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Fortschritte der Kryoballon-Technik

Nutzen und Risiken in der täglichen Anwendung

Advances in cryoballoon technology

Benefits and risks in daily practice

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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Die Kryoballonablation ist ein Standardverfahren zur Isolation der Pulmonalvenen bei symptomatischem Vorhofflimmern. Die zweite Generation des Kryoballons wurde 2012 eingeführt, eine höhere Effizienz aufgrund mehrerer Verbesserungen des Systems wurde erwartet.

Ziel der Arbeit und Methoden

Es wird ein Überblick über die Neuerungen in der Kryoballonablation und über Konsequenzen in der Anwendung auf Grundlage einer PubMed-Literaturrecherche und unter Berücksichtigung eigener Erfahrungen gegeben.

Ergebnisse und Diskussion

Die Weiterentwicklungen der Kryoballontechnik haben die Effizienz des Verfahrens weiter gesteigert. Um trotz der verbesserten Wirksamkeit Nebenwirkungen, wie die rechtsseitige Phrenikusparese oder Ösophagusläsionen zu verhindern, ist besondere Sorgfalt erforderlich. Empirische Abbruchkriterien werden etabliert. Eine Zunahme klinisch relevanter Komplikationen wurde nicht beobachtet. Ob Empfehlungen für eine gezielte Titration der Energie in Zukunft mit dem neuen Ballon möglich sind, muss geklärt werden. Prospektive Studien sind unterwegs, um die Kryoballon- und die RF-Ablation multizentrisch direkt zu vergleichen und um den Stellenwert der Kryoballonablation als Erstlinientherapie zu klären.

Abstract

Background

Cryoballoon ablation is nowadays a standard approach for pulmonary vein isolation in symptomatic atrial fibrillation. The second generation cryoballoon was introduced in 2012 and modifications and enhancement to the system promised a higher efficiency.

Objectives, materials and methods

A comprehensive overview of advances in cryoballoon ablation is provided and the consequences for daily practice are described based on a PubMed literature search, taking into account own experiences.

Results and conclusion

Advances in cryoballoon ablation result in a significantly higher efficiency. To maintain the overall safety of the procedure and to avoid phrenic nerve palsy and esophageal lesions, special care needs to be taken by following some safety aspects and cut-off criteria. More data are necessary to clarify if recommendations for cryoenergy titration with the new balloon are reasonable. Ongoing prospective studies comparing cryoballoon and radiofrequency (RF) ablation will give answers to the question which energy source is more favorable, and upcoming studies will evaluate the impact of cryoballoon ablation as a first line treatment option.

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Literatur

  1. Andrade JG, Khairy P, Guerra PG et al. (2011) Efficacy and safety of cryoballoon ablation for atrial fibrillation: A systematic review of published studies. Heart Rhythm 8:1444–1451

    Article  PubMed  Google Scholar 

  2. Andrade JG, Dubuc M, Guerra PG et al. (2013) Pulmonary vein isolation using a second-generation cryoballoon catheter: A randomized comparison of ablation duration and method of deflation. J Cardiovasc Electrophysiol 24:692–698

    Article  PubMed  Google Scholar 

  3. Calkins H, Kuck KH, Cappato R et al. (2012) 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 14:528–606

    Article  PubMed  Google Scholar 

  4. Casado-Arroyo R, Chierchia GB, Conte G et al. (2013) Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: A comparison between the first- and second-generation balloon. Heart Rhythm 10:1318–1324

    Article  PubMed  Google Scholar 

  5. Chierchia GB, Di Giovanni G, Ciconte G et al. (2014) Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-up. Europace 16:639–644

    Article  PubMed  Google Scholar 

  6. Chierchia GB, Di Giovanni G, Sieira-Moret J et al. (2014) Initial experience of three-minute freeze cycles using the second-generation cryoballoon ablation: acute and short-term procedural outcomes. J Interv Card Electrophysiol 39:145–151

    Article  PubMed  Google Scholar 

  7. Chun KR, Schmidt B, Metzner A et al. (2009) The ’single ‚single big cryoballoon’ cryoballoon‘ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: A prospective observational single centre study. Europ Heart J 30:699–709

    Article  Google Scholar 

  8. Dorwarth U, Schmidt M, Wankerl M et al. (2011) Pulmonary vein electrophysiology during cryoballoon ablation as a predictor for procedural success. J Interv Card Electrophysiol 32:205–211

    Article  PubMed  Google Scholar 

  9. Franceschi F, Koutbi L, Mancini J et al. (2013) Novel electromyographic monitoring technique for prevention of right phrenic nerve palsy during cryoballoon ablation. Circ Arrhythm Electrophysiol 6:1109–1114

    Article  PubMed  Google Scholar 

  10. Furnkranz A, Chun KR, Nuyens D et al. (2010) Characterization of conduction recovery after pulmonary vein isolation using the „single big cryoballoon“ technique. Heart Rhythm 7:184–190

    Article  PubMed  Google Scholar 

  11. Furnkranz A, Bordignon S, Schmidt B et al. (2013) Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation. Heart Rhythm 10:789–793

    Article  PubMed  Google Scholar 

  12. Furnkranz A, Bordignon S, Schmidt B et al. (2013) Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol 24:492–497

    Article  PubMed  Google Scholar 

  13. Gage AA, Baust JM, Baust JG (2009) Experimental cryosurgery investigations in vivo. Cryobiology 59:229–243

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  14. Giovanni GD, Wauters K, Chierchia GB et al. (2014) One-year follow-up after single single procedure procedure cryoballoon cryoballoon ablationablation: A a comparison comparison between the first first and second second generation generation balloon. J Cardiovasc Electrophysiol. doi: 10.1111/jce.12409

  15. Ho SY, Cabrera JA, Sanchez-Quintana D (2012) Left atrial anatomy revisited. Circ Arrhythm Electrophysiol 5:220–228

    Article  PubMed  Google Scholar 

  16. Khairy P, Chauvet P, Lehmann J et al. (2003) Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation 107:2045–2050

    Article  PubMed  Google Scholar 

  17. Kojodjojo P, O’’neill MD, Lim PB et al. (2010) Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: Medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation. Heart 96:1379–1384

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kuhne M, Knecht S, Altmann D et al. (2013) Validation of a novel spiral mapping catheter for real-time recordings from the pulmonary veins during cryoballoon ablation of atrial fibrillation. Heart Rhythm 10:241–246

    Article  PubMed  Google Scholar 

  19. Lakhani M, Saiful F, Bekheit S et al. (2012) Use of intracardiac echocardiography for early detection of phrenic nerve injury during cryoballoon pulmonary vein isolation. JCardiovascElectrophysiols23:874–876

    Article  Google Scholar 

  20. Lim HW, Cogert GA, Cameron CS et al. (2013) Atrioesophageal fistula during during cryoballoon cryoballoon ablation ablation for atrial atrial fibrillationfibrillation. J Cardiovasc Electrophysiol. doi: 10.1111/jce.12313

  21. Lustgarten DL, Keane D, Ruskin J (1999) Cryothermal ablation: mechanism of tissue injury and current experience in the treatment of tachyarrhythmias. Progress Cardiovasc Diseases 41:481–498

    Article  CAS  Google Scholar 

  22. Metzner A, Rausch P, Lemes C et al. (2014) The incidence incidence of phrenic phrenic nerve nerve injury injury during during pulmonary pulmonary vein vein isolation isolation using using the secondsecond-generation generation 28 mm cryoballoon. J Cardiovasc Electrophysiol 25:466–470

    Article  PubMed  Google Scholar 

  23. Metzner A, Reissmann B, Rausch P et al. (2014) One-year clinical clinical outcome outcome after pulmonary pulmonary vein vein isolation isolation using the secondsecond-generation generation 28 mm cryoballooncryoballoon. Circ Arrhythm Electrophysiol 7:288–292

    Article  PubMed  Google Scholar 

  24. Morillo CA, Verma A, Connolly SJ et al. (2014) Radiofrequency ablation vs antiarrhythmic drugs as first-line treatment of paroxysmal atrial fibrillation (RAAFT-2): a randomized trial. JAMA 311:692–700

    Article  CAS  PubMed  Google Scholar 

  25. Packer DL, Kowal RC, Wheelan KR et al. (2013) Cryoballoon ablation ablation of pulmonary pulmonary veins veins for paroxysmal paroxysmal atrial atrial fibrillationfibrillation: First first results results of the north american arctic front (stop AF) pivotal pivotal trialtrial. J Am Coll Cardiol 61:1713–1723

    Article  PubMed  Google Scholar 

  26. Piccini JP, Lopes RD, Kong MH et al. (2009) Pulmonary vein isolation for the maintenance of sinus rhythm in patients with atrial fibrillation: A meta-analysis of randomized, controlled trials. Circ Arrhythm Electrophysiol 2:626–633

    Article  PubMed  Google Scholar 

  27. Ripley KL, Gage AA, Olsen DB et al. (2007) Time course of esophageal lesions after catheter ablation with cryothermal and radiofrequency ablation: Implication for atrio-esophageal fistula formation after catheter ablation for atrial fibrillation. J Cardiovasc Electrophysiol 18:642–646

    Article  PubMed  Google Scholar 

  28. Schmidt M, Daccarett M, Marschang H et al. (2010) Intracardiac echocardiography improves procedural efficiency during cryoballoon ablation for atrial fibrillation: A pilot study. J Cardiovasc Electrophysiol 21:1202–1207

    Article  PubMed  Google Scholar 

  29. Schmidt M, Dorwarth U, Andresen D et al. (2014) Cryoballoon versus RF ablation ablation in paroxysmal paroxysmal atrial atrial fibrillationfibrillation: Results results from the german ablation ablation registryregistry. J Cardiovasc Electrophysiol 25:1–7

    Article  PubMed  Google Scholar 

  30. Schmidt M, Straube F, Ebersberger U et al. (2012) [Cardiac computed tomography and ablation of atrial fibrillation]. Herzschrittmachertherapie & Elektrophysiologie 23:281–288

    Article  Google Scholar 

  31. Schmidt M, Dorwarth U, Straube F et al. (2013) Cryoballoon in AF ablation: Impact of PV ovality on AF recurrence. IntJ Cardiol 167:114–120

    Google Scholar 

  32. Siklody CH, Minners J, Allgeier M et al. (2010) Pressure-guided cryoballoon isolation of the pulmonary veins for the treatment of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 21:120–125

    Article  PubMed  Google Scholar 

  33. Straube F, Dorwarth U, Schmidt M et al. (2014) Comparison of the first and second cryoballoon: High-volume single-center safety and efficacy analysis. Circ Arrhythm Electrophysiol 7(2):293–299. doi:10.1161/CIRCEP.113.000899. (Epub 2014 Mar 7)

  34. Thomas D, Katus HA, Voss F (2011) Asymptomatic pulmonary vein stenosis after cryoballoon catheter ablation of paroxysmal atrial fibrillation. J Electrocardiol 44:473–476

    Article  PubMed  Google Scholar 

  35. Wilke T, Groth A, Mueller S et al. (2013) Incidence and prevalence of atrial fibrillation: An analysis based on 8.3 million patients. Europace 15:486–493

    Article  PubMed  Google Scholar 

  36. Xu J, Huang Y, Cai H et al. (2014) Is cryoballoon ablation preferable to radiofrequency ablation for treatment of atrial fibrillation by pulmonary vein isolation? A meta-analysis. PloS one 9:e90323

    Article  PubMed Central  PubMed  Google Scholar 

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Interessenskonflikte

Dr. Straube, Dr. Dorwarth: Vortragshonorare und finanzielle Unterstützung für Fortbildungsreisen von Medtronic GmbH, CoreLab Tätigkeit für die FIRE&ICE Studie. Prof. Dr. Hoffmann: Vortragshonorare von Medtronic GmbH, Hauptprüfer der FREEZE Cohort Study, durchgeführt vom IHF Ludwigshafen und finanziell von der Medtronic GmbH unterstützt.

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Authors and Affiliations

  1. Klinik für Kardiologie und internistische Intensivmedizin, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Straße 77, 81925, München, Deutschland

    Florian Straube, Uwe Dorwarth & Ellen Hoffmann

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  1. Florian Straube
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  2. Uwe Dorwarth
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  3. Ellen Hoffmann
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Correspondence to Florian Straube.

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Straube, F., Dorwarth, U. & Hoffmann, E. Fortschritte der Kryoballon-Technik. Herzschr Elektrophys 25, 230–235 (2014). https://doi.org/10.1007/s00399-014-0329-3

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