Skip to main content
SpringerLink
Log in

Acute procedural and cryoballoon characteristics from cryoablation of atrial fibrillation using the first- and second-generation cryoballoon: a retrospective comparative study with follow-up outcomes

  • Published:
Journal of Interventional Cardiac Electrophysiology Aims and scope Submit manuscript

Abstract

Purpose

There is limited data available on the safety and efficacy of the second-generation cryoballoon (CB-2) for cryoablation of atrial fibrillation (Cryo-AF). We evaluated the procedural, biophysical, and clinical outcomes of Cryo-AF in a large patient cohort using CB-2 as compared with the first-generation cryoballoon (CB-1).

Methods

Three-hundred and forty consecutive patients undergoing Cryo-AF with CB-1 (n = 140) and CB-2 (n = 200) were retrospectively evaluated.

Results

Paroxysmal AF was more prevalent in CB-1 (86 %) versus CB-2 (72 %) (p = 0.001). During Cryo-AF, the mean balloon temperature was lower with CB-2 at 30 s (8 versus −4 °C; p < 0.001) and 60 s (−26 versus −32 °C; p < 0.001) with equivalent nadir temperatures (both at −50 °C; p = 0.542). With CB-2, time-to-nadir temperature was shorter (232 versus 209 s; p < 0.001) and thaw times were longer (47 versus 53 s; p < 0.001). Acute pulmonary vein (PV) isolation rate was higher with CB-2 (92 versus 98 %; p = 0.036) despite reduced cryoablation time (61 versus 47 min; p < 0.001) and freeze area-under-the-curve (−155,044 versus −116,740 s °C; p < 0.001). With CB-2, procedure time (209 versus 154 min; p < 0.001) and fluoroscopy time (42 versus 27 min; p < 0.001) were shorter, with similar acute/long-term adverse events (AEs) and freedom from AF at 6, 9, and 12 months (89, 86, and 82 %) during 16 ± 8 months of follow-up. However, CB-2 was associated with lower PV reconnection rates at redo ablation (30 versus 13 %; p = 0.037).

Conclusions

With CB-2, acute and long-term PV isolation rates were higher despite shorter ablations, faster balloon cooling, and longer thaw times, with similar AE rates and freedom from AF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Packer, D. L., Kowal, R. C., Wheelan, K. R., Cryoablation Investigators, S. T. O. P. A. F., et al. (2013). Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. Journal of the American College of Cardiology, 61(16), 1713–1723.

    Article  PubMed  Google Scholar 

  2. Namdar, M., Chierchia, G. B., Westra, S., et al. (2012). Isolating the pulmonary veins as first-line therapy in patients with lone paroxysmal atrial fibrillation using the Cryoballoon. Europace, 14(2), 197–203.

    Article  PubMed  Google Scholar 

  3. Van Belle, Y., Janse, P., Theuns, D., Szili-Torok, T., & Jordaens, L. (2008). One year follow-up after cryoballoon isolation of the pulmonary veins in patients with paroxysmal atrial fibrillation. Europace, 10(11), 1271–1276.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Klein, G., Oswald, H., Gardiwal, A., et al. (2008). Efficacy of pulmonary vein isolation by cryoballoon ablation in patients with paroxysmal atrial fibrillation. Heart Rhythm, 5(6), 802–806.

    Article  PubMed  Google Scholar 

  5. Neumann, T., Vogt, J., Schumacher, B., et al. (2008). Circumferential pulmonary vein isolation with the cryoballoon technique: results from a prospective 3-center study. Journal of the American College of Cardiology, 52(4), 273–278.

    Article  PubMed  Google Scholar 

  6. Fürnkranz, A., Chun, K. R., Nuyens, D., et al. (2010). Characterization of conduction recovery after pulmonary vein isolation using the “single big cryoballoon” technique. Heart Rhythm, 7(2), 184–190.

    Article  PubMed  Google Scholar 

  7. Fürnkranz, A., Bordignon, S., Schmidt, B., et al. (2013). Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. Journal of Cardiovascular Electrophysiology, 24(5), 492–497.

    Article  PubMed  Google Scholar 

  8. Casado-Arroyo, R., Chierchia, G. B., 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(9), 1318–1324.

    Article  PubMed  Google Scholar 

  9. Fürnkranz, A., Bordignon, S., Schmidt, B., et al. (2013). Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation. Heart Rhythm, 10(6), 789–793.

    Article  PubMed  Google Scholar 

  10. Metzner, A., Burchard, A., Wohlmuth, P., et al. (2013). Increased incidence of esophageal thermal lesions using the second-generation 28 mm cryoballoon. Circulation. Arrhythmia and Electrophysiology, 6(4), 769–775.

    Article  PubMed  Google Scholar 

  11. Lim, H. W., Cogert, G. A., Cameron, C. S., Cheng, V. Y., Sandler, D. A. (2014). Atrioesophageal fistula during cryoballoon ablation for atrial fibrillation. Journal of Cardiovascular Electrophysiology, 25(2), 208–213.

  12. Andrade, J. G., Dubuc, M., Guerra, P. G., et al. (2013). Pulmonary vein isolation using a second-generation cryoballoon catheter: a randomized comparison of ablation duration and method of deflation. Journal of Cardiovascular Electrophysiology, 24(6), 692–698.

    Article  PubMed  Google Scholar 

  13. Chierchia, G. B., 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. Journal of Interventional Cardiac Electrophysiology, 39(2), 145–151.

    Article  PubMed  Google Scholar 

  14. Fürnkranz, A., Bordignon, S., Dugo, D., et al. (2014). Improved one-year clinical success rate of pulmonary vein isolation with the second-generation cryoballoon in patients with paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology, 25(8), 840–844.

  15. Giovanni, G. D., Wauters, K., Chierchia, G. B., et al. (2014). One-year follow-up after single procedure cryoballoon ablation: a comparison between the first and second generation balloon. Journal of Cardiovascular Electrophysiology, 25(8), 834-839.

  16. Chinitz, J. S., Kulina, R. A., Gangireddy, S. R., et al. (2013). Objective quality assessment of atrial fibrillation ablation: a novel scoring system. Heart Rhythm, 10(7), 1074–1079.

    Article  PubMed  Google Scholar 

  17. Chun, K. R., Schmidt, B., Metzner, A., et al. (2009). The ‘single big cryoballoon’ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. European Heart Journal, 30(6), 699–709.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Ciconte, G., Chierchia, G. B., de Asmundis, C., et al. (2014). Spontaneous and adenosine-induced pulmonary vein reconnection after cryoballoon ablation with the second generation device. Journal of Cardiovascular Electrophysiology, 25(8), 848–851.

  19. Knecht, S., Kühne, M., Osswald, S., Sticherling, C., et al. (2014). Quantitative assessment of a second-generation cryoballoon ablation catheter with new cooling technology—a perspective on potential implications on outcome. Journal of Cardiovascular Electrophysiology, 40(1), 17–21.

    Article  Google Scholar 

  20. Metzner, A., Reissmann, B., Rausch, P., et al. (2014). One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circulation. Arrhythmia and Electrophysiology, 7(2), 288–292.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  22. Bordignon, S., Fürnkranz, A., Dugo, D., et al. (2014). Improved lesion formation using the novel 28 mm cryoballoon in atrial fibrillation ablation: analysis of biomarker release. Europace, 16(7), 987–993.

    Article  PubMed  Google Scholar 

  23. Metzner, A., Rausch, P., Lemes, C., et al. (2014). The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. Journal of Cardiovascular Electrophysiology, 25(5), 466–470.

    Article  PubMed  Google Scholar 

  24. Gage, A. A., & Baust, J. (1998). Mechanisms of tissue injury in cryosurgery. Cryobiology, 37(3), 171–186.

    Article  PubMed  CAS  Google Scholar 

  25. Ghosh, J., Martin, A., Keech, A. C., et al. (2013). Balloon warming time is the strongest predictor of late pulmonary vein electrical reconnection following cryoballoon ablation for atrial fibrillation. Heart Rhythm, 10(9), 1311–1317.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

H. Lim and R. Sara are employees of Medtronic, Inc., the manufacturer of the cryoballoons evaluated in this study.

Author information

Authors and Affiliations

  1. Regional Cardiology Associates, 3941 J Street, Suite #350, Sacramento, CA, 95819, USA

    Arash Aryana, Shemsa Morkoch & P. Gearoid O’Neill

  2. Mercy General Hospital, Dignity Health Heart & Vascular Institute​, 4001 J Street, Sacramento, Sacramento, CA, 95819, USA

    Arash Aryana, Sean Bailey & P. Gearoid O’Neill

  3. Medtronic, Inc., Minneapolis, MN, USA

    Hae W. Lim & Rahmani Sara

  4. Hospital Cardiologico, Florianópolis, SC, Brazil

    André d’Avila

Authors
  1. Arash Aryana
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shemsa Morkoch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sean Bailey
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hae W. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Rahmani Sara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. André d’Avila
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. P. Gearoid O’Neill
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arash Aryana.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Aryana, A., Morkoch, S., Bailey, S. et al. Acute procedural and cryoballoon characteristics from cryoablation of atrial fibrillation using the first- and second-generation cryoballoon: a retrospective comparative study with follow-up outcomes. J Interv Card Electrophysiol 41, 177–186 (2014). https://doi.org/10.1007/s10840-014-9942-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-014-9942-7

Keywords

Search

Navigation