Advertisement
Heart Rhythm
Advanced searchSave search
Focus Issue: Atrial Fibrillation| Volume 14, ISSUE 9, P1311-1318, September 2017

Download started.

Ok

Second-generation cryoballoon ablation in the setting of left common pulmonary veins: Procedural findings and clinical outcome

Published:June 15, 2017DOI:https://doi.org/10.1016/j.hrthm.2017.06.019
Second-generation cryoballoon ablation in the setting of left common pulmonary veins: Procedural findings and clinical outcome
Previous ArticleEWOLUTION—The next evolution in appendage closure?
Next ArticleVerification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: Results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance)

      Background

      A left common pulmonary vein (LCPV) accounts for the most frequent PV variation. Use of the cryoballoon (CB) for isolating these veins is still debatable. To date, no data are available regarding the feasibility, acute PV isolation, and clinical outcome of the second-generation CB (CB-A) in this setting.

      Objective

      The purpose of this study was to investigate the performance of the CB-A in patients with LCPVs.

      Methods

      In a total cohort of 433 patients having undergone CB-A ablation for drug-refractory atrial fibrillation together with preprocedural computed tomographic scanning, 146 patients presented an LCPV. Measurement of ostial area and trunk distance was performed, together with analysis of procedural and fluoroscopic data in order to determine the ablation strategy. The latter 146 LCPV+ patients were compared for outcome with a cohort of 146 propensity-score matched LCPV– patients.

      Results

      Electrical isolation could be achieved in all left-sided veins. A long left common trunk (>15 mm) was found in 25% (37/146) of the LCPV+ patients. LCPVs treated with a single-shot freeze strategy presented a longer trunk (22 ± 5 mm vs 9 ± 4 mm, P <.001) and smaller ostial area (305 ± 109 mm2 vs 400 ± 108 mm2, P <.001) compared to LCPV patients in whom a segmental (superior and inferior) freeze was delivered. Survival free from atrial fibrillation was similar between LCPV+ and LCPV– patients during mean follow-up of 19 ± 10 months (log rank P = .33).

      Conclusion

      CB-A ablation in LCPV+ patients is effective and showed no difference in clinical outcome compared to LCPV– patients.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Heart Rhythm
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Haïssaguerre M.
        • Jaïs P.
        • Shah D.C.
        • Takahashi A.
        • Hocini M.
        • Quiniou G.
        • Garrigue S.
        • Le Mouroux A.
        • Le Métayer P.
        • Clémenty J.
        Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.
        N Engl J Med. 1998; 339: 659-666
        View in Article
        • Pappone C.
        • Rosanio S.
        • Oreto G.
        • Tocchi M.
        • Gugliotta F.
        • Vicedomini G.
        • Salvati A.
        • Dicandia C.
        • Mazzone P.
        • Santinelli V.
        • Gulletta S.
        • Chierchia S.
        Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation.
        Circulation. 2000; 102: 2619-2628
        View in Article
        • Thorning C.
        • Hamady M.
        • Liaw J.V.
        • Juli C.
        • Lim P.B.
        • Dhawan R.
        • Peters N.S.
        • Davies D.W.
        • Kanagaratnam P.
        • O'Neill M.D.
        • Wright A.R.
        CT evaluation of pulmonary venous anatomy variation in patients undergoing catheter ablation for atrial fibrillation.
        Clin Imaging. 2011; 35: 1-9
        View in Article
        • Jongbloed M.R.
        • Dirksen M.S.
        • Bax J.J.
        • Boersma E.
        • Geleijns K.
        • Lamb H.J.
        • van der Wall E.E.
        • de Roos A.
        • Schalij M.J.
        Atrial fibrillation: multi-detector row CT of pulmonary vein anatomy prior to radiofrequency catheter ablation—initial experience.
        Radiology. 2005; 234: 702-709
        View in Article
        • Kuck K.H.
        • Brugada J.
        • Fürnkranz A.
        • Metzner A.
        • Ouyang F.
        • Chun K.R.
        • Elvan A.
        • Arentz T.
        • Bestehorn K.
        • Pocock S.J.
        • Albenque J.P.
        • Tondo C.
        • FIRE AND ICE Investigators
        Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation.
        N Engl J Med. 2016; 374: 2235-2245
        View in Article
        • Andrade J.G.
        • Khairy P.
        • Guerra P.G.
        • Deyell M.W.
        • Rivard L.
        • Macle L.
        • Thibault B.
        • Talajic M.
        • Roy D.
        • Dubuc M.
        Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies.
        Heart Rhythm. 2011; 8: 1444-1451
        View in Article
        • Kubala M.
        • Hermida J.S.
        • Nadji G.
        • Quenum S.
        • Traulle S.
        • Jarry G.
        Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein.
        Pacing Clin Electrophysiol. 2011 Jul; 34: 837-843
        View in Article
        • Di Giovanni G.
        • Wauters K.
        • Chierchia G.B.
        • 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: 834-839
        View in Article
        • Metzner A.
        • Reissmann B.
        • Rausch P.
        • et al.
        One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon.
        Circ Arrhythm Electrophysiol. 2014; 7: 288-292
        View in Article
        • Cabrera J.A.
        • Ho S.Y.
        • Climent V.
        • Sanchez-Quintana D.
        The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation.
        Eur Heart J. 2008; 29: 356-362
        View in Article
        • Ströker E.
        • de Asmundis C.
        • Saitoh Y.
        • Velagić V.
        • Mugnai G.
        • Irfan G.
        • Hünük B.
        • Tanaka K.
        • Belsack D.
        • Buyl R.
        • Brugada P.
        • Chierchia G.B.
        Anatomic predictors of phrenic nerve injury in the setting of pulmonary vein isolation using the 28-mm second-generation cryoballoon.
        Heart Rhythm. 2016; 13: 342-351
        View in Article
        • Irfan G.
        • de Asmundis C.
        • Mugnai G.
        • 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: 987-993
        View in Article
        • Ghosh J.
        • Singarayar S.
        • Kabunga P.
        • McGuire M.A.
        Subclavian vein pacing and venous pressure waveform measurement for phrenic nerve monitoring during cryoballoon ablation of atrial fibrillation.
        Europace. 2015; 17: 884-890
        View in Article
        • McLellan A.J.
        • Ling L.H.
        • Ruggiero D.
        • Wong M.C.
        • Walters T.E.
        • Nisbet A.
        • Shetty A.K.
        • Azzopardi S.
        • Taylor A.J.
        • Morton J.B.
        • Kalman J.M.
        • Kistler P.M.
        Pulmonary vein isolation: the impact of pulmonary venous anatomy on long-term outcome of catheter ablation for paroxysmal atrial fibrillation.
        Heart Rhythm. 2014; 11: 549-556
        View in Article
        • Iacopino S.
        • Mugnai G.
        • Takarada K.
        • Paparella G.
        • Ströker E.
        • De Regibus V.
        • Coutino-Moreno H.E.
        • Choudhury R.
        • Abugattas de Torres J.P.
        • Brugada P.
        • de Asmundis C.
        • Chierchia G.B.
        Second-generation cryoballoon ablation without the use of real-time recordings: a novel strategy based on a temperature-guided approach to ablation.
        Heart Rhythm. 2017; 14: 322-328
        View in Article
        • Kenigsberg D.N.
        • Martin N.
        • Lim H.W.
        • Kowalski M.
        • Ellenbogen K.A.
        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: 283-290
        View in Article

      Article info

      Publication history

      Published online: June 15, 2017

      Footnotes

      Drs. Chierchia and de Asmundis have received compensation for teaching purposes and proctoring from AF Solutions, Medtronic, and Biosense Webster. Dr. Brugada has received research grants on behalf of the center from Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Ströker and Takarada contributed equally as first authors.

      Identification

      DOI: https://doi.org/10.1016/j.hrthm.2017.06.019

      Copyright

      © 2017 Heart Rhythm Society. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect
      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties. The content on this site is intended for healthcare professionals.


      RELX