Impact of Cryoballoon Freeze Duration on Long-Term Durability of Pulmonary Vein Isolation

Abstract Background Second-generation cryoballoon (CB2) represents a powerful pulmonary vein isolation (PVI) tool. Recently, the randomized time-to-effect guided (ICE-T) CB2 strategy targeting a 240s single freeze demonstrated fast and efficient PVI. To further optimize safety and efficacy, a shortened 3min freeze duration has been suggested but PVI durability remains unclear. Methods Between May 2013 and December 2017 all CB2 ablations followed the ICE-T concept (target-freeze: 240s or 180s). Patients undergoing a second procedure for arrhythmia recurrence were analyzed. Two groups were defined based on the index freeze duration (group 240s vs. group 180s). In all repeat procedures a 3D left-atrial map was obtained. Durability of PVI and localization of conduction gaps were compared. Results A total of 106/788 (13%) patients underwent a second procedure (group 240s: 80/604 vs. group 180s: 26/184) after a mean of 377 days. There was no difference regarding PV occlusion and time-to-isolation in the index procedure between two groups. No major complications occurred. During the second procedure significantly more patients demonstrated durable isolation of all PVs in group 240 (61% vs 35%, p=0.02) along with a significantly increased rate of PVI durability (88% vs. 69%, per vein, p<0.001). Left sided PVs did significantly benefit from 240s freezes (reconnection LSPV: 6% vs 27%, p=0.004, LIPV: 14 vs. 39%, p=0.006). Conclusions The ICE-T strategy is associated with a high rate of durable PVI in patients with arrhythmia recurrence. Target freeze duration of 240s vs. 180s is associated with significantly increased lesion durability, particularly at left sided PVs, without increasing complications.

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Presence of non-pulmonary vein foci in patients with atrial fibrillation undergoing standard ablation of pulmonary vein isolation: Clinical characteristics and long-term ablation outcome

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100717 ◽

2021 ◽

Vol 32 ◽

pp. 100717

Author(s):

Yukihiro Inamura ◽

Junichi Nitta ◽

Osamu Inaba ◽

Akira Sato ◽

Tomomasa Takamiya ◽

...

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Clinical Characteristics

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Comparison of Direct Current Synchronized Cardioversion to Ibutilide-Guided Catheter Ablation for Long-Term Sinus Rhythm Maintenance After Isolated Pulmonary Vein Isolation of Persistent Atrial Fibrillation

The American Journal of Cardiology ◽

10.1016/j.amjcard.2017.03.027 ◽

2017 ◽

Vol 119 (12) ◽

pp. 1997-2002 ◽

Cited By ~ 2

Author(s):

Maojing Wang ◽

Qing Zhao ◽

Wei Ding ◽

Shanglang Cai

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Direct Current ◽

Persistent Atrial Fibrillation ◽

Sinus Rhythm Maintenance

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Incidence and Long-Term Follow-Up of Silent Cerebral Lesions After Pulmonary Vein Isolation Using a Remote Robotic Navigation System as Compared With Manual Ablation

Circulation Arrhythmia and Electrophysiology ◽

10.1161/circep.111.967497 ◽

2012 ◽

Vol 5 (1) ◽

pp. 15-21 ◽

Cited By ~ 36

Author(s):

Andreas Rillig ◽

Udo Meyerfeldt ◽

Roland Richard Tilz ◽

Jochen Talazko ◽

Anita Arya ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Navigation System ◽

Robotic Navigation ◽

Cerebral Lesions ◽

Long Term Follow Up

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Identifying patients with atrial fibrillation recurrences after two pulmonary vein isolation procedures

Open Heart ◽

10.1136/openhrt-2021-001718 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001718

Author(s):

Bart A Mulder ◽

Meelad I H Al-Jazairi ◽

Federico T Magni ◽

Hessel F Groenveld ◽

Robert G Tieleman ◽

...

Keyword(s):

Atrial Fibrillation ◽

Sinus Rhythm ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Area Under The Curve ◽

Holter Monitoring ◽

Underlying Disease ◽

Volume Index ◽

Left Atrium Volume

IntroductionPulmonary vein isolation (PVI) is an important treatment for atrial fibrillation (AF). However, many patients need more than one procedure to maintain long-term sinus rhythm. Even after two PVIs some may suffer from AF recurrences. We aimed to identify characteristics of patients who fail after two PVI procedures.Methods and resultsWe included 557 consecutive patients undergoing a first PVI procedure with a second-generation 28 mm cryoballoon. Follow-up procedures were performed using radiofrequency ablation targeting reconnected PVs only. Recurrent AF was defined as any episode of AF lasting >30 s on ECG or 24 hour Holter monitoring performed at 3, 6 and 12 months post procedure. Mean age was 59.1±10.2 years, 383 (68.8%) were male, 448 (80.4%) had paroxysmal AF and the most common underlying condition was hypertension (36.6%). A total of 140/557 (25.1%) patients underwent redo procedure with PVI only. Of these patients 45 (32.4%) had recurrence of AF. These patients were comparable regarding age and sex to those in sinus rhythm after one or two procedures. Multivariate logistic regression showed that non-paroxysmal AF (OR 1.08 (95% CI 1.01 to 1.15), estimated glomerular filtration rate (OR 0.96, 95% CI 0.94 to 0.99), bundle branch block (OR 4.17, 95% CI 1.38 to 12.58), heart failure (OR 4.17, 95% CI 1.38 to 12.58) and Left Atrium Volume Index (OR 1.04, 95% CI 1.01 to 1.08) were associated with AF recurrence after two PVIs. The area under the curve for the identified risk factors was 0.74.ConclusionsUsing a PVI-only approach, recurrence of AF after two AF ablation procedures is associated with more advanced underlying disease and persistent types of AF.

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