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Single freeze strategy with the second- generation cryballoon for atrial fibrillation: a multicenter international retrospective analysis in a large cohort of patients

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Abstract

Purpose

The second-generation cryoballoon (CB-A, Arctic Front Advance, Medtronic, Minneapolis, MN, USA) has proven to be highly effective in achieving freedom from atrial fibrillation; nonetheless, the ideal number and duration of freezing cycles is still a matter of debate. We investigated the acute success, procedural complications, and clinical outcome of a single freeze strategy using the CB-A in a large, retrospective, international multicenter study.

Methods

Between January 2013 and September 2015, 818 consecutive patients (58 ± 12 years, 68% males) with drug-resistant atrial fibrillation (AF) who underwent a CB-A using a single freeze strategy were taken into consideration for our analysis.

Results

Paroxysmal AF was documented in 74.1% of the patients, while 25.9% presented with persistent AF. Additional freezes were needed in a mean 1.4 veins per patient. 0.2% of the patients experienced persistent PNP that was still documented at the last follow-up. After a median follow-up of 14 ± 8 months, taking into consideration a blanking period (BP) of 3 months, 692 patients (84.6%) were free from arrhythmia recurrence. After a single procedure, AF recurrence during BP and persistent AF were identified as predictors of clinical recurrence after BP.

Conclusions

Single freeze CB-A ablation is effective in treating drug-resistant AF and affords freedom from arrhythmia recurrences in 84.6% of patients during a 14-month follow-up. Persistent AF and recurrence during BP are predictors of arrhythmia recurrences.

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References

  1. 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;16:639–44.

    Article  PubMed  Google Scholar 

  2. Irfan G, de Asmundis C, Mugnai G, Poelaert J, Verborgh C, Umbrain V, et al. One-year follow-up after second-generation cryoballoon ablation for atrial fibrillation in a large cohort of patients: a single-centre experience. Europace. 2016;18:987–93.

    Article  PubMed  Google Scholar 

  3. 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;7:288–92.

    Article  PubMed  Google Scholar 

  4. 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;25:834–9.

    Article  PubMed  Google Scholar 

  5. Fürnkranz A, Bordignon S, Schmidt B, Gunawardene M, Schulte-Hahn B, Urban V, et al. Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol. 2013;24:492–7.

    Article  PubMed  Google Scholar 

  6. Ciconte G, de Asmundis C, Sieira J, Conte G, Di Giovanni G, Mugnai G, et al. Single 3-minute freeze for second-generation cryoballoon ablation: one-year follow up after pulmonary vein isolation. Heart Rhythm. 2015;12:673–80.

    Article  PubMed  Google Scholar 

  7. 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;27:796–803.

    Article  PubMed  Google Scholar 

  8. Wissner E, Heeger CH, Grahn H, Reissmann B, Wohlmuth P, Lemes C, et al. One-year clinical success of a ‘no-bonus’ freeze protocol using the second-generation 28 mm cryoballoon for pulmonary vein isolation. Europace. 2015;17(8):1236–40.

    Article  PubMed  Google Scholar 

  9. Medi C, Evered L, Silbert B, Teh A, Halloran K, Morton J, et al. Subtle post-procedural cognitive dysfunction after atrial fibrillation ablation. J Am Coll Cardiol. 2013;62(6):531–9.

    Article  PubMed  Google Scholar 

  10. Andrade JG, Dubuc M, Guerra PG, Landry E, Coulombe N, Leduc H, et al. Pulmonary vein isolation using a second-generation cryoballoon catheter: a randomized comparison of ablation duration and method of deflation. J Cardiovasc Electrophysiol. 2013;24:692–8.

    Article  PubMed  Google Scholar 

  11. Coulombe N, Paulin J, Su W. Improved in vivo performance of secondgeneration cryoballoon for pulmonary vein isolation. J Cardiovasc Electrophysiol. 2013;24:919–25.

    Article  PubMed  Google Scholar 

  12. Dubuc M, Roy D, Thibault B, Ducharme A, Tardif JC, Villemaire C, et al. Transvenous catheter ice mapping and cryoablation of the atrioventricular node in dogs. Pacing Clin Electrophysiol. 1999;22:1488–98.

    Article  CAS  PubMed  Google Scholar 

  13. Chierchia GB, Di Giovanni G, Sieira-Moret J, de Asmundis C, Conte G, Rodriguez-Mañero M, et al. Initial experience of three-minute freeze cycles using the second-generation cryoballoon ablation: acute and short-term procedural outcomes. J Interv Card Electrophysiol. 2014 Mar;39(2):145–51.

    Article  PubMed  Google Scholar 

  14. Miyazaki S, Hachiya H, Nakamura H, Taniguchi H, Takagi T, Hirao K, et al. Pulmonary vein isolation using a second-generation cryoballoon in patients with paroxysmal atrial fibrillation: one-year outcome using a single big-balloon 3-minute freeze technique. J Cardiovasc Electrophysiol. 2016 Dec;27(12):1375–80.

    Article  PubMed  Google Scholar 

  15. 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;10:646–52.

    Article  PubMed  Google Scholar 

  16. Chun KR, Fürnkranz A, Köster I, Metzner A, Tönnis T, Wohlmuth P, et al. Two versus one repeat freeze-thaw cycle(s) after cryoballoon pulmonary vein isolation: the alster extra pilot study. J Cardiovasc Electrophysiol. 2012;23(8):814–9.

  17. Tebbenjohanns J, Höfer C, Bergmann L, Dedroogh M, Gaudin D, von Werder A, et al. Shortening of freezing cycles provides equal outcome to standard ablation procedure using second-generation 28 mm cryoballoon after 15-month follow-up. Europace. 2016;18(2):206–10.

    Article  PubMed  Google Scholar 

  18. Gage AA, Baust J. Mechanisms of tissue injury in cryosurgery. Cryobiology. 1998;37:171–86.

    Article  CAS  PubMed  Google Scholar 

  19. Lim HW, Cogert GA, Cameron CS, Cheng VY, Sandler DA. Atrioesophageal fistula during cryoballoon ablation for atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25:208–13.

    Article  PubMed  Google Scholar 

  20. Kawasaki R, Gauri A, Elmouchi D, Duggal M, Bhan A. Atrioesophageal fistula complicating cryoballoon pulmonary vein isolation for paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2014;25:787–92.

    Article  PubMed  Google Scholar 

  21. Guhl EN, Siddoway D, Adelstein E, Bazaz R, Mendenhall GS, Nemec J, et al. Incidence and predictors of complications during cryoballoon pulmonary vein isolation for atrial fibrillation. J Am Heart Assoc. 2016;21:5(7). doi:10.1161/JAHA.116.003724.

  22. Matsuda J, Miyazaki S, Nakamura H, Taniguchi H, Kajiyama T, Hachiya H, et al. Pulmonary vein stenosis after second-generation cryoballoon ablation. J Cardiovasc Electrophysiol. 2017;28(3):298–303.

  23. Martí-Almor J, Jauregui-Abularach ME, Benito B, Vallès E, Bazan V, Sánchez-Font A, et al. Pulmonary hemorrhage after cryoballoon ablation for pulmonary vein isolation in the treatment of atrial fibrillation. Chest. 2014;145:156–7.

    Article  PubMed  Google Scholar 

  24. Oral H, Knight BP, Ozaydin M, Tada H, Chugh A, Hassan S, et al. Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. J Am Coll Cardiol. 2002;40(1):100–4.

    Article  PubMed  Google Scholar 

  25. Koyama T, Sekiguchi Y, Tada H, Arimoto T, Yamasaki H, Kuroki K, et al. Comparison of characteristics and significance of immediate versus early versus no recurrence of atrial fibrillation after catheter ablation. Am J Cardiol. 2009;103(9):1249–54.

    Article  PubMed  Google Scholar 

  26. Mugnai G, de Asmundis C, Hünük B, Ströker E, Velagic V, Moran D, et al. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences. Heart Rhythm. 2016;13(4):845–51.

    Article  PubMed  Google Scholar 

  27. Quan D, Huang H, Kong B, Li Q, Liao J, Wang G. Predictors of late atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation: a meta-analysis. Kardiol Pol. 2017. doi:10.5603/KP.a2016.0186.

  28. Burstein B, Nattel S. Atrial fibrosis: mechanisms and clinical relevance in atrial fibrillation. J Am Coll Cardiol. 2008;51(8):802–9.

    Article  CAS  PubMed  Google Scholar 

  29. Verma A, Jiang CY, Betts TR, Chen J, Deisenhofer I, Mantovan R, et al., STAR AF II Investigators. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372(19):1812–22.

  30. Mugnai G, de Asmundis C, Ströker E, Hünük B, Moran D, Ruggiero D, et al. Femoral venous pressure waveform as indicator of phrenic nerve injury in the setting of second-generation cryoballoon ablation. J Cardiovasc Med (Hagerstown). 2016. doi:10.2459/JCM.0000000000000418.

  31. Robicsek F, Duncan GD, Hawes AC, Rice HE, Harrill S, Robicsek SA. Biological thresholds of cold-induced phrenic nerve injury. J Thorac Cardiovasc Surg. 1990;99:167–70.

    CAS  PubMed  Google Scholar 

  32. Dureuil B, Viires N, Pariente R, Desmonts JM, Aubier M. Effects of phrenic nerve cooling on diaphragmatic function. J Appl Physiol. 1987;63:1763–9.

    CAS  PubMed  Google Scholar 

  33. Kühne M, Knecht S, Altmann D, Ammann P, Schaer B, Osswald S, et al. Validation of a novel spiral mapping catheter for real-time recordings from the pulmonary veins during cryoballoon ablation of atrial fibrillation. Heart Rhythm. 2013;10(2):241–6.

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Author notes

  1. Drs De Regibus and Iacopino contributed equally to the article as the first authors.

Authors and Affiliations

  1. Heart Rhythm Management Centre, Postgraduate course in Cardiac Electrophysiology and Pacing, Vrije Universiteit Brussel, Universitair Ziekenhuis Brussel, Brussels, Belgium

    Valentina De Regibus, Juan Pablo Abugattas, Hugo Enrique Coutiño, Darragh Moran, Erwin Ströker, Luis Marroquin, Ken Takarada, Rajin Choudhury, Carlo de Asmundis, Pedro Brugada & Gian-Battista Chierchia

  2. Cardiac Electrophysiology Unit, Maria Cecilia Hospital, GVM, Cotignola, Italy

    Saverio Iacopino

  3. Electrophisiology and Cardiac Pacing Unit, Istituto di Cura Città di Pavia, Pavia, Italy

    Giacomo Mugnai & Cesare Storti

  4. Division of Cardiology, Cardiocentro Ticino, Lugano, Switzerland

    Giulio Conte & Angelo Auricchio

Authors
  1. Valentina De Regibus
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  2. Saverio Iacopino
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  3. Juan Pablo Abugattas
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  4. Hugo Enrique Coutiño
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  5. Giacomo Mugnai
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  6. Cesare Storti
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  7. Giulio Conte
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  8. Angelo Auricchio
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  9. Darragh Moran
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  10. Erwin Ströker
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  11. Luis Marroquin
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  12. Ken Takarada
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  13. Rajin Choudhury
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  14. Carlo de Asmundis
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  16. Gian-Battista Chierchia
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Corresponding author

Correspondence to Valentina De Regibus.

Ethics declarations

The protocol was carried out in accordance with the ethical principles for medical research involving human subjects established by the Helsinki declaration, protecting the privacy of all the participants as well as the confidentiality of their personal information. The study was approved by the local ethics committee.

Conflict of interest

CdA, PB, SI, AA, and GBC have received consulting fees and speaker honoraria from Medtronic.

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De Regibus, V., Iacopino, S., Abugattas, J.P. et al. Single freeze strategy with the second- generation cryballoon for atrial fibrillation: a multicenter international retrospective analysis in a large cohort of patients. J Interv Card Electrophysiol 49, 173–180 (2017). https://doi.org/10.1007/s10840-017-0254-6

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  • DOI: https://doi.org/10.1007/s10840-017-0254-6

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