open access

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

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

Christian-Hendrik Heeger, Christopher Schuette, Valentina Seitelberger, Erik Wissner, Andreas Rillig, Shibu Mathew, Bruno Reissmann, Christine Lemes, Tilman Maurer, Thomas Fink, Osamu Inaba, Naotaka Hashiguchi, Francesco Santoro, Feifan Ouyang, Karl-Heinz Kuck, Andreas Metzner
DOI: 10.5603/CJ.a2018.0056
·
Pubmed: 29924380
·
Cardiol J 2019;26(4):368-374.

open access

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

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.

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.

Get Citation

Keywords

atrial fibrillation; pulmonary vein isolation; cryoballoon; long-term outcome

About this article
Title

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

Journal

Cardiology Journal

Issue

Vol 26, No 4 (2019)

Pages

368-374

Published online

2018-06-05

DOI

10.5603/CJ.a2018.0056

Pubmed

29924380

Bibliographic record

Cardiol J 2019;26(4):368-374.

Keywords

atrial fibrillation
pulmonary vein isolation
cryoballoon
long-term outcome

Authors

Christian-Hendrik Heeger
Christopher Schuette
Valentina Seitelberger
Erik Wissner
Andreas Rillig
Shibu Mathew
Bruno Reissmann
Christine Lemes
Tilman Maurer
Thomas Fink
Osamu Inaba
Naotaka Hashiguchi
Francesco Santoro
Feifan Ouyang
Karl-Heinz Kuck
Andreas Metzner

References (21)
  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.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
tel.:+48 58 320 94 94, fax:+48 58 320 94 60, e-mail: viamedica@viamedica.pl