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Published in: Journal of Interventional Cardiac Electrophysiology 2/2015

01-03-2015

Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques

Authors: Justo Juliá, Gian-Battista Chierchia, Carlo de Asmundis, Giacomo Mugnai, Juan Sieira, Giuseppe Ciconte, Giacomo Di Giovanni, Giulio Conte, Giannis Baltogiannis, Yukio Saitoh, Kristel Wauters, Ghazala Irfan, Pedro Brugada

Published in: Journal of Interventional Cardiac Electrophysiology | Issue 2/2015

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Abstract

Purpose

Occurrence of atrial tachycardias (ATs) following radiofrequency (RF) pulmonary vein (PV) isolation for the treatment of paroxysmal atrial fibrillation (PAF) is a frequent complication. Cryoballoon (CB) ablation might create more homogeneous and demarcated lesions than traditional point by point RF approach, hypothetically leading to a lower incidence of ATs. Our aim is to compare incidence and mechanism of regular ATs occurring after ablation of PAF by means of circumferential point by point RF vs CB ablation.

Methods

Two hundred eighty-six consecutive patients undergoing a first PV isolation procedure, as treatment for PAF, were included and followed up for 12 months. Point by point RF ablation was performed in 186 patients and CB ablation in the remaining 100. Among the last ones, first generation (CB-1) was used in 59 patients and second generation one (CB-2) in 41.

Results

Incidence of regular ATs was higher following RF PV isolation when compared with CB ablation (11.3 vs 3.0 %, P = 0.028). When compared separately with RF ablation, both CB-1 and CB-2 presented lower incidences of ATs (5.1 and 0.0 %) but differences only remained significant for the CB-2 (P = 0.027).

Conclusion

Patients with PAF undergoing a first PV isolation procedure by means of CB ablation present a significantly lower incidence of ATs than those in which PV isolation is achieved by means of circumferential point by point RF ablation.
Literature
1.
go back to reference Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339, 659–666.CrossRefPubMed Haïssaguerre, M., Jaïs, P., Shah, D. C., Takahashi, A., Hocini, M., Quiniou, G., et al. (1998). Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. The New England Journal of Medicine, 339, 659–666.CrossRefPubMed
2.
go back to reference Gerstenfeld, E. P., Callans, D. J., Dixit, S., Russo, A., Lin, D., Nayak, H., et al. (2004). Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation. Circulation, 14, 1351–1357.CrossRef Gerstenfeld, E. P., Callans, D. J., Dixit, S., Russo, A., Lin, D., Nayak, H., et al. (2004). Mechanisms of organized left atrial tachycardias occurring after pulmonary vein isolation. Circulation, 14, 1351–1357.CrossRef
3.
go back to reference Mesas, C. E., Pappone, C., Lang, C. C., Gugliotta, F., Tomita, T., Vicedomini, G., et al. (2004). Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: electroanatomic characterization and treatment. Journal of the American College of Cardiology, 44, 1071–1079.CrossRefPubMed Mesas, C. E., Pappone, C., Lang, C. C., Gugliotta, F., Tomita, T., Vicedomini, G., et al. (2004). Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: electroanatomic characterization and treatment. Journal of the American College of Cardiology, 44, 1071–1079.CrossRefPubMed
4.
go back to reference Chugh, A., Oral, H., Lemola, K., Hall, B., Cheung, P., Good, E., et al. (2005). Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm, 2, 464–471.CrossRefPubMed Chugh, A., Oral, H., Lemola, K., Hall, B., Cheung, P., Good, E., et al. (2005). Prevalence, mechanisms, and clinical significance of macroreentrant atrial tachycardia during and following left atrial ablation for atrial fibrillation. Heart Rhythm, 2, 464–471.CrossRefPubMed
5.
go back to reference Deisenhofer, I., Estner, H., Zrenner, B., Schreieck, J., Weyerbrock, S., Hessling, G., et al. (2006). Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation. Europace, 8, 573–582.CrossRefPubMed Deisenhofer, I., Estner, H., Zrenner, B., Schreieck, J., Weyerbrock, S., Hessling, G., et al. (2006). Left atrial tachycardia after circumferential pulmonary vein ablation for atrial fibrillation: incidence, electrophysiological characteristics, and results of radiofrequency ablation. Europace, 8, 573–582.CrossRefPubMed
6.
go back to reference Pappone, C., Manguso, F., Vicedomini, G., Gugliotta, F., Santinelli, O., Ferro, A., et al. (2004). Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing conventional pulmonary vein ablation with a modified approach. Circulation, 110, 3036–3042.CrossRefPubMed Pappone, C., Manguso, F., Vicedomini, G., Gugliotta, F., Santinelli, O., Ferro, A., et al. (2004). Prevention of iatrogenic atrial tachycardia after ablation of atrial fibrillation: a prospective randomized study comparing conventional pulmonary vein ablation with a modified approach. Circulation, 110, 3036–3042.CrossRefPubMed
7.
go back to reference Chang, S. L., Tsao, H. M., Lin, Y. J., Lo, L. W., Hu, Y. F., Tuan, T. C., et al. (2011). Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 22, 748–755.CrossRefPubMed Chang, S. L., Tsao, H. M., Lin, Y. J., Lo, L. W., Hu, Y. F., Tuan, T. C., et al. (2011). Differentiating macroreentrant from focal atrial tachycardias occurred after circumferential pulmonary vein isolation. Journal of Cardiovascular Electrophysiology, 22, 748–755.CrossRefPubMed
8.
go back to reference Wasmer, K., Mönnig, G., Bittner, A., Dechering, D., Zellerhoff, S., Milberg, P., et al. (2012). Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation. Heart Rhythm, 9, 1660–1666.CrossRefPubMed Wasmer, K., Mönnig, G., Bittner, A., Dechering, D., Zellerhoff, S., Milberg, P., et al. (2012). Incidence, characteristics, and outcome of left atrial tachycardias after circumferential antral ablation of atrial fibrillation. Heart Rhythm, 9, 1660–1666.CrossRefPubMed
9.
go back to reference Daoud, E. G., Weiss, R., Augostini, R., Hummel, J. D., Kalbfleisch, S. J., Van Deren, J. M., et al. (2006). Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 17, 157–165.CrossRefPubMed Daoud, E. G., Weiss, R., Augostini, R., Hummel, J. D., Kalbfleisch, S. J., Van Deren, J. M., et al. (2006). Proarrhythmia of circumferential left atrial lesions for management of atrial fibrillation. Journal of Cardiovascular Electrophysiology, 17, 157–165.CrossRefPubMed
10.
go back to reference Andrade, J. G., Dubuc, M., Guerra, P. G., Macle, L., Mondésert, B., Rivard, L., et al. (2012). The biophysics and biomechanics of cryoballoon ablation. Pacing and Clinical Electrophysiology, 35, 1162–1168.CrossRefPubMed Andrade, J. G., Dubuc, M., Guerra, P. G., Macle, L., Mondésert, B., Rivard, L., et al. (2012). The biophysics and biomechanics of cryoballoon ablation. Pacing and Clinical Electrophysiology, 35, 1162–1168.CrossRefPubMed
11.
go back to reference Sorgente, A., Chierchia, G. B., de Asmundis, C., Sarkozy, A., Namdar, M., Capulzini, L., et al. (2011). Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation. Europace, 13, 205–212.CrossRefPubMed Sorgente, A., Chierchia, G. B., de Asmundis, C., Sarkozy, A., Namdar, M., Capulzini, L., et al. (2011). Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation. Europace, 13, 205–212.CrossRefPubMed
12.
go back to reference Chierchia, G. B., de Asmundis, C., Muller-Burri, S. A., Sarkozy, A., Capulzini, L., Paparella, G., et al. (2009). Early recovery of pulmonary vein conduction after cryoballoon ablation for paroxysmal atrial fibrillation: a prospective study. Europace, 11, 445–449.CrossRefPubMed Chierchia, G. B., de Asmundis, C., Muller-Burri, S. A., Sarkozy, A., Capulzini, L., Paparella, G., et al. (2009). Early recovery of pulmonary vein conduction after cryoballoon ablation for paroxysmal atrial fibrillation: a prospective study. Europace, 11, 445–449.CrossRefPubMed
13.
go back to reference Neumann, T., Vogt, J., Schumacher, B., Dorszewski, A., Kuniss, M., Neuser, H., et al. (2008). Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. Journal of the American College of Cardiology, 52, 273–278.CrossRefPubMed Neumann, T., Vogt, J., Schumacher, B., Dorszewski, A., Kuniss, M., Neuser, H., et al. (2008). Circumferential pulmonary vein isolation with the cryoballoon technique results from a prospective 3-center study. Journal of the American College of Cardiology, 52, 273–278.CrossRefPubMed
14.
go back to reference Chun, K. R., Schmidt, B., Metzner, A., Tilz, R., Zerm, T., Köster, I., et al. (2009). The ‘single big cryoballoon’ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. European Heart Journal, 30, 699–709.CrossRefPubMedCentralPubMed Chun, K. R., Schmidt, B., Metzner, A., Tilz, R., Zerm, T., Köster, I., et al. (2009). The ‘single big cryoballoon’ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. European Heart Journal, 30, 699–709.CrossRefPubMedCentralPubMed
15.
go back to reference Kojodjojo, P., O’Neill, M. D., Lim, P. B., Malcolm-Lawes, L., Whinnett, Z. I., Salukhe, T. V., et al. (2010). Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and nonrandomized comparison with pulmonary venous isolation by radiofrequency ablation. Heart, 96, 1379–1384.CrossRefPubMedCentralPubMed Kojodjojo, P., O’Neill, M. D., Lim, P. B., Malcolm-Lawes, L., Whinnett, Z. I., Salukhe, T. V., et al. (2010). Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and nonrandomized comparison with pulmonary venous isolation by radiofrequency ablation. Heart, 96, 1379–1384.CrossRefPubMedCentralPubMed
16.
go back to reference Kühne, M., Suter, Y., Altmann, D., Ammann, P., Schaer, B., Osswald, S., et al. (2010). Cryoballoon versus radiofrequency catheter ablation of paroxysmal atrial fibrillation: biomarkers of myocardial injury, recurrence rates, and pulmonary vein reconnection patterns. Heart Rhythm, 7, 1770–1776.CrossRefPubMed Kühne, M., Suter, Y., Altmann, D., Ammann, P., Schaer, B., Osswald, S., et al. (2010). Cryoballoon versus radiofrequency catheter ablation of paroxysmal atrial fibrillation: biomarkers of myocardial injury, recurrence rates, and pulmonary vein reconnection patterns. Heart Rhythm, 7, 1770–1776.CrossRefPubMed
17.
go back to reference Mikhaylov, E. N., Bhagwandien, R., Janse, P. A., Theuns, D. A., & Szili-Torok, T. (2013). Regular atrial tachycardias developing after cryoballoon pulmonary vein isolation: incidence, characteristics and predictors. Europace, 15, 1710–1717.CrossRefPubMed Mikhaylov, E. N., Bhagwandien, R., Janse, P. A., Theuns, D. A., & Szili-Torok, T. (2013). Regular atrial tachycardias developing after cryoballoon pulmonary vein isolation: incidence, characteristics and predictors. Europace, 15, 1710–1717.CrossRefPubMed
18.
go back to reference Khairy, P., & Dubuc, M. (2008). Transcatheter cryoablation part I: preclinical experience. Pacing and Clinical Electrophysiology, 31, 112–120.CrossRefPubMed Khairy, P., & Dubuc, M. (2008). Transcatheter cryoablation part I: preclinical experience. Pacing and Clinical Electrophysiology, 31, 112–120.CrossRefPubMed
19.
go back to reference Reddy, V. Y., Neuzil, P., d’Avila, A., Laragy, M., Malchano, Z. J., & Kralovec, S. (2008). Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation? Heart Rhythm, 5, 353–360.CrossRefPubMed Reddy, V. Y., Neuzil, P., d’Avila, A., Laragy, M., Malchano, Z. J., & Kralovec, S. (2008). Balloon catheter ablation to treat paroxysmal atrial fibrillation: what is the level of pulmonary venous isolation? Heart Rhythm, 5, 353–360.CrossRefPubMed
20.
go back to reference Knecht, S., Kühne, M., Altmann, D., Ammann, P., Schaer, B., Osswald, S., et al. (2013). Anatomical predictors for acute and mid-term success of cryoballoon ablation of atrial fibrillation using the 28 mm balloon. Journal of Cardiovascular Electrophysiology, 24, 132–138.CrossRefPubMed Knecht, S., Kühne, M., Altmann, D., Ammann, P., Schaer, B., Osswald, S., et al. (2013). Anatomical predictors for acute and mid-term success of cryoballoon ablation of atrial fibrillation using the 28 mm balloon. Journal of Cardiovascular Electrophysiology, 24, 132–138.CrossRefPubMed
21.
go back to reference Fürnkranz, A., Chun, K. R. J., Nuyens, D., Metzner, A., Köster, I., Schmidt, B., et al. (2010). Characterization of conduction recovery after pulmonary vein isolation using the ‘single big cryoballoon’ technique. Heart Rhythm, 7, 184–190.CrossRefPubMed Fürnkranz, A., Chun, K. R. J., Nuyens, D., Metzner, A., Köster, I., Schmidt, B., et al. (2010). Characterization of conduction recovery after pulmonary vein isolation using the ‘single big cryoballoon’ technique. Heart Rhythm, 7, 184–190.CrossRefPubMed
22.
go back to reference Fürnkranz, A., Bordignon, S., Schmidt, B., Gunawardene, M., Schulte-Hahn, B., Urban, V., et al. (2013). Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. Journal of Cardiovascular Electrophysiology, 24, 492–497.CrossRefPubMed Fürnkranz, A., Bordignon, S., Schmidt, B., Gunawardene, M., Schulte-Hahn, B., Urban, V., et al. (2013). Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. Journal of Cardiovascular Electrophysiology, 24, 492–497.CrossRefPubMed
23.
go back to reference Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace, 14, 528–606.CrossRefPubMed Calkins, H., Kuck, K. H., Cappato, R., Brugada, J., Camm, A. J., Chen, S. A., et al. (2012). HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace, 14, 528–606.CrossRefPubMed
24.
go back to reference Gerstenfeld, E. P., & Marchlinski, F. E. (2007). Mapping and ablation of left atrial tachycardias occurring after atrial fibrillation ablation. Heart Rhythm, 4, S65–S72.CrossRefPubMed Gerstenfeld, E. P., & Marchlinski, F. E. (2007). Mapping and ablation of left atrial tachycardias occurring after atrial fibrillation ablation. Heart Rhythm, 4, S65–S72.CrossRefPubMed
Metadata
Title
Regular atrial tachycardias following pulmonary vein isolation for paroxysmal atrial fibrillation: a retrospective comparison between the cryoballoon and conventional focal tip radiofrequency techniques
Authors
Justo Juliá
Gian-Battista Chierchia
Carlo de Asmundis
Giacomo Mugnai
Juan Sieira
Giuseppe Ciconte
Giacomo Di Giovanni
Giulio Conte
Giannis Baltogiannis
Yukio Saitoh
Kristel Wauters
Ghazala Irfan
Pedro Brugada
Publication date
01-03-2015
Publisher
Springer US
Published in
Journal of Interventional Cardiac Electrophysiology / Issue 2/2015
Print ISSN: 1383-875X
Electronic ISSN: 1572-8595
DOI
https://doi.org/10.1007/s10840-014-9961-4

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