Once Isolated, Always Isolated?
Open Access
- 1 October 2015
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Arrhythmia and Electrophysiology
- Vol. 8 (5), 1088-1094
- https://doi.org/10.1161/circep.115.003007
Abstract
Background—: The second-generation cryoballoon delivers effective pulmonary vein isolation (PVI) associated with superior 1-year clinical outcome. However, data on reconduction of previously isolated PV are sparse. Methods and Results—: A total of 421 patients underwent second-generation 28-mm cryoballoon-based PVI in 2 centers (St. George’s hospital and Harburg hospital, Hamburg, Germany) between June 2012 and May 2015. Sixty-six of 421 (16%) patients (39/66, 59% women; mean age, 63±10 years, mean left atrium diameter, 45±6 mm) with a history of paroxysmal (40/66, 61%) or persistent atrial fibrillation and atrial tachyarrhythmia recurrences despite previous successful second-generation 28-mm cryoballoon-based PVI were included in this analysis. During the index PVI, the standard freeze cycle duration was 240 s. After successful PVI, a bonus freeze cycle of 240 s was applied in the first 15 of 66 (23%) patients, whereas no bonus freeze cycle was applied in the remaining patients. Repeat procedures were performed after a median of 205 (131–357) days following the index ablation. Electric reconduction was assessed for all PVs, and reablation was performed using radiofrequency energy. Persistent electric isolation was noted in 178 of 258 (69%) PVs. In 17 of 66 (26%) patients, all previously targeted PVs remained isolated. A significant difference toward highest reconduction rate for the posteroinferior segment of the right inferior PV was found ( P =0.0002). Conclusions—: The second-generation cryoballoon ablation is associated with a high rate of persistent PVI. The posteroinferior segment of the right inferior PV showed the highest reconduction rate and seems to be a predilection site for PV reconduction.Keywords
This publication has 23 references indexed in Scilit:
- One-year clinical success of a ‘no-bonus’ freeze protocol using the second-generation 28 mm cryoballoon for pulmonary vein isolationEP Europace, 2015
- Electromyographic Monitoring for Prevention of Phrenic Nerve Palsy in Second-Generation Cryoballoon ProceduresCirculation: Arrhythmia and Electrophysiology, 2015
- Pulmonary vein isolation as index procedure for persistent atrial fibrillation: One-year clinical outcome after ablation using the second-generation cryoballoonHeart Rhythm, 2015
- Improved 1‐Year Clinical Success Rate of Pulmonary Vein Isolation with the Second‐Generation Cryoballoon in Patients with Paroxysmal Atrial FibrillationJournal of Cardiovascular Electrophysiology, 2014
- One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm CryoballoonCirculation: Arrhythmia and Electrophysiology, 2014
- Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: a step forward?EP Europace, 2014
- The Incidence of Phrenic Nerve Injury During Pulmonary Vein Isolation Using the Second‐Generation 28 mm CryoballoonJournal of Cardiovascular Electrophysiology, 2014
- Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: 1-year follow-upEP Europace, 2014
- Increased Incidence of Esophageal Thermal Lesions Using the Second-Generation 28-mm CryoballoonCirculation: Arrhythmia and Electrophysiology, 2013
- Characterization of Reentrant Circuits in Left Atrial Macroreentrant TachycardiaCirculation, 2002