Temperature-guided ablation with the second-generation cryoballoon for paroxysmal atrial fibrillation: 3-year follow-up
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Temperature-guided ablation with the second-generation cryoballoon for paroxysmal atrial fibrillation: 3-year follow-up in a multicenter experience Gaetano Paparella 1 & Saverio Iacopino 1 & Thiago Guimarães Osório 1 & Juan Pablo Abugattas de Torres 1 & Erwin Ströker 1 & Juan Sieira 1 & Hannes Vanacker 1 & Bernard De Ruyter 1 & Serge Boveda 1 & Riccardo Maj 1 & Gianluca Borio 1 & Alessandro Rizzo 1 & Alessio Galli 1 & Pedro Brugada 1 & Carlo de Asmundis 1 & Gian-Battista Chierchia 1 Received: 12 January 2020 / Accepted: 4 May 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose A strategy based on the attainment of the specific parameter of − 40 °C within the first 60 s during cryoenergy applications in the setting of cryoballoon ablation (CB-A) without the use of an inner lumen mapping catheter (ILMC) (Achieve; Medtronic, USA) for the visualization of real-time recordings (RTR) has been previously described. The latter has proven to be very effective in guaranteeing freedom from atrial arrhythmias in patients affected by paroxysmal atrial fibrillation (PAF) at 1-year follow-up. The purpose of this retrospective observational study was to evaluate the clinical outcomes of this strategy in a multicenter experience on a long-term follow-up of 3 years. Methods A total of 192 patients having undergone CB ablation for paroxysmal AF (PAF) starting from September 2015 to November 2016 that underwent a temperature-guided approach were included. Results Mean procedural time was 68.77 ± 18.88. The mean number of freezes in the LSPV was 1.2 ± 0.4, 1.2 ± 0.4 in the LIPV, 1.1 ± 0.4 in the RSPV, and 1.2 ± 0.4 in the RIPV. Considering a blanking period of 3 months, freedom from AF off-AAD was achieved in 77.6% (149/192) at mean 34.5 ± 5.5 months and median 35.1 months (IQR, 32.3–37.0 months) follow-up after 1 procedure. Conclusions A temperature-guided approach affords freedom from AF at a 3-year follow-up period in a large majority of patients affected by PAF having undergone a single CB-A procedure. Keywords Pulmonary vein isolation . Cryoballoon ablation . Paroxysmal atrial fibrillation . Temperature-guided approach
1 Introduction The second-generation cryoballoon (CB-A; Arctic Front Advance, Medtronic) has been equipped with technical developments resulting in a larger and more homogeneous zone of freezing on the balloon surface and leading to significant improvements in procedural and clinical outcomes as compared with its predecessor [1–4]. As previously reported [5], faster temperature drops during the initial phase of the ablation are associated with better outcomes; specifically, the achievement of − 40 °C within 60 s seems to independently predict a durable PV isolation [5, 6].
* Gian-Battista Chierchia [email protected] 1
Heart Rhythm Management Center, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
In addition, a strategy
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