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

Aim. To estimate the clinical success of cryoballoon pulmonary vein isolation (PVI).Methods.230 patients (males: 49.6%, mean age 57 (53; 62) with symptomatic paroxysmal and persistent atrial fibrillation (AF) resistant to antiarrhythmic therapy were included in a single-center prospective study. The patients were randomized into 2 groups to undergo either cryoballoon ablation (n = 122) or radiofrequency (RF) (n = 108) ablation. Both groups were comparable in baseline parameters. The follow-up period was 12 months. Clinical outcomes were estimated with the use of a three-stage scale. The rates of cardiovascular rehospitalizations, direct-current cardioversions and repeated ablations during were estimated within the follow-up. The quality of life (QoL) in the cryoablation group was measured using the AFEQT scale.Results.77% (n = 94) of patients in the cryoballoon ablation group and 71.3% (n = 77) of patients in the RF group (р = 0.71) demonstrated reported the optimal clinical effects. Both groups, cryo ablation and RF ablation, had similar rates of cardiovascular hospitalizations (23.8 vs 28.7%, OR 0.8, 95% CI 0.4–1.4; р = 0.39), direct-current cardioversions (12.3 vs 17.6%, OR 0.7, 95% CI 0.3–1.4; р = 0.26) and repeated ablations (9.8–11.1%, OR 0.9, 95% CI 0.4–2.0; р = 0.75). The patients treated with cryoballoon as opposed to RF ablation had significantly more successful usage of “pill-in-pocket” strategy – 14.8 vs 6.5% (OR 2.5, 95% CI 1.01–6.2; р = 0.04). Significant improvements of the QoL parameters with strong size effect have been found in the cryoablation group, i.e. global score (GS) increased by 8.9±6.9 (95% CI 6.6–10.1; dCohen 1.2; р<0.001), symptoms (S) – by 8.3±7.9 (95% CI 4.2–8.8; dCohen 1.5; р<0.001), daily activities (DA) – by 10.0±6.9 (95% CI = 6.4–10.6; dCohen 0.9; р<0.001), treatment concerns (TC) – by 5.5±6.0 (95% CI 6.3–9.2; dCohen 1.2; р<0.001) and treatment satisfaction (TS) – by 5.5±6.0 (95% CI 5.4–9.8; dCohen 0.9; р<0.001).Conclusion.The both catheter-based technologies had comparable clinical success. Cryoablation was characterized by improvement in all QoL parameters based on the AFEQT score.

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Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

Journal of Arrhythmia ◽

10.1002/joa3.12301 ◽

2020 ◽

Vol 36 (2) ◽

pp. 319-327

Author(s):

Riccardo Maj ◽

Gianluca Borio ◽

Thiago G. Osório ◽

Saverio Iacopino ◽

Erwin Ströker ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Cryoballoon Ablation ◽

Unusual Phenomenon

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Long-term follow up of second-generation cryoballoon-based pulmonary vein isolation: Lights and shadows

International Journal of Cardiology ◽

10.1016/j.ijcard.2020.04.078 ◽

2020 ◽

Vol 312 ◽

pp. 71-72

Author(s):

Giacomo Mugnai ◽

Carlo de Asmundis ◽

Gian-Battista Chierchia

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Long Term Follow Up

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

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2017.11.245 ◽

2018 ◽

Vol 10 (1) ◽

pp. 91

Author(s):

C. Alarçon ◽

A. Savoure ◽

B. Godin ◽

G. Viart ◽

F. Vandevelde ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Follow Up Study

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P1920Long-term outcomes of pulmonary vein isolation using second-generation cryoballoon during atrial fibrillation ablation: A single-center large-scale study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0667 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

U Canpolat ◽

D Kocyigit ◽

M U Yalcin ◽

C Coteli ◽

Y Z Sener ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Large Scale ◽

Second Generation ◽

Significant Proportion ◽

Complication Rates ◽

Long Term Outcomes ◽

Free Survival

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.

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