Abstract
Purpose
Rapid ventricular pacing (RVP) was reported to improve the cooling effects of the cryoballoon (CB). The aim of this study was to investigate the safety and efficacy of RVP for left atrial posterior wall isolation (PWI) by the CB.
Methods
One hundred consecutive patients (males 80, mean age 63 ± 10 years) with persistent atrial fibrillation underwent left atrial roof (LA-RB) and bottom block line (LA-BB) creation by CB to achieve PWI. Patients were randomized into two groups according to whether they underwent PWI with (RVP group, n = 50) or without RVP (control group, n = 50).
Results
The nadir CB temperature (NCT) during the LA-RB and LA-BB creation was significantly lower in the RVP group than control group (LA-RB − 45.7 °C and − 43.9 °C, p < 0.001, and LA-BB − 42.4 °C and − 40.0 °C, p < 0.001). The success rate of the LA-RB creation was significantly higher in the RVP group than the control group (98% vs. 88%, p = 0.039), however, there were no significant differences regarding the LA-BB creation (66% vs. 52%, p = 0.15) and PWI (66% vs. 50%, p = 0.1) between the two groups. The PWI success rate did not differ whether CB freezing was prematurely terminated due to an excessive luminal esophageal temperature (LET) drop in the RVP group (65.8% vs. 66.7%, respectively, p = 0.96).
Conclusions
RVP significantly decreased the NCT during the CB application resulting in the significant improvement of success rate of the LA-RB. The advantage of RVP in terms of the accomplishing PWI was not affected even when the CB freezing was prematurely terminated due to an excessive LET drop.
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References
The impact of cryoballoon versus radiofrequency ablation for paroxysmal atrial fibrillation on healthcare utilization and costs: an economic analysis from the FIRE AND ICE trial. J Am Heart Assoc. 2017;6(9). https://doi.org/10.1161/JAHA.117.002230.
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(7):1109–15. https://doi.org/10.1093/europace/euw146.
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(8):1121–9. https://doi.org/10.1016/j.hrthm.2018.05.014.
Chun KR, Furnkranz A, Schmidt B, Metzner A, Tilz R, Zerm T, et al. Right ventricular rapid pacing in catheter ablation of atrial fibrillation: a novel application for cryoballoon pulmonary vein isolation. Clin Res Cardiol. 2009;98(8):493–500. https://doi.org/10.1007/s00392-009-0031-3.
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. https://doi.org/10.1016/j.hrthm.2015.10.033.
Okishige K, Aoyagi H, Kawaguchi N, Katoh N, Yamashita M, Nakamura T, et al. Novel method for earlier detection of phrenic nerve injury during cryoballoon applications for electrical isolation of pulmonary veins in patients with atrial fibrillation. Heart Rhythm. 2016;13(9):1810–6. https://doi.org/10.1016/j.hrthm.2016.05.003.
Andrade J, Khairy P, Dubuc M, Deyell MW, Roy D, Talajic M, et al. The time course of exit and entrance block during cryoballoon pulmonary vein isolation. Europace. 2014;16:500–4. https://doi.org/10.1093/europace/eut231.
Nishimura T, Yamauchi Y, Aoyagi H, Tsuchiya Y, Shigeta T, Nakamura R, et al. The clinical impact of the left atrial posterior wall lesion formation by the cryoballoon application for persistent atrial fibrillation: feasibility and clinical implications. J Cardiovasc Electrophysiol. 2019. https://doi.org/10.1111/jce.13879.
Steen T, Voss BM, Smiseth OA. Influence of heart rate and left atrial pressure on pulmonary venous flow pattern in dogs. Am J Physiol. 1994;266(6 Pt 2):H2296–302. https://doi.org/10.1152/ajpheart.1994.266.6.H2296.
Furnkranz A, Bordignon S, Bohmig M, Konstantinou A, Dugo D, Perrotta L, et al. Reduced incidence of esophageal lesions by luminal esophageal temperature-guided second-generation cryoballoon ablation. Heart Rhythm. 2015;12(2):268–74. https://doi.org/10.1016/j.hrthm.2014.10.033.
Barbhaiya CR, Kumar S, John RM, Tedrow UB, Koplan BA, Epstein LM, et al. Global survey of esophageal and gastric injury in atrial fibrillation ablation: incidence, time to presentation, and outcomes. J Am Coll Cardiol. 2015;65(13):1377–8. https://doi.org/10.1016/j.jacc.2014.12.053.
Metzner A, Burchard A, Wohlmuth P, Rausch P, Bardyszewski A, Gienapp C, et al. Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol. 2013;6(4):769–75. https://doi.org/10.1161/CIRCEP.113.000228.
Furnkranz A, Bordignon S, Schmidt B, Bohmig M, Bohmer MC, Bode F, et al. Luminal esophageal temperature predicts esophageal lesions after second-generation cryoballoon pulmonary vein isolation. Heart Rhythm. 2013;10(6):789–93. https://doi.org/10.1016/j.hrthm.2013.02.021.
Miyazaki S, Nakamura H, Taniguchi H, Hachiya H, Takagi T, Igarashi M, et al. Gastric hypomotility after second-generation cryoballoon ablation-unrecognized silent nerve injury after cryoballoon ablation. Heart Rhythm. 2017;14(5):670–7. https://doi.org/10.1016/j.hrthm.2017.01.028.
Aksu T, Golcuk S, Guler TE, Yalin K, Erden I. Gastroparesis as a complication of atrial fibrillation ablation. Am J Cardiol. 2015;116(1):92–7. https://doi.org/10.1016/j.amjcard.2015.03.045.
Kumar P, Bamimore AM, Schwartz JD, Chung EH, Gehi AK, Kiser AC, et al. Challenges and outcomes of posterior wall isolation for ablation of atrial fibrillation. J Am Heart Assoc. 2016;5(9). https://doi.org/10.1161/JAHA.116.003885.
Tamborero D, Mont L, Berruezo A, Matiello M, Benito B, Sitges M, et al. Left atrial posterior wall isolation does not improve the outcome of circumferential pulmonary vein ablation for atrial fibrillation: a prospective randomized study. Circ Arrhythm Electrophysiol. 2009;2(1):35–40. https://doi.org/10.1161/CIRCEP.108.797944.
Lim TW, Koay CH, McCall R, See VA, Ross DL, Thomas SP. Atrial arrhythmias after single-ring isolation of the posterior left atrium and pulmonary veins for atrial fibrillation: mechanisms and management. Circ Arrhythm Electrophysiol. 2008;1(2):120–6. https://doi.org/10.1161/CIRCEP.108.769752.
Kumagai K, Muraoka S, Mitsutake C, Takashima H, Nakashima H. A new approach for complete isolation of the posterior left atrium including pulmonary veins for atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18(10):1047–52. https://doi.org/10.1111/j.1540-8167.2007.00911.x.
Chilukuri K, Scherr D, Dalal D, Cheng A, Spragg D, Nazarian S, et al. Conventional pulmonary vein isolation compared with the “box isolation” method: a randomized clinical trial. J Interv Card Electrophysiol. 2011;32(2):137–46. https://doi.org/10.1007/s10840-011-9587-8.
Sanders P, Hocini M, Jais P, Sacher F, Hsu LF, Takahashi Y, et al. Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome. Eur Heart J. 2007;28(15):1862–71. https://doi.org/10.1093/eurheartj/ehl548.
Thomas SP, Lim TW, McCall R, Seow SC, Ross DL. Electrical isolation of the posterior left atrial wall and pulmonary veins for atrial fibrillation: feasibility of and rationale for a single-ring approach. Heart Rhythm. 2007;4(6):722–30. https://doi.org/10.1016/j.hrthm.2007.01.034.
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Nishimura, T., Okishige, K., Yamauchi, Y. et al. Clinical impact of rapid ventricular pacing on the left atrial posterior wall isolation by a cryoballoon application: a randomized controlled trial. J Interv Card Electrophysiol 59, 565–573 (2020). https://doi.org/10.1007/s10840-019-00641-9
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DOI: https://doi.org/10.1007/s10840-019-00641-9