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Single 3-min freeze per vein ablation strategy with the second-generation cryoballoon for atrial fibrillation in a large cohort of patients: long term outcome after a single procedure

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Abstract

Purpose

The purpose of the present study was to assess the long-term success rate of a single 3-min freeze per vein ablation strategy in the setting of pulmonary vein isolation (PVI) by means of second-generation cryoballoon (CB-A; Arctic Front Advance, Medtronic, Minneapolis, MN, USA) in a large cohort of patients.

Methods

Three hundred and one patients with drug resistant atrial fibrillation (AF) having undergone PVI by means of CB-A using a single 3-min freeze per vein ablation strategy were included in the analysis.

Results

Paroxysmal AF (PAF) was documented in 70.8% of the patients, while 29.2% presented with persistent AF (PersAF). The mean number of CB applications was 1.09 ± 0.3 in the left superior pulmonary vein (LSPV), 1.04 ± 0.2 in the left inferior pulmonary vein (LIPV), 1.12 ± 0.3 in the right superior pulmonary vein (RSPV), and 1.12 ± 0.3 in the right inferior pulmonary vein (RIPV). All PVs were successfully isolated with a 28-mm CB-A only. After a mean follow-up of 38.1 ± 7.5 months, 207 (68.8%) patients were free of atrial tachyarrhythmia (ATa) recurrences following a single procedure. Specifically, 72.8% of patients presenting with PAF and 59.1% of individuals with PersAF did not experience a recurrence.

Conclusions

A single 3-min freeze per vein strategy is effective in treating AF on a long term follow-up of 38 months. Specifically, it can afford freedom from ATa recurrences in 72.8% of patients affected by PAF and 59.1% of patients initially presenting with PersAF after a single CB-A procedure.

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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(5):639–44.

    Article  PubMed  Google Scholar 

  2. 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 

  3. 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(4):673–80.

    Article  PubMed  Google Scholar 

  4. 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 

  5. Giuseppe Ciconte MD, Giacomo Mugnai MD, Juan Sieira MD, Vedran Velagić MD, Yukio Saitoh MD, Ghazala Irfan MD. 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.

    Article  PubMed  Google Scholar 

  6. 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(5):646–52.

    Article  PubMed  Google Scholar 

  7. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 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. J Interv Card Electrophysiol. 2012;33(2):171–257.

    Article  PubMed  Google Scholar 

  8. Lemes C, Wissner E, Lin T, Mathew S, Deiss S, Rillig A, et al. One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis. Europace. 2016;18(2):201–5.

    Article  PubMed  Google Scholar 

  9. Ciconte G, Ottaviano L, De Asmundis C, Baltogiannis G, Conte G, Sieira J, et al. Pulmonary vein isolation as index procedure for persistent atrial fibrillation: one-year clinical outcome after ablation using the second-generation cryoballoon. Heart Rhythm. 2015;12(1):60–6.

    Article  PubMed  Google Scholar 

  10. Rao JY, Chierchia G-B, de Asmundis C, Casado-Arroyo R, Overeinder I, Sarkozy A, et al. Cryoballoon ablation as index procedure for paroxysmal atrial fibrillation: long-term results from a single center early experience. J Cardiovasc Med (Hagerstown). 2014;15(3):194–8.

    Article  Google Scholar 

  11. Vogt J, Heintze J, Gutleben KJ, Muntean B, Horstkotte D, Nolker G. Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. J Am Coll Cardiol. 2013;61(16):1707–12. https://doi.org/10.1016/j.jacc.2012.09.033.

    Article  PubMed  Google Scholar 

  12. Heeger C-H, Wissner E, Knöll M, B K, B R, S M, et al. Three-year clinical outcome after 2nd-generation cryoballoon-based pulmonary vein isolation for the treatment of paroxysmal and persistent atrial fibrillation—a 2-center experience. Circ J. 2017;81(7):974–80.

    Article  PubMed  Google Scholar 

  13. De Regibus V, Iacopino S, Abugattas JP, Mugnai G, Storti C, Conte G, et al. Single freeze strategy with the second-generation cryoballoon for atrial fibrillation: a multicenter international retrospective analysis in a large cohort of patients. J Interv Card Electrophysiol. 2017;49(2):173–80.

    Article  PubMed  Google Scholar 

  14. Chun KRJ, Stich M, Fürnkranz A, Bordignon S, Perrotta L, Dugo D, et al. Individualized cryoballoon energy pulmonary vein isolation guided by real-time pulmonary vein recordings, the randomized ICE-T trial. Heart Rhythm. 2017;14(4):495–500.

    Article  PubMed  Google Scholar 

  15. De Regibus V, Abugattas JP, Iacopino S, Mugnai G, Storti C, Conte G. Single freeze per vein strategy with the second-generation cryoballoon for atrial fibrillation: a propensity score-matched study between 180- and 240-s application time in a large cohort of patients. Europace. 2017; https://doi.org/10.1093/europace/eux279.

  16. Hunt GB, Chard RB, Johnson DC, Ross DL. Comparison of early and late dimensions and arrhythmogenicity of cryolesions in the normothermic canine heart. J Thorac Cardiovasc Surg. 1989;97(2):313–8.

    PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  Google Scholar 

  19. Sanders P, Morton JB, Davidson NC, Spence SJ, Vohra JK, Sparks PB, et al. Electrical remodeling of the atria in congestive heart failure: electrophysiological and electroanatomic mapping in humans. Circulation. 2003;108(12):1461–8.

    Article  PubMed  Google Scholar 

  20. Ullah W, Ling LH, Prabhu S, G L, P K, MC F, et al. Catheter ablation of atrial fibrillation in patients with heart failure: impact of maintaining sinus rhythm on heart failure status and long-term rates of stroke and death. Europace. 2016;18(5):679–86.

    Article  PubMed  Google Scholar 

  21. Mugnai G, De Asmundis C, Hünük B, E S, V 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 

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author information

Author notes

  1. Drs. Coutiño and Abugattas contributed equally to the article as first authors.

  2. Prof. Chierchia and Prof. de Asmundis contributed equally to the article as senior authors.

Authors and Affiliations

  1. Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, Brussels, Belgium

    Hugo-Enrique Coutiño, Juan-Pablo Abugattas, Juan Sieira, Francesca Salghetti, Erwin Ströker, Varnavas Varnavas, Vincent Umbrain, Muryo Terasawa, Yves De Greef, Pedro Brugada, Carlo de Asmundis & Gian-Battista Chierchia

  2. Cardiac Electrophysiology Unit, St Elisabeth Hospital, Brussels, Belgium

    Gaetano Paparella & Emmanuel Haine

  3. Cardiac Electrophysiology Unit, Villa Maria Cecilia Hospital, GVM, Cotignola, Italy

    Saverio Iacopino

Authors
  1. Hugo-Enrique Coutiño
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  2. Juan-Pablo Abugattas
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  3. Juan Sieira
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  4. Francesca Salghetti
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  6. Gaetano Paparella
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  7. Emmanuel Haine
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  8. Varnavas Varnavas
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  9. Vincent Umbrain
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  10. Muryo Terasawa
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  11. Yves De Greef
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  12. Pedro Brugada
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  13. Saverio Iacopino
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  14. Carlo de Asmundis
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  15. Gian-Battista Chierchia
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Corresponding author

Correspondence to Gian-Battista Chierchia.

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Conflict of interest

Dr. Chierchia and Dr. Asmundis have received compensation for teaching purposes and proctoring from AF Solutions and Medtronic. Dr. Chierchia has received speaker fees from Biosense and Webster. Dr. Brugada has received research grants on behalf of the center from Biotronik, Medtronic, St. Jude Medical, Sorin, and Boston Scientific and speaker’s fees from Biosense Webster, Biotronik, and Medtronic. Dr. Asmundis is a consultant for Daiichi Sankyo. Dr. Abugattas is currently receiving an educational grant for postgraduate in Cardiac Electrophysiology and Pacing academic course from St. Jude Medical.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Coutiño, HE., Abugattas, JP., Sieira, J. et al. Single 3-min freeze per vein ablation strategy with the second-generation cryoballoon for atrial fibrillation in a large cohort of patients: long term outcome after a single procedure. J Interv Card Electrophysiol 53, 81–89 (2018). https://doi.org/10.1007/s10840-018-0393-4

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  • DOI: https://doi.org/10.1007/s10840-018-0393-4

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