Skip to main content
SpringerLink
Log in

The optimized clinical workflow for pulmonary vein isolation with the radiofrequency balloon

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

Abstract

Purpose

Pulmonary vein isolation (PVI) with radiofrequency (RF) catheter ablation is an effective treatment option for patients with paroxysmal AF. However, traditional point by point RF ablation can be time consuming and technically challenging. To simplify the ablation procedure, without compromising procedure outcome, several “single shot” ablation systems have been developed. The multi-electrode RF Balloon catheter HELIOSTAR is a 28-mm compliant balloon compatible with the CARTO 3D electroanatomical mapping system; an optimized step-by-step workflow to perform PVI is described.

Methods

Procedures are performed under general anesthesia with unique transseptal puncture. To evaluate the optimal electrode-tissue contact and best RF Balloon positioning, the following baseline indicators should be fulfilled: inflation index > 0.8, impedance range close to 100 Ohms with a variability of less than 20 Ohms across electrodes, temperature variability on all electrodes < 3 °C with a maximum temperature of 31 °C.

Results

RF delivery along the posterior wall is programmed to 20 s or shorter in case of esophageal temperature rise (> 2 °C compared to baseline) and 60 s for all the other segments. Target parameters for PVI are 1) time to isolation less than 12 s; 2) impedance drop > 12 Ohms; 3) temperature rise > 6 °C.

Conclusions

Standardized workflow for RF Balloon is mandatory to achieve efficacy and safety with this new promising technology. In the absence of international guidelines, a single high-volume center procedural strategy is described for PVI.

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

Similar content being viewed by others

Data availability

Not applicable.

Code availability

Not applicable.

Abbreviations

AF:

Atrial fibrillation

PVI:

Pulmonary vein isolation

RF:

Radiofrequency

References

  1. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons. Circulation NLM (Medline). 2019;140:e125–51.

    Google Scholar 

  2. Taghji P, el Haddad M, Phlips T, et al. Evaluation of a Strategy Aiming to Enclose the Pulmonary Veins With Contiguous and Optimized Radiofrequency Lesions in Paroxysmal Atrial Fibrillation: A Pilot Study. JACC: Clinical Electrophysiology Elsevier Inc, 2018; 4:99–108.

  3. Duytschaever M, de Pooter J, Demolder A, et al. Long-term impact of catheter ablation on arrhythmia burden in low-risk patients with paroxysmal atrial fibrillation: The CLOSE to CURE study. Heart Rhythm Elsevier B.V., 2020; 17:535–543.

  4. Murray MI, Arnold A, Younis M, Varghese S, Zeiher AM. Cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation: a meta-analysis of randomized controlled trials. Clinical Research in Cardiology [Internet] Dr. Dietrich Steinkopff Verlag GmbH and Co. KG, 2018 [cited 2021 Jun 5]; 107:658–669. Available from: https://pubmed.ncbi.nlm.nih.gov/29564527/.

  5. Kuck KH, Albenque JP, Chun KRJ, et al. Repeat Ablation for Atrial Fibrillation Recurrence Post Cryoballoon or Radiofrequency Ablation in the FIRE and ICE Trial. Circulation: Arrhythmia and Electrophysiology [Internet] Lippincott Williams and Wilkins, 2019 [cited 2021 Jun 5]; 12. Available from: https://pubmed.ncbi.nlm.nih.gov/31693319/.

  6. Dhillon GS, Honarbakhsh S, di Monaco A, et al. Use of a multi-electrode radiofrequency balloon catheter to achieve pulmonary vein isolation in patients with paroxysmal atrial fibrillation: 12-Month outcomes of the RADIANCE study. Journal of Cardiovascular Electrophysiology [Internet] Blackwell Publishing Inc., 2020 [cited 2021 Jun 5]; 31:1259–1269. Available from: https://pubmed.ncbi.nlm.nih.gov/32250514/.

  7. Schilling R, Dhillon GS, Tondo C, et al. Safety, effectiveness, and quality of life following pulmonary vein isolation with a multi-electrode radiofrequency balloon catheter in paroxysmal atrial fibrillation: 1-year outcomes from SHINE. EP Europace [Internet] Oxford University Press (OUP), 2020 [cited 2021 Apr 29]; . Available from: https://pubmed.ncbi.nlm.nih.gov/33450010/.

  8. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373–498. https://doi.org/10.1093/eurheartj/ehaa612.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101 1090, Brussels, Belgium

    Alexandre Almorad, Gian Battista Chierchia, Luigi Pannone, Thiago Guimaraes Osorio, Antonio Sorgente, Antonio Bisignani, Gezim Bala, Ingrid Overeinder, Erwin Ströker, Pedro Brugada, Juan Sieira & Carlo de Asmundis

Authors
  1. Alexandre Almorad
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gian Battista Chierchia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Luigi Pannone
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Thiago Guimaraes Osorio
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Antonio Sorgente
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Bisignani
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Gezim Bala
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ingrid Overeinder
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Erwin Ströker
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Pedro Brugada
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Juan Sieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Carlo de Asmundis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carlo de Asmundis.

Ethics declarations

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Conflict of interest

AB is a consultant for Biotronik. PB received compensation for teaching purposes from Biotronik. MLM is consultant for Atricure. GC received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Boston Scientific, Acutus Medical. CdA receives research grants on behalf of the center from Biotronik, Medtronic, Abbott, LivaNova, Boston Scientific, AtriCure, Philips, and Acutus; CdA received compensation for teaching purposes and proctoring from Medtronic, Abbott, Biotronik, Livanova, Boston Scientific, Atricure, Acutus Medical, Daiichi Sankyo. The remaining authors have nothing to disclose.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Alexandre Almorad and Gian Battista Chierchia are shared first authors.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 52780 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Almorad, A., Chierchia, G.B., Pannone, L. et al. The optimized clinical workflow for pulmonary vein isolation with the radiofrequency balloon. J Interv Card Electrophysiol 64, 531–538 (2022). https://doi.org/10.1007/s10840-021-01094-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-021-01094-9

Keywords

Search

Navigation