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For cryoballoon ablation, time to effect is time well spent

  • Byron K. Lee
    Affiliations
    Division of Cardiology, Department of Medicine, San Francisco Medical Center, University of California, San Francisco, California
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  • Gregory M. Marcus
    Correspondence
    Address reprint requests and correspondence: Dr Gregory M. Marcus, Division of Cardiology, Department of Medicine, San Francisco Medical Center, University of California, 500 Parnassus Avenue, Box 1354, San Francisco, CA 94143.
    Affiliations
    Division of Cardiology, Department of Medicine, San Francisco Medical Center, University of California, San Francisco, California
    Search for articles by this author
      Pulmonary vein isolation with the Medtronic cryoballoon is an increasingly popular approach for the treatment of paroxysmal atrial fibrillation (AF). In a head-to-head comparison, cryoablation has been shown to be equally effective to radiofrequency ablation for paroxysmal AF, with the benefit of shorter procedure times.
      • Kuck K.H.
      • Brugada J.
      • Furnkranz 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.
      Since the approval of the second-generation cryoballoon, the Arctic Front Advance, in April 2012, there has been a trend toward fewer and shorter cryoablation applications per pulmonary vein.
      • Ciconte G.
      • de Asmundis C.
      • Sieira J.
      • et al.
      Single 3-minute freeze for second-generation cryoballoon ablation: one-year follow-up after pulmonary vein isolation.
      • Furnkranz A.
      • Bordignon S.
      • Schmidt B.
      • Gunawardene M.
      • Schulte-Hahn B.
      • Urban V.
      • Bode F.
      • Nowak B.
      • Chun J.K.
      Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon.
      • Metzner A.
      • Reissmann B.
      • Rausch P.
      • et al.
      One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon.
      Instead of the conventional 2 cryoablation procedures of 2–4 minutes per pulmonary vein, some sites have moved to a tailored approach, curtailing cryoablation if the Medtronic Achieve mapping catheter reveals an early time to pulmonary vein isolation (TT-PVI). Preliminary studies have suggested that this approach might reduce the number and duration of cryoablation procedures, with the promise of even shorter fluoroscopy and procedure times.
      • Aryana A.
      • Kowalski M.
      • O’Neill P.G.
      • Koo C.H.
      • Lim H.W.
      • Khan A.
      • Hokanson R.B.
      • Bowers M.R.
      • Kenigsberg D.N.
      • Ellenbogen K.A.
      • Cryo D.I.
      Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: short- and long-term results of a multicenter study.
      • Chan N.Y.
      • Yuen H.C.
      • Chu P.S.
      • Choy C.C.
      • Chow H.F.
      • Fong H.F.
      • Lau C.L.
      • Lo Y.K.
      • Tsui P.T.
      • Lau S.T.
      • Mok N.S.
      Inner lumen mapping catheter-facilitated big cryoballoon treatment for atrial fibrillation shortens procedural duration and fluoroscopic exposure with comparable mid-term efficacy.
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      References

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