Skip to main content
SpringerLink
Log in

Increased rate of observed real-time pulmonary vein isolation with third-generation short-tip cryoballoon

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

Abstract

Purpose

Pulmonary vein isolation (PVI) with the cryoballoon is an established treatment for symptomatic atrial fibrillation. The second-generation cryoballoon increased efficacy in comparison to the first-generation cryoballoon. The third-generation cryoballoon was designed with a shorter distal tip to facilitate real-time recording of pulmonary vein (PV) isolation. Here, we compared the rate of real-time recordings of PVI of the second- and third-generation cryoballoon.

Methods

The incidence of real-time recording of PV isolation and time to PV isolation of the first 37 patients treated with the new third-generation cryoballoon at our center were compared to the last 37 patients treated with the second-generation cryoballoon.

Results

One hundred forty-nine pulmonary veins (PVs) were identified in each group. All PVs were isolated successfully with the second- or third-generation cryoballoon. Real-time registration of PVI occurred in 83 PVs (55.7 %) with the second-generation cryoballoon and in 124 PVs (83.2 %) with the third-generation cryoballoon (p < 0.001). The rate of observed real-time PVI was significantly higher with the third-generation cryoballoon for each individual PV. The time-to-isolation was 44 ± 25 s with the second-generation cryoballoon vs. 42 ± 22 s with the third-generation cryoballoon (p = 0.25). In a short-term clinical follow-up, there was no significant difference in atrial arrhythmia recurrence rates between both groups.

Conclusions

The third-generation cryoballoon facilitates real-time recording of PV isolation with significantly higher rates of observed time-to-isolation. The time to PV isolation is not different between second- and third-generation cryoballoon.

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

Similar content being viewed by others

References

  1. Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med 2016;374(23):2235–45.

  2. Luik A, Radzewitz A, Kieser M, Walter M, Bramlage P, Hormann P, et al. Cryoballoon versus open irrigated radiofrequency ablation in patients with paroxysmal atrial fibrillation: The prospective, randomized, controlled, noninferiority freezeAF study. Circulation. 2015;132(14):1311–9.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Packer DL, Kowal RC, Wheelan KR, Irwin JM, Champagne J, Guerra PG, et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013;61(16):1713–23.

    Article  PubMed  Google Scholar 

  4. Aryana A, Morkoch S, Bailey S, Lim HW, Sara R, d’Avila A, 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. 2014;41(2):177–86.

    Article  PubMed  Google Scholar 

  5. Aytemir K, Gurses KM, Yalcin MU, Kocyigit D, Dural M, Evranos B, et al. Safety and efficacy outcomes in patients undergoing pulmonary vein isolation with second-generation cryoballoondagger. Europace. 2015;17(3):379–87.

    Article  PubMed  Google Scholar 

  6. 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.

    Article  PubMed  Google Scholar 

  7. 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.

    Article  PubMed  Google Scholar 

  8. Furnkranz 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.

    Article  PubMed  Google Scholar 

  9. Jourda F, Providencia R, Marijon E, Bouzeman A, Hireche H, Khoueiry Z, et al. Contact-force guided radiofrequency vs. second-generation balloon cryotherapy for pulmonary vein isolation in patients with paroxysmal atrial fibrillation-a prospective evaluation. Europace. 2015;17(2):225–31.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Pandya B, Sheikh A, Spagnola J, Bekheit S, Lafferty J, Kowalski M. Safety and efficacy of second-generation versus first-generation cryoballoons for treatment of atrial fibrillation: a meta-analysis of current evidence. J Interv Card Electrophysiol. 2016;45(1):49–56.

    Article  PubMed  Google Scholar 

  12. Aryana A, Mugnai G, Singh SM, Pujara DK, de Asmundis C, Singh SK, et al. Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation. Heart Rhythm. 2016;13(2):424–32.

    Article  PubMed  Google Scholar 

  13. 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.

    PubMed  Google Scholar 

  14. Ciconte G, Velagic V, Mugnai G, Saitoh Y, Irfan G, Hunuk B, et al. Electrophysiological findings following pulmonary vein isolation using radiofrequency catheter guided by contact-force and second-generation cryoballoon: lessons from repeat ablation procedures. Europace. 2016;18(1):71–7.

    Article  PubMed  Google Scholar 

  15. Lakhani M, Saiful F, Parikh V, Goyal N, Bekheit S, Kowalski M. Recordings of diaphragmatic electromyograms during cryoballoon ablation for atrial fibrillation accurately predict phrenic nerve injury. Heart Rhythm. 2014;11(3):369–74.

    Article  PubMed  Google Scholar 

  16. Mondesert B, Andrade JG, Khairy P, Guerra PG, Dyrda K, Macle L, et al. Clinical experience with a novel electromyographic approach to preventing phrenic nerve injury during cryoballoon ablation in atrial fibrillation. Circ Arrhythm Electrophysiol. 2014;7(4):605–11.

    Article  PubMed  Google Scholar 

  17. Furnkranz A, Bologna F, Bordignon S, Perrotta L, Dugo D, Schmidt B, Chun JK. Procedural characteristics of pulmonary vein isolation using the novel third-generation cryoballoon. Europace. 2016, [Epub ahead of print].

  18. Heeger CH, Wissner E, Mathew S, Hayashi K, Sohns C, Reissmann B et al. Short tip-big difference? First-in-man experience and procedural efficacy of pulmonary vein isolation using the third-generation cryoballoon. Clin Res Cardiol. 2015;105(6):482–8.

  19. Mugnai G, de Asmundis C, Hunuk B, Stroker E, Moran D, Hacioglu E et al. Improved visualisation of real-time recordings during third generation cryoballoon ablation: a comparison between the novel short-tip and the second generation device. J Interv Card Electrophysiol. 2016, [Epub ahead of print].

Download references

Author information

Authors and Affiliations

  1. Department of Medicine II, Ulm University Medical Center, Albert-Einstein-Allee 23, 89081, Ulm, Germany

    Alexander Pott, Kerstin Petscher, Marvin Messemer, Wolfgang Rottbauer & Tillman Dahme

Authors
  1. Alexander Pott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kerstin Petscher
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marvin Messemer
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wolfgang Rottbauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tillman Dahme
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tillman Dahme.

Ethics declarations

Funding sources

None

Disclosures

T. Dahme received speaker’s honoraria from Medtronic. The other authors have no conflicts to report.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pott, A., Petscher, K., Messemer, M. et al. Increased rate of observed real-time pulmonary vein isolation with third-generation short-tip cryoballoon. J Interv Card Electrophysiol 47, 333–339 (2016). https://doi.org/10.1007/s10840-016-0160-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-016-0160-3

Keywords

Search

Navigation