Is “bonus” application required after pulmonary vein isolation using second-generation cryoballoon catheter? A 1-year follow-up study

Abstract Background Currently available second-generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exists about 1-year outcomes of CB2 ablation, data on long-term outcomes are scarce. Objective: We aimed to assess the long-term outcomes of PVI using CB2 in a large-scale symptomatic AF population at our tertiary referral center. Methods In this non-randomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa) free survival was defined as absence of AF, atrial flutter or atrial tachycardia recurrence >30 s following 3-months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models. Results Acute procedural success rate was 99.8% (1898/1902 PVs). Mean procedural and fluoroscopy time were 64.9±9.2 and 12.1±2.6, respectively. At median 39 (IQR: 26–56) months follow-up, ATa free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs 102/141 [72.3%] for persistent AF, p=0.019) and 84.4% after a mean 1.48±0.42 ablations.Cox regression analysis showed that left atrium diameter, duration of AF history and early ATa recurrence were found as the independent predictors of late recurrence. PNP was observed in 17 (3.5%) patients. Figure 1 Conclusions Second-generation CB based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and early persistent AF patients with an acceptable complication rates at long-term follow-up.

Download Full-text

Single 3-minute freeze for second-generation cryoballoon ablation: One-year follow-up after pulmonary vein isolation

Heart Rhythm ◽

10.1016/j.hrthm.2014.12.026 ◽

2015 ◽

Vol 12 (4) ◽

pp. 673-680 ◽

Cited By ~ 125

Author(s):

Giuseppe Ciconte ◽

Carlo de Asmundis ◽

Juan Sieira ◽

Giulio Conte ◽

Giacomo Di Giovanni ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Cryoballoon Ablation ◽

One Year

Download Full-text

Circumferential pulmonary vein isolation with second-generation multipolar catheter in patients with paroxysmal or persistent atrial fibrillation: Procedural and one-year follow-up results

International Journal of Cardiology ◽

10.1016/j.ijcard.2017.04.035 ◽

2017 ◽

Vol 241 ◽

pp. 212-217 ◽

Cited By ~ 11

Author(s):

Stefan G. Spitzer ◽

Patrick Leitz ◽

Anke Langbein ◽

Laszlo Karolyi ◽

Frank Scharfe ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Persistent Atrial Fibrillation ◽

One Year ◽

Circumferential Pulmonary Vein Isolation

Download Full-text

P1922Ablation index-guided ablation versus second-generation cryoballoon for first pulmonary vein isolation in atrial fibrillation

European Heart Journal ◽

10.1093/eurheartj/ehz748.0669 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Felix-Oliveira ◽

J Carmo ◽

P Carmo ◽

D Cavaco ◽

A Fontes ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Cox Regression ◽

Accurate Estimation ◽

Phrenic Nerve Palsy ◽

Recent Trial ◽

Baseline Characteristics

Abstract Background In a recent trial, cryoballoon (CB) ablation was non-inferior to radiofrequency ablation regarding effectiveness in atrial fibrillation (AF). Ablation index (AI) provides a more accurate estimation of ablation quality using three variables: power delivered with time, contact force and catheter stability. The additional benefit of AI-guided ablation versus CB ablation is unknown. Objective To compare AI-guided ablation and CB ablation for first pulmonary vein isolation (PVI) in patients with AF. Methods We assessed 141 patients (62±12 years old, 76 men and 126 paroxysmal AF) with drug refractory symptomatic AF submitted to AI-guided PVI or second-generation CB catheter. Endpoint was AF/AT/AFL recurrence after a 3-month blanking period with a minimum follow-up of 6 months. Cox regression was used to assess the relationship between type of ablation and AF recurrence. Results Fifty-seven patients underwent AI-guided PVI and 84 patients underwent CB ablation. The baseline characteristics are described in table 1. Procedure duration was significantly higher in AI group (150 vs 111 min, P<0.001) although requiring significant less fluoroscopy time (5 min vs 20 min; P<0.001). There was a transient phrenic nerve palsy in CB group and a cardiac tamponade in AI group. During a mean follow-up of 10±3 months there were 23 recurrences (27%) in CB group vs 7 recurrences (12%) in AI group (log rank 0.042) (Fig B). When adjusted for CHA2DS2-VASc score, left atrium diameter (mm) and type of AF (Cox regression), there was lower arrhythmia recurrence in AI group (HR 0.42; 95% CI 0.18–0.99; p=0.047). Table 1. Baseline characteristics Conclusion In this analysis, AI-guided ablation was associated with lower arrhythmia recurrence when compared with CB ablation. This hypothesis should be further evaluated in a prospective randomized trial.

Download Full-text

Second-generation cryoballoon-based pulmonary vein isolation: Lessons from a five-year follow-up

International Journal of Cardiology ◽

10.1016/j.ijcard.2020.03.062 ◽

2020 ◽

Vol 312 ◽

pp. 73-80 ◽

Cited By ~ 3

Author(s):

Christian-Hendrik Heeger ◽

Behnam Subin ◽

Erik Wissner ◽

Thomas Fink ◽

Shibu Mathew ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation

Download Full-text

6121Phrenic nerve injury during pulmonary vein isolation using the second-generation cryoballoon: characteristics and follow-up - The YETI registry

European Heart Journal ◽

10.1093/eurheartj/ehz746.0147 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C H Heeger ◽

A Pott ◽

C Sohns ◽

A Rillig ◽

M Kuniss ◽

...

Keyword(s):

Nerve Injury ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Pulmonary Veins ◽

Complication Rates ◽

Effective Treatment Option ◽

The Mean ◽

The Right

Abstract Background Second-generation cryoballoon (CB2) based pulmonary vein isolation (PVI) has emerged as a safe and effective treatment option for symptomatic atrial fibrillation (AF). Although published complication rates of CB2 based-PVI are relatively low and several safety algorithms have been implemented in the protocols the most frequent complication is right-sided phrenic nerve injury (PNI). The reported incidence of PNI varies from 2–5% of patients. However data on PNI characteristics as well as follow-up is sparse. Purpose We aimed to evaluate the incidence, characteristics and outcome of PNI during after CB2 based-PVI in a large patients population. Methods and results From July 2012 to November 2018 a total of 13693 patients received CB2 or CB3 (third-generation) based-PVI in 23 EP centers (Germany: 12, China: 1, Turkey: 3, Japan: 3, USA: 1, Austria: 1, Poland: 1, Swizerland: 1). A total of 596 (4.4%) of patients experienced PNI during treatment of the right superior (84%) right inferior (15%) right middle (0.3%) (and left superior (0.3%) pulmonary veins. The mean time to PNI was 127±51 seconds and the mean temperature at the time of PNI was −49±7 °C. The target PV was isolated at time of PNI in 84% of cases. The applications were interrupted using double-stop technique in (71%). In 212/306 (52%) a CMAP was utilized. At the end of the procedure PNI persistent in 45% of patients. Fluoroscopic or sonographic evaluation of PNI was performed 1–3 days after the procedure and revealed persistent PNI in 35% of patients. Dyspnea before discharge was reported in 18% of patients with persistent PNI. Patients follow up at 1–3, and 6–12 months included fluoroscopy and a visit in an outpatient clinic. After 1–3 months 18% of patients showed persistent PNI including 13% of patients complaining of dyspnea. After 6–12 months of follow-up including fluoroscopic evaluation PNI was persistent in 1.8% of patients while dyspnea was reported by 1.7% patients. Only 0.08% of the overall population of 13693 patients showed permanent and symptomatic PNI. Conclusion The incidence of PNI during CB2-based PVI is low. About 55% of PNI recovered until the end of the procedure. Most of PNI recovered within 12 months. Symptomatic permanent PNI is very rare in patients after CB2/CB3-based PVI.

Download Full-text

P1382Extended long-term follow-up of radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique (first versus second generation cryoballoon)

EP Europace ◽

10.1093/europace/euaa162.084 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

K Kettering

Keyword(s):

Catheter Ablation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Radiofrequency Catheter Ablation ◽

Second Generation ◽

Group A ◽

Redo Procedure ◽

Group B ◽

Segmental Approach

Abstract Catheter ablation has become the first line of therapy in patients with symptomatic, recurrent, drug-refractory atrial fibrillation. Cryoablation has been shown to be a safe and effective technique for pulmonary vein isolation. However, there is a significant arrhythmia recurrence rate after cryoablation procedures and there are no established strategies for redo procedures in these patients. Therefore, we have summarized our experience with radiofrequency catheter ablation for redo procedures after pulmonary vein isolation with the cryoballoon technique (including an analysis of pulmonary vein conduction recovery patterns ater procedures performed with the first or second generation cryoballoon). Methods One hundred and twenty patients (paroxysmal AF: 78 patients, persistent AF: 42 patients) had to undergo a redo procedure after initially successful circumferential PV isolation with the cryoballoon technique. The redo ablation procedures were performed using a segmental approach or a circumferential ablation strategy depending on the intra-procedural findings. Results During the redo procedure, a mean number of 1.8 re-conducting PVs were detected (using a circular mapping catheter; group A: 2.1 re-conducting PVs, group B: 1.5 re-conducting PVs). There was a slightly higher incidence of chronic PV reconnections related to the left-sided PV ostia than to the right-sided PVs in both groups. Furthermore, sites of chronic PV reconnection were found more frequently in the inferior parts of the PV ostia than in the superior parts. In 53 patients in group A, a segmental approach was sufficient to eliminate the residual PV conduction because there were only a few recovered PV fibers (1-3 reconnected PVs; group A1). In the remaining 7 patients in group A, a circumferential ablation strategy was used because of a complete recovery of the PV-LA conduction of all four pulmonary veins (group A2). In group B, a segmental approach was sufficient in all patients because there was only a minor reconnection of 1-2 PVs. All recovered PVs could be isolated sucessfully again. At 42-month follow-up, 78 % of all patients were free from an arrhythmia recurrence (94/120 patients; group A: 43/60 patients (71 %), group B: 51/60 patients (85 %)). There were no major complications in both groups. Conclusions In patients with an initial circumferential PVI using the cryoballoon technique, a repeat ablation procedure can be performed safely and effectively using radiofrequency catheter ablation. In most cases only a few re-conducting PV fibers were found and therefore, a segmental re-ablation approach seems to be sufficient in the majority of patients (especially in patients treated with the second generation cryoballoon).

Download Full-text