scholarly journals Cryoballoon Catheter Ablation in Atrial Fibrillation

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Cevher Ozcan ◽  
Jeremy Ruskin ◽  
Moussa Mansour
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Thrombus Formation ◽  
Persistent Atrial Fibrillation ◽  
Technical Aspect ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Tissue Integrity ◽  
Cryothermal Energy ◽  
Antiarrhythmic Medications

Pulmonary vein isolation with catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation refractory or intolerant to antiarrhythmic medications. The cryoballoon catheter was recently approved for this procedure. In this paper, the basics of cryothermal energy ablation are reviewed including its ability of creating homogenous lesion formation, minimal destruction to surrounding vasculature, preserved tissue integrity, and lower risk of thrombus formation. Also summarized here are the publications describing the clinical experience with the cryoballoon catheter ablation in both paroxysmal and persistent atrial fibrillation, its safety and efficacy, and discussions on the technical aspect of the cryoballoon ablation procedure.

scholarly journals Pulmonary Vein Capture is a Predictor for Long-Term Success of Stand-Alone Pulmonary Vein Isolation with Cryoballoon Ablation in Patients with Persistent Atrial Fibrillation

2020 ◽  
Author(s):  
Alexey Babak ◽  
Christine Bienvenue Kauffman ◽  
Cynthia Lynady ◽  
Reginald McClellan ◽  
Kalpathi Venkatachalam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Persistent Atrial Fibrillation ◽  
Cryoballoon Ablation ◽  
Long Term Outcomes ◽  
Initial Strategy ◽  
Study Completion ◽  
Antiarrhythmic Medications ◽  
Better Than

Background: It is unknown whether cryoballoon technology for persistent atrial fibrillation (AF) is a reasonable initial strategy for patients with persistent AF (perAF). Methods: 390 consecutive procedures using cryoballoon for initial AF ablation were evaluated and divided first by clinical presentation: paroxysmal AF (PAF) or perAF, and then whether PV potentials associated PV pacing (PV capture) were identified after ablation. Patients were followed for recurrent AF (median 20 months). Results: PV capture was identified in patients with PAF and perAF (PAF: 20.3% vs. perAF: 14.6%; p < 0.05). No patient charactieristic differences were identified between those patients with or without PV capture. The presence of PV capture was not associated with different outcomes in patients with PAF. However, in patients with perAF, the presence of PV capture was associated with long-term outcomes similar to patients with PAF and significantly better than patients with perAF without PV capture (p < 0.001). In patients with perAF and PV capture, a strategy of reisolation of the PVs only for recurrent AF resulted in 20/23 (87%) patients in sinus rhythm off antiarrhythmic medications at study completion. In patients with PV capture, specific electrophysiologic properties of PV tissue did not have an impact on AF recurrence. Conclusion: PV capture (and not specific PV electrophysiologic characteristics) was associated with decreased recurrent AF in patients with perAF. PV capture may identify those patients with perAF in whom PV isolation alone is sufficient at initial ablation procedure and also as the primary ablation strategy for recurrent AF.

scholarly journals Is Catheter Ablation Better Than Antiarrhythmic Drugs for the Treatment of Atrial Fibrillation?

2020 ◽  
Vol 29 (02) ◽  
pp. 131-140
Author(s):  
Balaji Natarajan ◽  
Srishti Nayak ◽  
Ramdas G. Pai
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Poor Quality ◽  
Treatment Side Effects ◽  
Randomized Controlled Studies ◽  
Antiarrhythmic Medications ◽  
Better Than

AbstractLong-standing atrial fibrillation is associated with significant morbidity including stroke and development of heart failure. Patients also report poor quality of life as a result of debilitating symptoms or treatment side effects from antiarrhythmic medications. Radio frequency or cryothermal mediated catheter ablation has a central role in the management of symptomatic patients with paroxysmal or persistent atrial fibrillation. Circumferential pulmonary vein isolation is vital to the success of this therapy and other ancillary techniques have been described, especially for persistent atrial fibrillation. Several randomized controlled studies have been reported over the last two decades studying important clinical outcomes in patients with atrial fibrillation. In this article, we aim to provide a review of the major studies that have helped define the role of catheter ablation in the management of symptomatic atrial fibrillation in patients with both diseased and structurally normal hearts.

scholarly journals Cryoballoon Ablation Strategy in Persistent Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Florian Straube ◽  
Janis Pongratz ◽  
Alexander Kosmalla ◽  
Benedikt Brueck ◽  
Lukas Riess ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Cryoballoon Ablation ◽  
Ablation Procedure ◽  
Phrenic Nerve Palsy ◽  
Dose Area Product ◽  
Af Ablation ◽  
Predictors Of Recurrence

Background: Cryoballoon ablation is established for pulmonary vein isolation (PVI) in paroxysmal atrial fibrillation (AF). The objective was to evaluate CBA strategy in consecutive patients with persistent AF in the initial AF ablation procedure.Material and Methods: Prospectively, patients with symptomatic persistent AF scheduled for AF ablation all underwent cryoballoon PVI. Technical enhancements, laboratory management, safety, single-procedure outcome, predictors of recurrence, and durability of PVI were evaluated.Results: From 2007 to 2020, a total of 1,140 patients with persistent AF, median age 68 years, underwent cryoballoon ablation (CBA). Median left atrial (LA) diameter was 45 mm (interquantile range, IQR, 8), and Congestive heart failure, Hypertension, Age ≥75 years (doubled), Diabetes mellitus, prior Stroke or TIA or thromboembolism (doubled), Vascular disease, Age 65 to 74 years, Sex category (CHA2DS2-VASc) score was 3. Acute isolation was achieved in 99.6% of the pulmonary veins by CBA. Median LA time and median dose area product decreased significantly over time (p &lt; 0.001). Major complications occurred in 17 (1.5%) patients including 2 (0.2%) stroke/transitory ischemic attack (TIA), 1 (0.1%) tamponade, relevant groin complications, 1 (0.1%) significant ASD, and 4 (0.4%) persistent phrenic nerve palsy (PNP). Transient PNP occurred in 66 (5.5%) patients. No atrio-esophageal fistula was documented. Five deaths (0.4%), unrelated to the procedure, occurred very late during follow-up. After initial CBA, arrhythmia recurrences occurred in 46.6% of the patients. Freedom from atrial arrhythmias at 1-, and 2-year was 81.8 and 61.7%, respectively. Independent predictors of recurrence were LA diameter, female sex, and use of the first cryoballoon generation. Repeat ablations due to recurrences were performed in 268 (23.5%) of the 1,140 patients. No pulmonary vein (PV) reconduction was found in 49.6% of the patients and 73.5% of PVs. This rate increased to 66.4% of the patients and 88% of PVs if an advanced cryoballoon was used in the first AF ablation procedure.Conclusion: Cryoballoon ablation for symptomatic persistent AF is a reasonable strategy in the initial AF ablation procedure.

scholarly journals B-PO04-096 FACTORS PREDICTING THE PROGRESSION FROM PAROXYSMAL TO PERSISTENT ATRIAL FIBRILLATION DESPITE AN INDEX CATHETER ABLATION PROCEDURE

Heart Rhythm ◽  
2021 ◽  
Vol 18 (8) ◽  
pp. S318-S319
Author(s):  
Ahmed Moustafa Elimam ◽  
Li-Wei Lo ◽  
Yenn-Jiang Lin ◽  
Shih-Lin Chang ◽  
Yu-Feng Hu ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Ablation Procedure

scholarly journals Longstanding Persistent Atrial Fibrillation Ablation: How Do You Perform It?

2020 ◽  
Vol 33 (2) ◽  
pp. 89-95
Author(s):  
Carola Gianni ◽  
Andrea Natale ◽  
Amin Al-Ahmad
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
Catheter Ablation ◽  
Pulmonary Vein ◽  
Paroxysmal Atrial Fibrillation ◽  
Radiofrequency Catheter Ablation ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Ablation Procedure ◽  
First Time

Longstanding-persistent atrial fibrillation is one of the most challenging arrhythmias to treat. While radiofrequency catheter ablation is highly effective in paroxysmal atrial fibrillation, pulmonary vein antral isolation (including posterior wall isolation) alone is not enough for nonparoxysmal atrial fibrillation, other targets should be sought in this population. In this case report, we will describe our approach in a typical patient presenting for a first-time ablation procedure for longstanding persistent atrial fibrillation.

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