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The role of cryoballoon pulmonary vein isolation in patients with atrial fibrillation

Authors: Stupakov S.I., Tarashvili E.G., Yakh'yaev Ya.B.

Company:
Bakoulev National Мedical Research Center for Cardiovascular Surgery, Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

E-mail: Сведения доступны для зарегистрированных пользователей.

Heading: Reviews

UDC: 616.125

Link: Clinical Physiology of Blood Circulaiton. 2020; 1 (4): 5-11

Quote as: Stupakov S.I., Tarashvili E.G., Yakh'yaev Ya.B. The role of cryoballoon pulmonary vein isolation in patients with atrial fibrillation. Cardiovascular Surgery News. 2020; 4 (1): 5–11 (in Russ.). DOI: 10.24022/2588-0284-2020-4-1-5-11

Keywords:  atrial fibrillation balloon cryoablation radiofrequency ablation

Received / Accepted:  30.01.2020 / 10.02.2020

Full text:  


Abstract

Atrial fibrillation (AF) is currently one of the most common arrhythmias according to some data, in the population of developed countries, it occurs in 21 people per million men and 12 people per million women. Currently, radiofrequency ablation is a common and standard treatment for AF. Radiofrequency isolation of pulmonary veins is the most important component in the treatment of atrial fibrillation by catheter ablation. In addition to radiofrequency ablation, balloon cryoablation is used for successful isolation. When the cryobalon comes into contact with the tissue, this part of the tissue is frozen and the myocardial tissue is replaced with fibrous tissue. Cryoballon isolation of pulmonary veins is not inferior in clinical effectiveness to radiofrequency methods of isolation of pulmonary veins. It can be used as a primary surgical method for the treatment of atrial fibrillation. Long-term results for assessing the safety of vein isolation both in the experiment and in the clinic demonstrated high efficiency in terms of the lack of electrical activity in the pulmonary veins. The best results were obtained in the treatment of patients with paroxysmal AF, but the method is justified in patients with persistent and long-lasting AF, although with less effect. Thus cryoballon isolation is equivalent to an alternative radio frequency treatment of AF.

References

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****
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  2. Colilla S., Crow A., PetkunW., Singer D.E., Simon T., Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am. J. Cardiol. 2013; 112 (8): 1142–7. DOI: 10.1016/j.amjcard.2013.05.063
  3. Zoni-Berisso M., Lercari F., Carazza T., Domenicucci S. Epidemiology of atrial fibrillation: European perspective. Clin. Epidemiol. 2014; 6: 213–20. DOI: 10.2147/clep.s47385
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  9. Lustgarten D.L., Keane D., Ruskin J. Cryothermal ablation: mechanism of tissue injury and current experience in the treatment of tachyarrhythmias. Prog. Cardiovasc. Dis. 1999; 41 (6): 481–98. DOI: 10.1016/s0033-0620(99)70024-1
  10. Khairy P., Chauvet P., Lehmann J., Lambert J., Macle L., Tanguay J.F. et al. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation. 2003; 107 (15): 2045–50. DOI: 10.1161/01.cir.0000058706.82623.a1
  11. Dubuc M., Roy D., Thibault B., Ducharme A., Tardif J.C., Villemaire C. et al. Transvenous catheter ice mapping and cryoablation of the atrioventricular node in dogs. Pacing Clin. Electrophysiol. 1999; 22 (10): 1488–98. DOI: 10.1111/j.1540-8159.1999.tb00353.x
  12. Goff R.P., Quallich S.G., Buechler R.A., Bischof J.C., Iaizzo P.A. Determination of cryothermal injury thresholds in tissues impacted by cardiac cryoablation. Cryobiology. 2017; 75: 125–33. DOI: 10.1016/j.cryobiol.2017.01.002
  13. Chun K.R., Schmidt B., Metzner A., Tilz R., Zerm T., Koster I. et al. The 'single big cryoballoon' technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study. Eur. Heart J. 2009; 30 (6): 699–709. DOI: 10.1093/eurheartj/ehn570
  14. Aryana A., Mugnai G., Singh S.M., Pujara D.K., de Asmundis C., Singh S.K. et al. Procedural and biophysical indicators of durable pulmonary vein isolation during cryoballoon ablation of atrial fibrillation. Heart Rhythm. 2016; 13 (2): 424–32. DOI: 10.1016/j.hrthm.2015.10.033
  15. Kuhne M., Knecht S., Altmann D., Ammann P., Schaer B., Osswald S. et al. Validation of a novel spiral mapping catheter for real-time recordings from the pulmonary veins during cryoballoon ablation of atrial fibrillation. Heart Rhythm. 2013; 10 (2): 241–6. DOI: 10.1016/j.hrthm.2012.10.009
  16. Metzner A., Reissmann B., Rausch P., Mathew S., Wohlmuth P., Tilz R. et al. One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ. Arrhythm. Electrophysiol. 2014; 7 (2): 288–92. DOI: 10.1161/circep.114.001473
  17. Aryana A., Kowalski M., O'Neill P.G., Koo C.H., Lim H.W., Khan A. et al. Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: Shortand long-term results of a multicenter study. Heart Rhythm. 2016; 13 (12): 2306–13. DOI: 10.1016/j.hrthm.2016.08.011
  18. Andrade J.G., Dubuc M., Guerra P.G., Landry E., Coulombe N., Leduc H. et al. Pulmonary vein isolation using a second-generation cryoballoon catheter: a randomized comparison of ablation duration and method of deflation. J. Cardiovasc. Electrophysiol. 2013; 24 (6): 692–8. DOI: 10.1111/jce.12114
  19. Chierchia G.B., Di Giovanni G., Sieira-Moret J., de A.C., Conte G., Rodriguez-Manero M. et al. Initial experience of threeminute freeze cycles using the second-generation cryoballoon ablation: acute and short-term procedural outcomes. J. Interv. Card. Electrophysiol. 2014; 39 (2): 145–51. DOI: 10.1007/s10840-013-9855-x
  20. Chun K.R., Furnkranz A., Koster I., Metzner A., Tonnis T., Wohlmuth P. et al. Two versus one repeat freeze-thaw cycle(s) after cryoballoon pulmonary vein isolation: the alster extra pilot study. J. Cardiovasc. Electrophysiol. 2012; 23 (8): 814–9. DOI: 10.1111/j.1540-8167.2012.02315.x
  21. Ciconte G., Sieira-Moret J., Hacioglu E., Mugnai G., Di Giovanni G., Velagic V. et al. Single 3-minute versus double 4-minute freeze strategy for second-generation cryoballoon ablation: A single-center experience. J. Cardiovasc. Electrophysiol. 2016; 27 (7): 796–803. DOI: 10.1111/jce.12986
  22. Furnkranz A., Koster I., Chun K.R., Metzner A., Mathew S., Konstantinidou M. et al. Cryoballoon temperature predicts acute pulmonary vein isolation. Heart Rhythm. 2011; 8 (6): 821–5. DOI: 10.1016/j.hrthm.2011.01.044
  23. Boveda S., Providencia R., Defaye P., Pavin D., Cebron J.P., Anselme F. et al. Outcomes after cryoballoon or radiofrequency ablation for persistent atrial fibrillation: A multicentric propensity-score matched study. J. Interv. Card. Electrophysiol. 2016; 47 (2): 133–42. DOI: 10.1007/s10840-016-0138-1
  24. Knecht S., Kuhne M., Altmann D., Ammann P., Schaer B., Osswald S. et al. Anatomical predictors for acute and mid-term success of cryoballoon ablation of atrial fibrillation using the 28 mm balloon. J. Cardiovasc. Electrophysiol. 2013; 24 (2): 132–8. DOI: 10.1111/jce.12003
  25. Tokuda M., Matsuo S., Isogai R., Uno G., Tokutake K., Yokoyama K. et al. Adenosine testing during cryoballoon ablation and radiofrequency ablation of atrial fibrillation: A propensity score-matched analysis. Heart Rhythm. 2016; 13 (11): 2128–34. DOI: 10.1016/j.hrthm.2016.08.018
  26. Ghosh J., Martin A., Keech A.C., Chan K.H., Gomes S., Singarayar S. et al. Balloon warming time is the strongest predictor of late pulmonary vein electrical reconnection following cryoballoon ablation for atrial fibrillation. Heart Rhythm. 2013; 10 (9): 1311–7. DOI: 10.1016/j.hrthm.2013.06.014
  27. Ciconte G., Mugnai G., Sieira J., Velagic V., Saltoh Y., Irfan G. et al. On the quest for the best freeze: Predictors of late pulmonary vein reconnections after second generation cryoballoon ablation. Circ. Arrhythm. Electrophysiol. 2015; 8 (6): 1359–65. DOI: 10.1161/circep.115.002966
  28. Iacopino S., Mugnai G., Takarada K., Paparella G., Stroker E., De Regibus V. et al. Second-generation cryoballoon ablation without the use of real-time recording: A novel strategy based on a temperature-guided approach to ablation. Heart Rhythm. 2017; 14 (3): 322–8. DOI: 10.1016/j.hrthm.2016.11.023
  29. Chun K.R., Stich M., Furnkranz A., Bordignon S., Perrotta L., Dugo D. et al. Individualized cryoballoon energy pulmonary vein isolation guided by real-time pulmonary vein recordings, the randomized ICE-T trial. Heart Rhythm. 2017; 14 (4): 495–500. DOI: 10.1016/j.hrthm.2016.12.014
  30. Reddy V.Y., Sediva L., Petru J., Skoda J., Chovanec M., Chitovova Z. et al. Durability of pulmonary vein isolation with cryoballoon ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) Study. J. Cardiovasc. Electrophysiol. 2015; 26 (5): 493-500. DOI: 10.1111/jce.12626
  31. Heeger C.H., Wissner E., Mathew S., Deiss S., Lemes C., Rillig A. 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): 1088–94. DOI: 10.1161/circep.115.003007
  32. Packer D.L., Kowal R.C., Wheelan K.R., Irwin J.M., Champagne J., Guerra P.G. et al. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J. Am. Coll. Cardiol. 2013; 61 (16): 1713–23. DOI: 10.1016/j.jacc.2012.11.064
  33. Andrade J.G., Khairy P., Guerra P.G., Deyell M.W., Rivard L., Macle L. et al. Efficacy and safety of cryoballoon ablation for atrial fibrillation: a systematic review of published studies. Heart Rhythm. 2011; 8 (9): 1444–51. DOI: 10.1016/j.hrthm.2011.03.050
  34. Pandya B., Sheikh A., Spagnola J., Bekheit S., Lafferty J., Kowalski M. Safety and efficacy of second-generation versus first-generation cryoballoons for treatment of atrial fibrillation: a meta-analysis of current evidence. J. Interv. Card. Electrophysiol. 2016; 45 (1): 49–56. DOI: 10.1007/s10840-015-0075-4
  35. He X., Chen, Y. Zhou Y., Huang Y., He J. One-year clinical outcome of pulmonary vein isolation using the second-generation cryoballoon: A meta-analysis. Pacing Clin. Electrophysiol. 2016; 39 (2): 182–9. DOI: 10.1111/pace.12787
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About Authors

  • Sergey I. Stupakov, Dr. Med. Sc., Senior Researcher, ORCID
  • Eka G. Tarashvili, Сand. Med. Sc., Researcher, ORCID
  • Yakh'ya B. Yakh'yaev, Cardiovascular Surgeon, ORCID

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