Earliest pulmonary vein potential-guided cryoballoon ablation for atrial fibrillation

• Published in: Heart and vessels Vol. 35; no. 2; pp. 232 - 238
• Main Authors: Mizutani, Yoshiaki, Kanashiro, Masaaki, Makino, Yuichiro, Satake, Akinori, Suzuki, Wataru, Kurobe, Masanari, Mizutani, Kouji, Ichimiya, Hitoshi, Uchida, Yasuhiro, Watanabe, Junji, Ichimiya, Satoshi, Inden, Yasuya, Murohara, Toyoaki
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.02.2020; Springer Nature B.V
• Subjects: Ablation; Action Potentials; Aged; Atrial Fibrillation - diagnosis; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Biomedical Engineering and Bioengineering; Cardiac arrhythmia; Cardiac Surgery; Cardiology; Cryosurgery - adverse effects; Dwell time; Female; Fibrillation; Fluoroscopy; Heart Rate; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Operative Time; Original Article; Pressing; Prospective Studies; Pulmonary Veins - physiopathology; Pulmonary Veins - surgery; Time Factors; Treatment Outcome; Vascular Surgery; Time-to-isolation; Cryoballoon ablation; Atrial fibrillation; Earliest potential; Pulmonary vein isolation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-019-01471-5

No studies have evaluated both the time-to-isolation (TTI) and the sequence of pulmonary vein (PV) potentials in cryoballoon ablation (CBA) for atrial fibrillation (AF). This study aimed to prospectively evaluate the acute results of pulmonary vein isolation (PVI) using a novel CBA technique—the earliest potential (EP) of PV-guided CBA—in paroxysmal AF. We pressed a balloon against the earliest PV potential site during PVI when TTI could not be achieved within 60 s (EP-guided CBA group). We compared 32 patients consecutively treated by EP-guided CBA to 32 patients treated without pressing the balloon against the EP site (conventional CBA group). The cryoapplication protocol was the same, except with regard to the pressing of the balloon. All 256 PVs (EP-guided CBA group, 128 PVs; conventional CBA group, 128 PVs) were isolated successfully. The TTI observation rate was similar in both groups. Compared with conventional CBA, EP-guided CBA was associated with a lower non-success rate of TTI ≤ 90 s (9% vs. 26%; P  = 0.040) and shorter left atrial dwell time (38 ± 9 vs. 46 ± 19 min; P  = 0.036), total procedure time (76 ± 15 vs. 87 ± 23 min; P  = 0.043), and fluoroscopy time (23 ± 8 vs. 30 ± 11 min; P  = 0.006). This novel EP-guided CBA approach may help facilitate the ablation procedure.