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Journal of Interventional Cardiac Electrophysiology

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31.05.2020 | Atrial Fibrillation

Temperature-guided ablation with the second-generation cryoballoon for paroxysmal atrial fibrillation: 3-year follow-up in a multicenter experience

verfasst von: Gaetano Paparella, Saverio Iacopino, Thiago Guimarães Osório, Juan Pablo Abugattas de Torres, Erwin Ströker, Juan Sieira, Hannes Vanacker, Bernard De Ruyter, Serge Boveda, Riccardo Maj, Gianluca Borio, Alessandro Rizzo, Alessio Galli, Pedro Brugada, Carlo de Asmundis, Gian-Battista Chierchia

Erschienen in: Journal of Interventional Cardiac Electrophysiology | Ausgabe 1/2021

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Abstract

Purpose

A strategy based on the attainment of the specific parameter of − 40 °C within the first 60 s during cryoenergy applications in the setting of cryoballoon ablation (CB-A) without the use of an inner lumen mapping catheter (ILMC) (Achieve; Medtronic, USA) for the visualization of real-time recordings (RTR) has been previously described. The latter has proven to be very effective in guaranteeing freedom from atrial arrhythmias in patients affected by paroxysmal atrial fibrillation (PAF) at 1-year follow-up. The purpose of this retrospective observational study was to evaluate the clinical outcomes of this strategy in a multicenter experience on a long-term follow-up of 3 years.

Methods

A total of 192 patients having undergone CB ablation for paroxysmal AF (PAF) starting from September 2015 to November 2016 that underwent a temperature-guided approach were included.

Results

Mean procedural time was 68.77 ± 18.88. The mean number of freezes in the LSPV was 1.2 ± 0.4, 1.2 ± 0.4 in the LIPV, 1.1 ± 0.4 in the RSPV, and 1.2 ± 0.4 in the RIPV. Considering a blanking period of 3 months, freedom from AF off-AAD was achieved in 77.6% (149/192) at mean 34.5 ± 5.5 months and median 35.1 months (IQR, 32.3–37.0 months) follow-up after 1 procedure.

Conclusions

A temperature-guided approach affords freedom from AF at a 3-year follow-up period in a large majority of patients affected by PAF having undergone a single CB-A procedure.

Chierchia GB, Di Giovanni G, Ciconte G, De Asmundis C, Conte G, Sieira-Moret J, et al. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-up. Europace. 2014;16(5):639–44. https://doi.org/10.1093/europace/eut417.CrossRefPubMed

Metzner A, Reissmann B, Rausch P, Mathew S, Wohlmuth P, Tilz R, et al. One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol. 2014;7(2):288–92. https://doi.org/10.1161/CIRCEP.114.001473.CrossRefPubMed

Di Giovanni G, Wauters K, Chierchia GB, Sieira J, Levinstein M, Conte G, et al. One-year follow-up after single procedure cryoballoon ablation: a comparison between the first and second generation balloon. J Cardiovasc Electrophysiol. 2014;25(8):834–9. https://doi.org/10.1111/jce.12409.CrossRefPubMed

Fürnkranz A, Bordignon S, Dugo D, Perotta L, Gunawardene M, Schulte-Hahn B, et al. Improved 1-year clinical success rate of pulmonary vein isolation with the second-generation cryoballoon in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25(8):840–4. https://doi.org/10.1111/jce.12417.CrossRefPubMed

Ciconte G, Mugnai G, Sieira J, Velagic V, Saitoh Y, Irfan G, et al. On the quest for the best freeze: predictors of late pulmonary vein reconnections after second-generation cryoballoon ablation. Circ Arrhythm Electrophysiol. 2015;8(6):1359–65. https://doi.org/10.1161/CIRCEP.115.002966.CrossRefPubMed

Ciconte G, Sieira-Moret J, Hacioglu E, Mugnai G, Di Giovanni G, Velagic V, et al. Single 3-minute versus double 4-minute freeze strategy for second-generation cryoballoon ablation: a single-center experience. J Cardiovasc Electrophysiol. 2016;27(7):796–803. https://doi.org/10.1111/jce.12986.CrossRefPubMed

Iacopino S, Mugnai G, Takarada K, Paparella G, Ströker E, De Regibus V, et al. Second-generation cryoballoon ablation without the use of real-time recordings: a novel strategy based on a temperature-guided approach to ablation. Heart Rhythm. 2017;14(3):322–8. https://doi.org/10.1016/j.hrthm.2016.11.023.CrossRefPubMed

Priori SG, Blomström-Lundqvist C, Mazzanti A, Blom N, Borggrefe M, Camm J, et al. 2015 ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. Russ J Cardiol. 2016. https://doi.org/10.15829/1560-4071-2016-7-5-86.

Ghosh J, Sepahpour A, Chan KH, Singarayar S, McGuire MA. Immediate balloon deflation for prevention of persistent phrenic nerve palsy during pulmonary vein isolation by balloon cryoablation. Heart Rhythm. 2013;10(5):646–52. https://doi.org/10.1016/j.hrthm.2013.01.011.CrossRefPubMed

10.

Neumann T, Vogt J, Schumacher B, Dorszewski A, Kuniss M, Neuser H, et al. Circumferential pulmonary vein isolation with the cryoballoon technique. J Am Coll Cardiol. 2008;52(4):273–8. https://doi.org/10.1016/j.jacc.2008.04.021.CrossRefPubMed

11.

Chun KRJ, Schmidt B, Metzner A, Tilz R, Zerm T, Köster I, et al. The “single big cryoballoon” technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. Eur Heart J. 2009;30(6):699–709. https://doi.org/10.1093/eurheartj/ehn570.CrossRefPubMed

12.

Dorwarth U, Schmidt M, Wankerl M, Krieg J, Straube F, Hoffmann E. Pulmonary vein electrophysiology during cryoballoon ablation as a predictor for procedural success. In: Journal of Interventional Cardiac Electrophysiology, vol. 32; 2011. p. 205–11. https://doi.org/10.1007/s10840-011-9585-x.CrossRef

13.

Sorgente A, Chierchia GB, De Asmundis C, Sarkozy A, Namdar M, Capulzini L, et al. Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation. Europace. 2011;13(2):205–12. https://doi.org/10.1093/europace/euq388.CrossRefPubMed

14.

Osório TG, Coutiño HE, Brugada P, Chierchia GB, De Asmundis C. Recent advances in cryoballoon ablation for atrial fibrillation. Expert Rev Med Devices. 2019;16(9):799–808. https://doi.org/10.1080/17434440.2019.1653181.CrossRefPubMed

15.

Knight BP, Novak PG, Sangrigoli R, Champagne J, Dubuc M, Adler SW, et al. Long-term outcomes after ablation for paroxysmal atrial fibrillation using the second-generation cryoballoon. JACC Clin Electrophysiol. 2019;5(3):306–14. https://doi.org/10.1016/j.jacep.2018.11.006.CrossRefPubMed

16.

Choudhury R, Coutino HE, Darciuc R, Ströker E, De Regibus V, Mugnai G, et al. Continuous monitoring after second-generation cryoballoon ablation for paroxysmal atrial fibrillation in patients with cardiac implantable electronic devices. Heart Rhythm. 2019. https://doi.org/10.1016/j.hrthm.2018.08.015.

17.

Fürnkranz A, Köster I, Chun KRJ, Metzner A, Mathew S, Konstantinidou M, et al. Cryoballoon temperature predicts acute pulmonary vein isolation. Heart Rhythm. 2011;8(6):821–5. https://doi.org/10.1016/j.hrthm.2011.01.044.CrossRefPubMed

18.

Ghosh J, Martin A, Keech AC, Chan KH, Gomes S, Singarayar S, et al. Balloon warming time is the strongest predictor of late pulmonary vein electrical reconnection following cryoballoon ablation for atrial fibrillation. Heart Rhythm. 2013;10(9):1311–7. https://doi.org/10.1016/j.hrthm.2013.06.014.CrossRefPubMed

19.

Ciconte G, Chierchia GB, De Asmundis C, Sieira J, Conte G, Juliá J, et al. Spontaneous and adenosine-induced pulmonary vein reconnection after cryoballoon ablation with the second-generation device. J Cardiovasc Electrophysiol. 2014;25(8):845–51. https://doi.org/10.1111/jce.12421.CrossRefPubMed

20.

Heeger CH, Wissner E, Mathew S, Deiss S, Lemes C, Rillig A, et al. Once isolated, always isolated? Incidence and characteristics of pulmonary vein reconduction after second-generation cryoballoon-based pulmonary vein isolation. Circ Arrhythm Electrophysiol. 2015;8(5):1088–94. https://doi.org/10.1161/CIRCEP.115.003007.CrossRefPubMed

21.

Kuck KH, Brugada J, Fürnkranz A, Chun KRJ, Metzner A, Ouyang F, et al. Impact of female sex on clinical outcomes in the FIRE and ICE trial of catheter ablation for atrial fibrillation. Circ Arrhythmia Electrophysiol. 2018;11(5):e006204. https://doi.org/10.1161/CIRCEP.118.006204.CrossRef

22.

Ricciardi D, Arena G, Verlato R, Iacopino S, Pieragnoli P, Molon G, et al. Sex effect on efficacy of pulmonary vein cryoablation in patients with atrial fibrillation: data from the multicenter real-world 1STOP project. J Interv Card Electrophysiol. 2019;56(1):9–18. https://doi.org/10.1007/s10840-019-00601-3.CrossRefPubMed

23.

Chun KRJ, Stich M, Fürnkranz A, Bordignon S, Perrotta L, Dugo D, et al. Individualized cryoballoon energy pulmonary vein isolation guided by real-time pulmonary vein recordings, the randomized ICE-T trial. Heart Rhythm. 2017;14(4):495–500. https://doi.org/10.1016/j.hrthm.2016.12.014.CrossRefPubMed

24.

Santangeli P, Di Biase L, Pelargonio G, Natale A. Outcome of invasive electrophysiological procedures and gender: are males and females the same? J Cardiovasc Electrophysiol. 2011. https://doi.org/10.1111/j.1540-8167.2010.01920.x.

25.

Ströker E, De Asmundis C, Kupics K, Takarada K, Mugnai G, De Cocker J, et al. Value of ultrasound for access guidance and detection of subclinical vascular complications in the setting of atrial fibrillation cryoballoon ablation. Europace. 2019;21(3):434–9. https://doi.org/10.1093/europace/euy154.CrossRefPubMed

Titel: Temperature-guided ablation with the second-generation cryoballoon for paroxysmal atrial fibrillation: 3-year follow-up in a multicenter experience
verfasst von: Gaetano Paparella
Saverio Iacopino
Thiago Guimarães Osório
Juan Pablo Abugattas de Torres
Erwin Ströker
Juan Sieira
Hannes Vanacker
Bernard De Ruyter
Serge Boveda
Riccardo Maj
Gianluca Borio
Alessandro Rizzo
Alessio Galli
Pedro Brugada
Carlo de Asmundis
Gian-Battista Chierchia
Publikationsdatum: 31.05.2020
Verlag: Springer US
Schlagwörter: Atrial Fibrillation
Atrial Flutter
Erschienen in: Journal of Interventional Cardiac Electrophysiology / Ausgabe 1/2021
Print ISSN: 1383-875X
Elektronische ISSN: 1572-8595
DOI: https://doi.org/10.1007/s10840-020-00770-6

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