients treated by PVI using a novel no-contrast (NC) protocol without routine contrast injections to demonstrate PV occlusion (NC group) were compared to patients undergoing PVI with contrast injections to demonstrate PV occlusion (standard group). One hundred patients with paroxysmal or persistent AF (age 61 ± 10 years, ejection fraction 59 ± 11%, left atrial volume index 37.2 ± 2.0 mL/m2) were studied. The NC protocol was feasible in 72 of 75 patients (96%). Total procedure time and fluoroscopy time were 64.0 ± 14.1 min and 11.0 ± 4.6 min in the NC group and 92.0 ± 25.3 min and 18.0 ± 6.0 min in the standard group, respectively (all p < 0.001). Dose area product was 368 ± 362 cGy*cm2 in the NC group compared to 1928 ± 1541 cGy*cm2 in the standard group (p < 0.001). Forty-five of 75 patients (60%) in the NC group and 16 of 25 patients (64%) in the standard group remained in stable sinus rhythm after a single PVI and a 1-year follow-up (p = 0.815).Conclusions: Performing CB ablation without using contrast injections to demonstrate PV occlusion was feasible, resulted in reduced radiation exposure, and increased the efficiency of the procedure.

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Second-Generation Cryoballoon Ablation for Atrial Fibrillation　― A Detailed Analysis of the Impact of Left Atrial Volume Index on Clinical Outcome ―

Circulation Journal ◽

10.1253/circj.cj-18-0650 ◽

2018 ◽

Vol 83 (1) ◽

pp. 84-90 ◽

Cited By ~ 1

Author(s):

Ken Takarada ◽

Erwin Ströker ◽

Carlo de Asmundis ◽

Juan Sieira ◽

Juan-Pablo Abugattas ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Outcome ◽

Detailed Analysis ◽

Left Atrial ◽

Left Atrial Volume ◽

Volume Index ◽

Cryoballoon Ablation ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

The Impact

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Left Atrial Volume Index Predicts Arrhythmia-Free Survival in Patients with Persistent Atrial Fibrillation Undergoing Cryoballoon Ablation

Journal of Atrial Fibrillation ◽

10.4022/jafib.2192 ◽

2019 ◽

Vol 12 (2) ◽

Author(s):

Albano Alfred J ◽

Bush Jared ◽

Parker Jessica L ◽

Corner Kristin ◽

Lim Hae W ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Volume ◽

Persistent Atrial Fibrillation ◽

Volume Index ◽

Cryoballoon Ablation ◽

Atrial Volume ◽

Free Survival ◽

Left Atrial Volume Index

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Abstract 13793: Role of Cardiac Autoantibodies for the Prediction of Recurrence Following Cryoballoon-based Lone Atrial Fibrillation Ablation

Circulation ◽

10.1161/circ.130.suppl_2.13793 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Muhammed U Yalcin ◽

Kadri M Gurses ◽

Duygu Kocyigit ◽

Sacit A Kesikli ◽

Hikmet Yorgun ◽

...

Keyword(s):

Atrial Fibrillation ◽

Predictive Value ◽

Cox Regression ◽

Muscarinic Acetylcholine Receptor ◽

Left Atrial Volume ◽

Volume Index ◽

Lone Atrial Fibrillation ◽

Left Atrial Volume Index ◽

One Year ◽

Af Recurrence

Introduction: Recent evidence have suggested that autoantibodies may play an important role in the development of atrial fibrillation (AF). Predictive value of pre-procedural autoantibodies against beta-1 adrenergic receptor (anti-β1-R) and M2-muscarinic acetylcholine receptor (anti-M2-R) for AF recurrence following cryoballoon-based pulmonary vein isolation (PVI) is still unclear. We aimed to determine the predictive value of pre-procedural anti-β1-R and anti-M2-R levels for AF recurrence in lone AF patients following cryoballoon-based PVI. METHODS: 80 patients (mean age 54.25±7.7 years; 40% males) with lone AF who underwent cryoballoon-based PVI were included in the study. Pre-procedural anti-M2-R and anti-β1-R levels were measured with ELISA. RESULTS: At one-year follow-up after ablation, late AF recurrence was observed in 17 (21.25%) patients. In the Cox regression model including number of antiarrhythmic drugs, early AF recurrence, anti-β1-R levels >159.88 ng/mL, anti-M2-R levels >277.65 ng/mL, AF duration and left atrial volume index; only anti-β1-R levels >159.88 ng/mL (HR: 4.281, p=0.039) and anti-M2-R levels >277.65 ng/mL (HR: 4.313, p=0.030) were found to be independent predictors of late AF recurrence. Anti-β1-R level >159.88 ng/mL was shown to predict late AF recurrence with a sensitivity of 70.59% and specificity of 90.48%. A cut-off value of 277.65 ng/mL for anti-M2-R level predicted AF recurrence with a sensitivity of 70.59% and specificity of 95.24%. CONCLUSION: Pre-procedural serum anti-β1-R and anti-M2-R levels are independent predictors of late AF recurrence following cryoballoon-based PVI in lone AF patients. Detection of pre-procedural anti-β1-R and anti-M2-R levels may serve as a novel method for determination of lone AF patients who may not benefit from cryoballoon-based PVI.

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Left Atrial Volume Index as a Clinical Marker for Atrial Fibrillation and Predictor of Cardiovascular Outcomes

Journal of Cardiology & Current Research ◽

10.15406/jccr.2016.06.00223 ◽

2016 ◽

Vol 6 (5) ◽

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Left Atrial Volume ◽

Cardiovascular Outcomes ◽

Volume Index ◽

Atrial Volume ◽

Left Atrial Volume Index ◽

Clinical Marker

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Abstract 13956: Cystatin C Based Estimated Glomerular Filtration Rate is a Feasible Parameter for Incident Stroke in Patients With Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.13956 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Naoto Hashimoto ◽

Satoshi Nishiyama ◽

Tetsu Watanabe ◽

Masahiro Wanezaki ◽

Gensai Yamaura ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cystatin C ◽

Left Atrial ◽

Left Atrial Appendage ◽

Left Atrial Volume ◽

Atrial Appendage ◽

Volume Index ◽

Chads2 Score ◽

Left Atrial Volume Index ◽

Ckd Stage

Introduction: Chronic kidney disease (CKD) is an important risk factor of stroke in patients with atrial fibrillation (AF). Since AF patients with high CHADS2 score are likely to be old and have history of TIA or stroke, there could be patients who have sarcopenia. Cystatin C based estimated glomerular filtrarion rate (eGFRcys) is less affected by age, gender and muscle mass compared to creatine based eGFR (eGFRcr). We investigated whether eGFRcys is more closely associated with incident stroke in AF patients compared to eGFRcr. Methods: We performed transthoracic and transesophageal echocardiography and measured eGFRcys and eGFRcr in 349 patients with paroxysmal AF and chronic AF (256 males, 64.4 ± 11.7 years). We excluded those who had severe valvular heart disease and end stage renal desease. There were 42 patients with stroke history. Results: eGFRcys showed better correlation with left atrial volume index, levels of brain natriuretic peptide, von Willebrand factor, and left atrial appendage emptying flow velocity, than eGFRcr. eGFRcys was decreased with increading CHADS2 and CHA2DS2VASc score. Patients with left atrial appendage and/or spontaneous echo contrast had a significantly lower eGFRcys compared to those without. The proportion of patients with stroke was increased with advancing CKD stage in eGFRcys. Although eGFRcys and eGFRcr were associated with stroke in logistic regression analysis, eGFRcys but not eGFRcr was an independent predictor for stroke after adjustment for CHADS2 score. Conclusion: eGFRcys is a feasible parameter for incident stroke in AF patients.

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