Vol 26, No 4 (2019)
Original articles — Clinical cardiology
Published online: 2018-06-05

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Time-to-effect guided pulmonary vein isolation utilizing the third-generation versus second generation cryoballoon: One year clinical success

Christian-Hendrik Heeger123, Christopher Schuette2, Valentina Seitelberger2, Erik Wissner4, Andreas Rillig25, Shibu Mathew2, Bruno Reissmann2, Christine Lemes2, Tilman Maurer2, Thomas Fink123, Osamu Inaba2, Naotaka Hashiguchi2, Francesco Santoro2, Feifan Ouyang26, Karl-Heinz Kuck2, Andreas Metzner25
Pubmed: 29924380
Cardiol J 2019;26(4):368-374.

Abstract

Background: The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging and reproducible clinical outcome data. The latest- -generation cryoballoon (CB3) incorporates a 40% shorter distal tip, thus allowing for an increased rate of PVI real-time signal recording and facilitating individualized ablation strategies taking the time-to- -effect (TTE) into account. However, whether this characteristic translates into favorable clinical success has not been evaluated yet. Herein was investigated 1-year clinical success after CB3 in comparison to CB2 based-PVI.

Methods: One hundred and ten consecutive patients with paroxysmal or short-standing persistent atrial fibrillation (AF) underwent CB2 (n = 55 patients) -or CB3 (n = 55 patients) -based PVI. The freeze-cycle duration was set to TTE + 120 s if TTE could be recorded, otherwise a fixed freeze-cycle duration of 180 s was applied.

Results: A total of 217/218 (99%, CB3) and 217/217 (100%, CB2) pulmonary veins (PV) were successfully isolated. The real-time PVI visualization rate was 69.2% (CB3) and 54.8% (CB2; p = 0.0392). The mean freeze-cycle duration was 194 ± 77 s (CB3) and 206 ± 85 s (CB2; p = 0.132), respectively. During a median follow-up of 409 days (interquartile range [IQR] 378–421, CB3) and 432 days (IQR 394–455, CB2) 73.6% (CB3) and 73.1% of patients (CB2) remained in stable sinus rhythm after a single procedure (p = 0.806).

Conclusions: A higher rate of real-time electrical PV recordings was seen using the CB3 as compared to CB2. There was no difference in 1-year clinical follow-up.

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References

  1. Heeger CH, Wissner E, Knöll 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): 974–980.
  2. Lemes C, Wissner E, Lin T, 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): 201–205.
  3. Metzner A, Heeger CH, Wohlmuth P, et al. Two-year outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon: lessons from the bonus freeze protocol. Clin Res Cardiol. 2016; 105(1): 72–78.
  4. Metzner A, Reissmann B, Rausch P, et al. One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon. Circulation: Arrhythmia and Electrophysiology. 2014; 7(2): 288–292.
  5. Kuck KH, Brugada J, Fürnkranz A, et al. FIRE AND ICE Investigators. Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. N Engl J Med. 2016; 374(23): 2235–2245.
  6. Kirchhof P, Benussi S, Kotecha D, et al. ESC Scientific Document Group . 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016; 37(38): 2893–2962.
  7. 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. Heart Rhythm. 2015; 12(4): 673–680.
  8. Heeger CH, Wissner E, Wohlmuth P, et al. Bonus-freeze: benefit or risk? Two-year outcome and procedural comparison of a "bonus-freeze" and "no bonus-freeze" protocol using the second-generation cryoballoon for pulmonary vein isolation. Clin Res Cardiol. 2016; 105(9): 774–782.
  9. Heeger CH, Wissner E, Mathew S, et al. Short tip-big difference? First-in-man experience and procedural efficacy of pulmonary vein isolation using the third-generation cryoballoon. Clin Res Cardiol. 2016; 105(6): 482–488.
  10. Chierchia GB, Mugnai G, Ströker E, et al. Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon. Europace. 2016; 18(8): 1158–1163.
  11. Aryana A, Kowalski M, O'Neill PG, et al. 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. Heart Rhythm. 2016; 13(12): 2306–2313.
  12. Wissner E, Heeger CH, Grahn H, 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): 1236–1240.
  13. Martins RP, Hamon D, Césari O, et al. Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation. Heart Rhythm. 2014; 11(3): 386–393.
  14. Fürnkranz A, Bordignon S, Schmidt B, et al. Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol. 2013; 24(5): 492–497.
  15. Heeger CH, Wissner E, Mathew S, et al. Once Isolated, Always Isolated? Incidence and Characteristics of Pulmonary Vein Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation. Circ Arrhythm Electrophysiol. 2015; 8(5): 1088–1094.
  16. Reissmann B, Wissner E, Deiss S, et al. First insights into cryoballoon-based pulmonary vein isolation taking the individual time-to-isolation into account. Europace. 2017; 19(10): 1676–1680.
  17. Su W, Kowal R, Kowalski M, et al. Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures. Heart Rhythm. 2015; 12(7): 1658–1666.
  18. Metzner A, Burchard A, Wohlmuth P, et al. Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol. 2013; 6(4): 769–775.
  19. Straube F, Dorwarth U, Vogt J, et al. Differences of two cryoballoon generations: insights from the prospective multicentre, multinational FREEZE Cohort Substudy. Europace. 2014; 16(10): 1434–1442.
  20. Rottner L, Fink T, Heeger CH, et al. Is less more? Impact of different ablation protocols on periprocedural complications in second-generation cryoballoon based pulmonary vein isolation. Europace. 2017 [Epub ahead of print].
  21. Fürnkranz A, Bologna F, Bordignon S, et al. Procedural characteristics of pulmonary vein isolation using the novel third-generation cryoballoon. Europace. 2016; 18(12): 1795–1800.