Skip to main content
SpringerLink
Log in

Posterior box isolation as an adjunctive ablation strategy during repeat ablation with the second-generation cryoballoon for recurrence of persistent atrial fibrillation: 1-year follow-up

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

Abstract

Background

The creation of a posterior box isolation of the left atrium (LAPWI) in addition to pulmonary vein isolation (PVI) with the second-generation cryoballoon (CB-A) seems to offer promising clinical outcome in patients affected by persistent atrial fibrillation (PersAF).

Aim

This work aims to study the clinical outcome of an ablation strategy based on the creation of a LAPWI during repeat procedures for recurrent AF after an index CB-A procedure for PersAF.

Methods and results

A total of 33 patients having undergone a repeat procedure consisting in redo PVI plus LAPWI for recurrent PersAF with the CB-A after an index PVI ablation were retrospective included in our study. Electrical reconnection could be documented in 18 veins (13%). The LAPW was successfully isolated solely by CB-A ablation in 30 out of 33 (91%) patients; in the remaining 3 patients, isolation of the LAPW was completed by focal tip-irrigated RF ablation. The mean number of CB-A applications required for the superior portion of the LAPW and the inferior portion of the LAPW creation were 5.4 ± 0.9 and 4 ± 0.6, respectively. After a mean follow-up of 11.8 ± 3 months, 28 patients (85%) did not experience recurrence of any atrial arrhythmias during follow-up, without the need of further ablation or class I or III AADs.

Conclusion

Left posterior wall isolation with the CB-A is feasible and safe during repeat ablation procedures for recurrent PersAF. In our study, the 12-month freedom from any arrhythmia was 85% following this ablation strategy.

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

Similar content being viewed by others

References

  1. Chierchia G-B, 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. 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 

  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. Calkins H, Kuck KH, Cappato R, Brugada J, John Camm A, 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;33:171–257.

    Article  PubMed  Google Scholar 

  5. Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation. Europace. 2010;12(10):1360–420.

  6. Kojodjojo P, O’Neill MD, Lim PB, Malcolm-Lawes L, Whinnett ZI, Salukhe TV, et al. Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation. Heart. 2010;96:1379–84.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 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.

  8. Coutiño HE, Abugattas JP, Sieira J, Salghetti F, Ströker E, Paparella G, 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. 2018;53(1):81–89.

  9. Heeger C-H, Wissner E, Knöll M, Knoop B, Reissmann B, Mathew S, 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;81:974–80.

    Article  CAS  PubMed  Google Scholar 

  10. Aryana A, Baker JH, Espinosa Ginic MA, Pujara DK, Bowers MR, O’Neill PG, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: a multicenter experience. Heart Rhythm. 2018;15:1121–9.

    Article  PubMed  Google Scholar 

  11. Kuniss M, Greiß H, Pajitnev D, Akkaya E, Deubner N, Hain A, et al. Cryoballoon ablation of persistent atrial fibrillation: feasibility and safety of left atrial roof ablation with generation of conduction block in addition to antral pulmonary vein isolation. Europace. 2017;19:1109–15.

    PubMed  Google Scholar 

  12. 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;372:1812–22.

    Article  PubMed  Google Scholar 

  13. Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, et al. A new approach for catheter ablation of atrial fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43:2044–53.

    Article  PubMed  Google Scholar 

  14. Narayan SM, Krummen DE, Shivkumar K, Clopton P, Rappel WJ, Miller JM. Treatment of atrial fibrillation by the ablation of localized sources: CONFIRM (conventional ablation for atrial fibrillation with or without focal impulse and rotor modulation) trial. J Am Coll Cardiol. 2012;60:628–36.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Corradi D, Callegari S, Maestri R, Ferrara D, Mangieri D, Alinovi R, et al. Differential structural remodeling of the left-atrial posterior wall in patients affected by mitral regurgitation with or without persistent atrial fibrillation: a morphological and molecular study. J Cardiovasc Electrophysiol. 2012;23:271–9.

    Article  PubMed  Google Scholar 

  16. Roberts-Thomson KC, Stevenson I, Kistler PM, Haqqani HM, Spence SJ, Goldblatt JC, et al. The role of chronic atrial stretch and atrial fibrillation on posterior left atrial wall conduction. J Am Coll Cardiol. 2008;51(8):856–62.

  17. Markides V, Schilling RJ, Ho SY, AWC C, Davies DW, Peters NS. Characterization of left atrial activation in the intact human heart. Circulation. 2003;107(5):733–9.

  18. Kalifa J, Tanaka K, Zaitsev AV, Warren M, Vaidyanathan R, Auerbach D, et al. Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation. 2006;113:626–33.

    Article  PubMed  Google Scholar 

  19. Kenigsberg DN, Martin N, Lim HW, Kowalski M, Ellenbogen KA. Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon. Heart Rhythm. 2015;12:283–90.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Drs Saverio Iacopino and Gaetano Paparella contributed equally to the article as first authors.

Authors and Affiliations

  1. Electrophysiology Unit, Villa Maria Cecilia Hospital, Gruppo Villa Maria, Cotignola, Italy

    Saverio Iacopino

  2. Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit, Brussels, Belgium

    Gaetano Paparella, Lucio Capulzini, Erwin Ströker, Stefan Beckers, Thiago Guimarães Osório, Varnavas Varnavas, Juan Sieira, Juan Pablo Abugattas, Riccardo Maj, Francesca Salghetti, Vincent Umbrain, Muryo Terasawa, Pedro Brugada, Carlo de Asmundis & Gian Battista Chierchia

Authors
  1. Saverio Iacopino
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Gaetano Paparella
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lucio Capulzini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erwin Ströker
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Stefan Beckers
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Thiago Guimarães Osório
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Varnavas Varnavas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Juan Sieira
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Juan Pablo Abugattas
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Riccardo Maj
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Francesca Salghetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Vincent Umbrain
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Muryo Terasawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Pedro Brugada
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Carlo de Asmundis
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Gian Battista Chierchia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gian Battista Chierchia.

Additional information

Publisher’s note

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

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Iacopino, S., Paparella, G., Capulzini, L. et al. Posterior box isolation as an adjunctive ablation strategy during repeat ablation with the second-generation cryoballoon for recurrence of persistent atrial fibrillation: 1-year follow-up. J Interv Card Electrophysiol 56, 1–7 (2019). https://doi.org/10.1007/s10840-019-00551-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10840-019-00551-w

Keywords

Search

Navigation