scholarly journals Time to –30°C as a predictor of acute success during cryoablation in patients with atrial fibrillation

2021 ◽  
Author(s):  
Carlos Antonio Álvarez-Ortega ◽  
Miguel Angel Ruiz ◽  
César Solórzano-Guillén ◽  
Alberto Barrera ◽  
Jorge Toquero-Ramos ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Success

Abstract 16017: Mid-term Outcomes in Persistent and Long-standing Persistent Atrial Fibrillation Patients Undergoing Rotor Ablation

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Carola Gianni ◽  
Tamara Metz ◽  
Luigi Di Biase ◽  
Sanghamitra Mohanty ◽  
Chintan Trivedi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Statistical Difference ◽  
Antiarrhythmic Drugs ◽  
Prospective Observational Study ◽  
Persistent Atrial Fibrillation ◽  
Success Rates ◽  
Single Procedure ◽  
Acute Success ◽  
Multicenter Prospective Observational Study

Introduction: Focal impulse and rotor modulation (FIRM)-guided ablation targets localized sources that are thought to sustain AF. We sought to evaluate if acute success of FIRM-guided ablation in patients with non-paroxysmal AF influenced the mid-term ablation outcomes. Methods: This was a multicenter prospective observational study of persistent and LSP AF patients undergoing FIRM ablation in 3 centers. Patients with at least 2 months follow-up were included in the analysis. FIRM was performed alone or in addition to conventional ablation and rotors were ablated as confirmed by their absence during remapping. Acute success was defined as AF termination, organization or slowing 10%. Mid-term success was defined as freedom from AT/AF off antiarrhythmic drugs (AADs) and after a single procedure during the initial follow-up (excluding the 2-month blanking period). Results: A total of 43 patients were enrolled (mean age 62 ± 10; 91% persistent, 9% LSP). Rotors-only ablation was performed in 65% of patients, and in addition to conventional ablation in the remaining 35%. Overall, acute success was achieved in 33% of patients. During a mean follow-up of 5.5 ± 2.4 months, 35% of patients were free of AT/AF off AADs after a single procedure. When comparing patients who underwent rotors-only ablation with those who received additional conventional ablation, mid-term success rates were respectively 25% vs. 53% (P = NS). There was no statistical difference in SR maintenance between patients with and without acute success during FIRM ablation (29% vs. 38%, P = NS). Conclusion: FIRM-guided ablation in persistent and LSP AF was not effective in obtaining AF slowing/organization/termination during the procedure and in preventing mid-term AT/AF recurrences. Acute success did not impact the mid-term success rate.

scholarly journals Characteristics of anatomical difficulty for cryoballoon ablation: insights from CT

Open Heart ◽  
2022 ◽  
Vol 9 (1) ◽  
pp. e001724
Author(s):  
Takahiro Hayashi ◽  
Masato Murakami ◽  
Shigeru Saito ◽  
Kiyotaka Iwasaki
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrium ◽  
Phrenic Nerve ◽  
Cochrane Library ◽  
Cryoballoon Ablation ◽  
Systematic Analysis ◽  
Acute Success ◽  
Poor Outcomes ◽  
The Right ◽  
Af Recurrence

BackgroundThe limited availability of balloon sizes for cryoballoon leads to anatomical limitations for pulmonary vein (PV) isolation. We conducted a comprehensive systematic analysis on procedural success rate, atrial fibrillation (AF) recurrence rate and complications of cryoballoon ablation in association with the anatomy of the left atrium and PV based on preprocedural CT to gain insights into proper treatments of patients with AF using cryoballoon.MethodA systematic search of literature databases, including PubMed, Web of Science and Cochrane Library, from the inception of each database through February 2021 was conducted. Search keywords included ‘atrial fibrillation’, ‘cryoballoon ablation’ and ‘anatomy’.ResultsOverall, 243 articles were identified. After screening, 16 articles comprising 1396 patients were included (3, 5 and 8 for acute success, AF recurrence and complications, respectively). Regarding acute success and AF recurrences, thinner width of the left lateral ridge, higher PV ovality, PV ostium-bifurcation distance, shorter distance from the non-coronary cusp to inferior PVs, shallower angle of right PVs against the atrial septum and larger right superior PV (RSPV) were associated with poor outcomes. Regarding complications, shorter distance between the RSPV ostium and the right phrenic nerve, larger RSPV-left atrium angle, larger RSPV area and smaller right carina width were associated with incidences of phrenic nerve injury.ConclusionThis study elucidated several key anatomical features of PVs possibly affecting acute success, AF recurrence and complications in patients with AF using cryoballoon ablation. CT analysis has helped to describe benefits and anatomical limitations for cryoballoon ablation.

scholarly journals Cryoballoon ablation of the left atrial posterior wall reduces recurrence of persistent atrial fibrillation in patients with non-paroxysmal atrial fibrillation

2021 ◽  
Author(s):  
Takatoshi Shigeta ◽  
Yasuteru Yamauchi ◽  
Yuichiro Sagawa ◽  
Atsuhito Oda ◽  
Shinichi Tachibana ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Paroxysmal Atrial Fibrillation ◽  
Left Atrial ◽  
Conduction Block ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cryoballoon Ablation ◽  
Acute Success ◽  
Af Recurrence

Introduction: Detailed clinical outcomes of cryoballoon ablation of the left atrial (LA) posterior wall (LAPW) in patients with non-paroxysmal atrial fibrillation (AF) have not been fully examined. Methods: We analyzed the outcomes of 191 patients with non-paroxysmal AF, of whom 135 underwent cryoballoon ablation of the LAPW including the LA roof in addition to pulmonary vein isolation with a cryoballoon. Results: Complete conduction block at the LA roof was obtained in 97.0% (131/135) of patients and LAPW was isolated in 85.2% (115/135) of patients. Over 372 days (range, 182–450 days) of follow-up, atrial arrhythmia recurrence was observed in 55 (40.7%) patients, and atrial tachycardia (AT) recurrence accounted for 25.5% of cases. The prevalence of LA roof cryoballoon ablation tended to be higher in patients without recurrence than those with (74.3% vs. 61.8%, respectively; p=0.11), especially those with persistent AF recurrence (74.5% vs. 46.2%, p=0.01). Multivariate analysis revealed that cryoballoon ablation of the LA roof was a predictor of freedom from persistent AF recurrence and that it was not associated with AT recurrence. Durable LA roof lesions were confirmed in 18 (72.0%) of 25 patients who underwent redo ablation. Conclusion: Cryoballoon ablation of the LAPW leads to a sufficient acute success rate of complete conduction block and durable lesions of the LA roof without increasing the risk of AT recurrence. The prevalence of persistent AF recurrence decreases after additional cryoballoon ablation of the LAPW in patients with non-paroxysmal AF.

Utility of Amiodarone Pre-Treatment as a Facilitator of the Acute Success of Electrical Cardioversion in Persistent Atrial Fibrillation

2020 ◽  
Vol 34 (1) ◽  
pp. 89-94 ◽  
Author(s):  
Josep M. Alegret ◽  
Xavier Viñolas ◽  
Hernán Tajes ◽  
Pilar Valdovinos ◽  
Raquel Palomares ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Persistent Atrial Fibrillation ◽  
Electrical Cardioversion ◽  
Acute Success ◽  
Pre Treatment

scholarly journals Atrial Fibrillation Ablation with Multipolar Phased-Radiofrequency Catheter: The Learning Curve Effect for Procedural Parameters, but not for the Long-Term Outcome

2019 ◽  
Vol 8 (10) ◽  
pp. 1589 ◽  
Author(s):  
Glowniak ◽  
Tarkowski ◽  
Wojewoda ◽  
Wysokinska ◽  
Kozak ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Learning Curve ◽  
Complication Rate ◽  
Left Atrial ◽  
Single Shot ◽  
Rf Ablation ◽  
Curve Effect ◽  
Acute Success ◽  
Phased Radiofrequency

Background: Pulmonary vein isolation (PVI) is a routine treatment in atrial fibrillation (AF). Single-shot techniques were introduced to simplify the procedure. We analyzed time-dependent changes in procedural parameters, acute success, complication rates, and long-term outcomes during our initial experience with multipolar phased-radiofrequency (RF) ablation. Methods and Results: The first 126 consecutive patients (98 male; age: 58.8 ± 8.7 years) who underwent PVI with phased-RF ablation at our center were included in the study. Procedural parameters, complication rate, acute success and 12-month efficacy were compared in the first, second and third group of 42 consecutive patients. In all patients, 516/526 PVs were effectively isolated (98.1%), with no differences between the tierces (p = 0.67). Procedure (169.8 vs. 132.9 vs. 105.8 min, p < 0.0001), fluoroscopy (32.9 vs. 24.3 vs. 14.1 min, p < 0.0001) and left atrial dwell (83.0 vs. 61.9 vs. 51.4 min, p < 0.0001) times were significantly reduced with experience in tierces 1–3, respectively. In the 12-month follow-up, 60.3% of patients were arrhythmia-free with no differences between the tierces (p = 0.88). In multivariate analysis, the relapse in the blanking period (p < 0.0001), time from AF diagnosis (p = 0.004) and left atrial diameter (p = 0.012) were the only independent predictors of AF recurrence. Conclusions: The learning curve effect was demonstrated in procedural parameters, but not in the complication rate nor the long-term success of PVI with phased-RF technique. The relapse in the blanking period was the strongest predictor of treatment failure in long-time observation.

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