Safety and Efficacy using second-generation cryoballoon in patients with atrial fibrillation with a Common Ostium of Inferior Pulmonary Veins

Background: Common ostium of inferior pulmonary veins (COIPV) is a kind of pulmonary vein variation. The safety and efficacy of COIPV isolation using the second-generation cryoballoon (CB) ablation remain unknown.Methods: A total of 10 patients with COIPV from a consecutive series of 1,751 patients with atrial fibrillation (AF) were included. Pulmonary vein isolation (PVI) was performed using the second-generation CB.Results: The prevalence of a COIPV was 0.57% in this study. PVI was achieved in all pulmonary veins (PVs) without the need for a touch-up. A segmental freeze strategy was applied for each inferior PV, respectively. The mean number of freeze cycles of inferior PVs was 1.4 ± 0.5 for the left inferior pulmonary vein (LIPV), and 2.0 ± 0.9 for the right inferior pulmonary vein (RIPV). Pulmonary vein potential (PVP) of RIPV could not be monitored in real-time in three cases. Eight of 10 patients (80%) were free from atrial arrhythmias without the use of antiarrhythmic drugs during a follow-up period of 23.6 ± 12.9 months. No procedure-related complications occurred in any of the 10 patients.Conclusions: Common ostium of inferior pulmonary veins is a rare but challenging PV variant. PVI with this unusual anatomic variation using the second-generation 28-mm CB is effective and safe.

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Ablation of atrial fibrillation using the fourth-generation cryoballoon Arctic Front Advance PRO

Future Cardiology ◽

10.2217/fca-2020-0066 ◽

2021 ◽

Vol 17 (1) ◽

pp. 81-87

Author(s):

Erik Wissner

Keyword(s):

Atrial Fibrillation ◽

Second Generation ◽

Retrospective Studies ◽

Pulmonary Veins ◽

Thermodynamic Characteristics ◽

The Arctic ◽

Fourth Generation ◽

Safety And Efficacy ◽

Front Advance ◽

Arctic Front

The cryoballoon (CB) is a popular ablation technology used for pulmonary vein isolation. The fourth-generation CB, Arctic Front Advance PRO features a 40% shorter distal tip but retains the internal design from its second-generation predecessor. The Arctic Front Advance PRO and the second-generation CB demonstrated similar thermodynamic characteristics in a computational model. Several observational and retrospective studies established the acute safety and efficacy of the Arctic Front Advance PRO. Real-time electrical isolation was observed in 75–85% of pulmonary veins targeted with the Arctic Front Advance PRO resulting in shorter fluoroscopy and procedure times.

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Safety and efficacy of cryoballoon-ablation for atrial fibrillation performed at local hospitals: results of the german register on cryoballoon-ablation in local hospitals (REGIONAL)

EP Europace ◽

10.1093/europace/euab116.230 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

J Michaelsen ◽

U Parade ◽

H Bauerle ◽

K-D Winter ◽

U Rauschenbach ◽

...

Keyword(s):

Atrial Fibrillation ◽

Phrenic Nerve ◽

Nerve Palsy ◽

Pulmonary Veins ◽

Hospital Death ◽

Cryoballoon Ablation ◽

Complication Rates ◽

Community Hospitals ◽

Phrenic Nerve Palsy ◽

Safety And Efficacy

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf REGIONAL Background Pulmonary vein isolation (PVI) using cryoballoon ablation (CBA) has become an established procedure for the treatment of symptomatic paroxysmal and persistent atrial fibrillation (AF). The safety and efficacy of PVI at community hospitals with low to moderate case numbers is unknown. Aim To determine safety and efficacy of PVI using CBA performed at community hospitals with limited annual case numbers. Methods 1004 PVI performed consecutively between 01/2019 and 09/2020 at 20 community hospitals (each <100 PVI using CBA/year) for symptomatic paroxysmal AF (n = 563) or persistentAF (n= 441) were included in this registry. CBA was performed considering local standards. Procedural data, efficacy and complications were determined. Results Mean number of PVI using CBA/year was 59 ± 26. Mean procedure time was 90.1 ± 31.6 min and mean fluoroscopy time was 19.2 ± 11.4 min. Isolation of all pulmonary veins could be achieved in 97.9% of patients, early termination of CBA due to phrenic nerve palsy was the most frequent reason for incomplete isolation. There was no in-hospital death. 2 patients (0.2%) suffered a clinical stroke. Pericardial effusion occurred in 6 patients (0.6%), 2 of them (0.2%) required pericardial drainage. Vascular complications occurred in 24 patients (2.4%), in 2 of these patients (0.2%) vascular surgery was required. In 48 patients (4.8 %) phrenic nerve palsy was noticed which persisted up to hospital discharge in 6 patients (0.6%). Conclusions PVI for paroxysmal or persistent AF using CBA can be performed at community hospitals with high efficacy and low complication rates despite low to moderate annual procedure numbers.

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Experience in cryobaloon atrial fibrillation ablation – Polish operators perspective

In a good rythm ◽

10.5604/01.3001.0013.4759 ◽

2019 ◽

Vol 2 (51) ◽

pp. 4-7

Author(s):

Agnieszka Wojdyła-Hordyńska ◽

Jakub Baran ◽

Paweł Derejko

Keyword(s):

Atrial Fibrillation ◽

Second Generation ◽

Pulmonary Veins ◽

Atrial Fibrillation Ablation ◽

Cryoballoon Ablation ◽

Years Of Experience ◽

Technology Changes ◽

Front Advance ◽

Arctic Front ◽

Over 40 Years

The first use of cryoablation in the treatment of arrhythmia has already been described over 40 years ago [1]. Since the introduction of cryoballoon in pulmonary veins isolation in atrial fibrillation treatment, the method has started to attract a lot of interest. Over 350,000 procedures around the word were carried out only by 2018 [2]. Recently, there have been several new publications on the results of second-generation cryoballoon ablation [2, 3, 4]. In view of technology changes, and to summarize years of experience in the treatment of atrial fibrillation, the first Cryousers conference was organized, and held in 2018 in Poland. During this meeting a survey was conducted, obtaining data on the practice of atrial fibrillation treatment in 38 Polish electrophysiological centers performing cryoablation of atrial fibrillation using both balloons, Arctic Front Advance, Medtronic Inc., Minneapolis MN, and radiofrequency point by point ablation. Around 3,745 cryoballoon procedures were performed in the surveyed centers during the year preceding the survey. The survey concerned practical issues related to the qualification and preparation of patients for the procedure, its course, and the results of pulmonary veins isolation in Poland.

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Normal distal pulmonary vein anatomy

PeerJ ◽

10.7717/peerj.1579 ◽

2016 ◽

Vol 4 ◽

pp. e1579 ◽

Cited By ~ 10

Author(s):

Wiesława Klimek-Piotrowska ◽

Mateusz K. Hołda ◽

Katarzyna Piątek ◽

Mateusz Koziej ◽

Jakub Hołda

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Interventional Procedures ◽

Critical Role ◽

Pulmonary Veins ◽

Safety And Efficacy ◽

Classical Pattern ◽

The Common ◽

The Mean ◽

Pulmonary Vein Anatomy

Background.It is well known that the pulmonary veins (PVs), especially their myocardial sleeves play a critical role in the initiation and maintenance of atrial fibrillation. Understanding the PV anatomy is crucial for the safety and efficacy of all procedures performed on PVs. The aim of this study was to present normal distal PV anatomy and to create a juxtaposition of all PV ostium variants.Methods.A total of 130 randomly selected autopsied adult human hearts (Caucasian) were examined. The number of PVs ostia was evaluated and their diameter was measured. The ostium-to-last-tributary distance and macroscopic presence of myocardial sleeves were also evaluated.Results.Five hundred forty-one PV ostia were identified. Four classical PV ostia patterns (two left and two right PVs) were observed in 70.8% of all cases. The most common variant was the classical pattern with additional middle right PV (19.2%), followed by the common ostium for the left superior and the inferior PVs (4.44%). Mean diameters of PV ostia (for the classical pattern) were: left superior = 13.8 ± 2.9 mm; left inferior = 13.3 ± 3.4 mm; right superior = 14.3 ± 2.9 mm; right inferior = 13.7 ± 3.3 mm. When present, the additional middle right PV ostium had the smallest PV ostium diameter in the heart (8.2 ± 4.1 mm). The mean ostium-to-last-tributary (closest to the atrium) distances were: left superior = 15.1 ± 4.6 mm; left inferior = 13.5 ± 4.0 mm; right superior = 11.8 ± 4.0 mm; right inferior = 11.0 ± 3.7 mm. There were no statistically significant differences between sexes in ostia diameters and ostium-to-last-tributary distances.Conclusion.Only 71% of the cases have four standard pulmonary veins. The middle right pulmonary vein is present in almost 20% of patients. Presented data can provide useful information for the clinicians during interventional procedures or radiologic examinations of PVs.

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Common ostium of the left pulmonary veins – to freeze or not to freeze – that was the question?

In a good rythm ◽

10.5604/01.3001.0010.7497 ◽

2017 ◽

Vol 4 (45) ◽

pp. 33-34

Author(s):

Michał Orczykowski

Keyword(s):

Atrial Fibrillation ◽

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Second Generation ◽

Pulmonary Veins ◽

Persistent Atrial Fibrillation ◽

Clinical Results ◽

Common Pulmonary Vein

Second-generation cryoballoon (CB2) - based pulmonary vein isolation (PVI) has demonstrated encouraging clinical results in the treatment of paroxysmal (PAF) and persistent atrial fibrillation (PersAF). Nevertheless, the acute efficacy, safety, and long-term clinical results of CB2-based PVI in patients with a left common pulmonary vein (LCPV) are still a matter of debate. Commented paper by Heeger ChH, et al. analyzes this issue with some practical conclusions.

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Safety and efficacy of persistent atrial fibrillation ablation using the second-generation cryoballoon

Clinical Research in Cardiology ◽

10.1007/s00392-018-1219-1 ◽

2018 ◽

Vol 107 (7) ◽

pp. 570-577 ◽

Cited By ~ 11

Author(s):

Kivanc Yalin ◽

Amr Abdin ◽

Evgeny Lyan ◽

Noureddin Sawan ◽

Spyridon Liosis ◽

...

Keyword(s):

Atrial Fibrillation ◽

Second Generation ◽

Persistent Atrial Fibrillation ◽

Atrial Fibrillation Ablation ◽

Safety And Efficacy

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P899The impact of the pulmonary veins and left atrium anatomy on the success of exclusively a 28-mm second - generation cryoballoon ablation in patients with paroxysmal Atrial fibrillation

EP Europace ◽

10.1093/ehjci/eux151.081 ◽

2017 ◽

Vol 19 (suppl_3) ◽

pp. iii176-iii176

Author(s):

K. Hanazawa ◽

M. Tanaka ◽

N. Inada ◽

K. Su ◽

M. Ooi ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Paroxysmal Atrial Fibrillation ◽

Second Generation ◽

Pulmonary Veins ◽

Cryoballoon Ablation

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Beating Heart Direct Left Atrial Access Balloon Cryoablation: Safety and Efficacy of Pulmonary Vein Isolation in an Ovine Model

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e318159375d ◽

2007 ◽

Vol 2 (4) ◽

pp. 188-191

Author(s):

James S. Gammie ◽

G Kwame Yankey ◽

Timothy Nolan ◽

Z. Jon Wu ◽

Timm Dickfeld ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrium ◽

Pulmonary Vein ◽

Left Atrial ◽

Pulmonary Veins ◽

Beating Heart ◽

Direct Access ◽

Large Animal ◽

Cryoballoon Ablation ◽

Safety And Efficacy

Objective Clinical experience with endocardial cryoablation for the surgical treatment of atrial fibrillation has demonstrated safety and efficacy. Direct access to the left atrium via a thoracoscopic or pericardial approach with a balloon-tipped cryoablation catheter might facilitate endocardial cryoablation on the beating heart. We investigated the ability of a novel cryoballoon to produce endocardial pulmonary vein ostial cryolesions on the beating heart in a large-animal model. Methods Six sheep underwent small left thoracotomy. A 10.5F catheter with a 23-mm cryoballoon was inserted directly into the left atrium under fluoroscopic and intracardiac echo (ICE) guidance. Cryoablation of the pulmonary vein ostia was performed. Animals were killed at 14 days. Pulmonary venous electrical isolation was assessed immediately before the animals were killed. Results All animals survived balloon cryoablation with no periprocedural complications. Balloon occlusion was well tolerated hemodynamically, with minimal change in blood pressure (–4 ± 6 mm Hg systolic BP) and no change in heart rate. ICE demonstrated an absence of intracardiac air or ice embolization during ablation. Mean balloon temperature was −67 ± 8°C. All animals were neurologically intact after the procedure. Five of 6 (83%) veins exhibited circumferential exit block. Phrenic nerve function was intact in all animals. On gross inspection, all lesions were circumferential and continuous without evidence of endocardial thrombus. Pathology confirmed circumferential transmurality in all treated veins. Conclusions Direct left atrial access cryoballoon ablation was effective for isolating pulmonary veins. This technology may be an important component of a minimally invasive beating heart CryoMaze procedure for the treatment of atrial fibrillation.

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CRYOABLATION IN ATRIAL FIBRILLATION: RATIONALE OF THE NATIONAL PROSPECTIVE REGISTRY AND PRELIMINARY RESULTS

Russian Journal of Cardiology ◽

10.15829/1560-4071-2018-7-21-25 ◽

2018 ◽

pp. 21-25

Author(s):

E. N. Mikhailov ◽

T. A. Lyubimtseva ◽

K. V. Davtyan ◽

A. G. Topchian ◽

E. S. Tarasyuk ◽

...

Keyword(s):

Atrial Fibrillation ◽

Clinical Practice ◽

Pulmonary Veins ◽

National Study ◽

Cryoballoon Ablation ◽

Ablation Procedure ◽

Safety And Efficacy ◽

Informational System ◽

Real Clinical Practice

Aim. Current registry is the continued national study on cryoablation in atrial fibrillation (AF). The aim of the project is assessment of safety and efficacy of cryoballoon ablation of pulmonary veins from AF treatment in real clinical practice prospective observation.Material and methods. The project has been developed for prospective inclusion of the data to guarded automatic informational system, on clinical data of patients, ablation parameters, repeat ablation and results of 12-month follow-up. To participate in the project in January of 2017, the representatives of 33 in-patient facilities were invited, that routinely perform the procedure.Results. Twenty five institutions confirmed their participation, and by December of 2017, the database was completed by specialists from 13 clinics: information on the ablation procedure and outcomes is included for 451 patient. The enrollment is ongoing with estimated end by January 2019; prospective follow-up to be completed by January 2020.Conclusion. Prospective registry of AF cryoablation is important for gathering of experience and common analysis of the procedures throughout the country. Detailed analysis will make it to reveal predictors of efficacy and methods for procedural risk decrease.

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