Practical Techniques in Cryoballoon Ablation: How to Isolate Inferior Pulmonary Veins.

Catheter ablation is the most effective treatment option for patients suffering from symptomatic atrial fibrillation. Electrical isolation of the pulmonary veins is the procedural cornerstone. Point-by-point radiofrequency current energy ablation in combination with a 3D electro-anatomical mapping system is the established approach to ablation. In contrast, cryoballoon ablation uses a single-shot approach to facilitate pulmonary vein isolation. However, fixed cryoballoon diameters (28 mm or 23 mm) and non-balloon compliance can lead to technical difficulties in isolating variable pulmonary vein anatomies. This review focuses on key procedural aspects and illustrates practical techniques in cryoballoon pulmonary vein isolation to shorten the learning curve without compromising safety and efficacy. It has a special emphasis on inferior pulmonary veins.

[1]  Qi Sun,et al.  Pulmonary vein isolation with real‐time pulmonary vein potential recording using second‐generation cryoballoon: Procedural and biophysical predictors of acute pulmonary vein reconnection , 2018, Pacing and clinical electrophysiology : PACE.

[2]  C. Hamm,et al.  Second‐generation cryoballoon ablation for treatment of persistent atrial fibrillation: Three‐year outcome and predictors of recurrence after a single procedure , 2018, Journal of cardiovascular electrophysiology.

[3]  P. Neužil,et al.  Laser Balloon or Wide-Area Circumferential Irrigated Radiofrequency Ablation for Persistent Atrial Fibrillation: A Multicenter Prospective Randomized Study , 2017, Circulation. Arrhythmia and electrophysiology.

[4]  K. Hirao,et al.  Left phrenic nerve injury during electrical isolation of left‐sided pulmonary veins with the second‐generation cryoballoon , 2017, Pacing and clinical electrophysiology : PACE.

[5]  K. Kuck,et al.  Acute efficacy, safety, and long-term clinical outcomes using the second-generation cryoballoon for pulmonary vein isolation in patients with a left common pulmonary vein: A multicenter study. , 2017, Heart rhythm.

[6]  S. Matsuo,et al.  Incidence and Factors Associated With the Occurrence of Pulmonary Vein Narrowing After Cryoballoon Ablation , 2017, Circulation. Arrhythmia and electrophysiology.

[7]  B. Schmidt,et al.  Individualized cryoballoon energy pulmonary vein isolation guided by real-time pulmonary vein recordings, the randomized ICE-T trial. , 2017, Heart rhythm.

[8]  H. Hachiya,et al.  Pulmonary Vein Stenosis After Second‐Generation Cryoballoon Ablation , 2017, Journal of cardiovascular electrophysiology.

[9]  K. Ellenbogen,et al.  Atrioesophageal fistula formation with cryoballoon ablation is most commonly related to the left inferior pulmonary vein. , 2017, Heart rhythm.

[10]  K. Chun,et al.  Complications in Catheter Ablation of Atrial Fibrillation in 3,000 Consecutive Procedures: Balloon Versus Radiofrequency Current Ablation. , 2017, JACC. Clinical electrophysiology.

[11]  Gi-Byoung Nam,et al.  Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation , 2016 .

[12]  P. O’Neill,et al.  Catheter ablation using the third-generation cryoballoon provides an enhanced ability to assess time to pulmonary vein isolation facilitating the ablation strategy: Short- and long-term results of a multicenter study. , 2016, Heart rhythm.

[13]  A. Dello Russo,et al.  Comparison between First- and Second-Generation Cryoballoon for Paroxysmal Atrial Fibrillation Ablation , 2016, Cardiology research and practice.

[14]  Paul J. Wang,et al.  Novel usage of the cryoballoon catheter to achieve large area atrial substrate modification in persistent and long-standing persistent atrial fibrillation , 2016, Journal of Interventional Cardiac Electrophysiology.

[15]  P. Brugada,et al.  Improved visualisation of real-time recordings during third generation cryoballoon ablation: a comparison between the novel short-tip and the second generation device , 2016, Journal of Interventional Cardiac Electrophysiology.

[16]  P. Brugada,et al.  Incidence of real-time recordings of pulmonary vein potentials using the third-generation short-tip cryoballoon. , 2016, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[17]  P. Brugada,et al.  Anatomic predictors of phrenic nerve injury in the setting of pulmonary vein isolation using the 28-mm second-generation cryoballoon. , 2016, Heart rhythm.

[18]  K. Kuck,et al.  Short tip–big difference? First-in-man experience and procedural efficacy of pulmonary vein isolation using the third-generation cryoballoon , 2016, Clinical Research in Cardiology.

[19]  P. O’Neill,et al.  Acute and Long‐Term Outcomes of Catheter Ablation of Atrial Fibrillation Using the Second‐Generation Cryoballoon versus Open‐Irrigated Radiofrequency: A Multicenter Experience , 2015, Journal of cardiovascular electrophysiology.

[20]  P. Neužil,et al.  Durability of Pulmonary Vein Isolation with Cryoballoon Ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) Study , 2015, Journal of cardiovascular electrophysiology.

[21]  P. Brugada,et al.  Single 3-minute freeze for second-generation cryoballoon ablation: one-year follow-up after pulmonary vein isolation. , 2015, Heart rhythm.

[22]  J. Chun,et al.  Reduced incidence of esophageal lesions by luminal esophageal temperature-guided second-generation cryoballoon ablation. , 2015, Heart rhythm.

[23]  J. Chun,et al.  Incidence and characteristics of phrenic nerve palsy following pulmonary vein isolation with the second-generation as compared with the first-generation cryoballoon in 360 consecutive patients. , 2015, Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology.

[24]  W. Dassen,et al.  Hemoptysis after cryoablation for atrial fibrillation: truth or just a myth? , 2014, Chest.

[25]  P. O’Neill,et al.  Acute procedural and cryoballoon characteristics from cryoablation of atrial fibrillation using the first- and second-generation cryoballoon: a retrospective comparative study with follow-up outcomes , 2014, Journal of Interventional Cardiac Electrophysiology.

[26]  Laura Perotta,et al.  Improved 1‐Year Clinical Success Rate of Pulmonary Vein Isolation with the Second‐Generation Cryoballoon in Patients with Paroxysmal Atrial Fibrillation , 2014, Journal of cardiovascular electrophysiology.

[27]  J. Andrade,et al.  Clinical Experience With a Novel Electromyographic Approach to Preventing Phrenic Nerve Injury During Cryoballoon Ablation in Atrial Fibrillation , 2014, Circulation. Arrhythmia and electrophysiology.

[28]  K. Kuck,et al.  One-Year Clinical Outcome After Pulmonary Vein Isolation Using the Second-Generation 28-mm Cryoballoon , 2014, Circulation. Arrhythmia and electrophysiology.

[29]  E. Hoffmann,et al.  Comparison of the First and Second Cryoballoon: High-Volume Single-Center Safety and Efficacy Analysis , 2014, Circulation. Arrhythmia and electrophysiology.

[30]  J. Daubert,et al.  Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation. , 2014, Heart rhythm.

[31]  J. Brachmann,et al.  Cryoballoon versus RF Ablation in Paroxysmal Atrial Fibrillation: Results from the German Ablation Registry , 2014, Journal of cardiovascular electrophysiology.

[32]  I. Vollmer,et al.  Pulmonary hemorrhage after cryoballoon ablation for pulmonary vein isolation in the treatment of atrial fibrillation. , 2014, Chest.

[33]  K. Kuck,et al.  Increased Incidence of Esophageal Thermal Lesions Using the Second-Generation 28-mm Cryoballoon , 2013, Circulation. Arrhythmia and electrophysiology.

[34]  B. Schmidt,et al.  Improved Procedural Efficacy of Pulmonary Vein Isolation Using the Novel Second‐Generation Cryoballoon , 2013, Journal of cardiovascular electrophysiology.

[35]  J. Ruskin,et al.  Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. , 2013, Journal of the American College of Cardiology.

[36]  J. Vogt,et al.  Long-term outcomes after cryoballoon pulmonary vein isolation: results from a prospective study in 605 patients. , 2013, Journal of the American College of Cardiology.

[37]  L. Jordaens,et al.  Hemoptysis After Pulmonary Vein Isolation with a Cryoballoon: An Analysis of the Potential Etiology , 2011, Journal of cardiovascular electrophysiology.

[38]  P. Khairy,et al.  Diaphragmatic electromyography during cryoballoon ablation: a novel concept in the prevention of phrenic nerve palsy. , 2011, Heart rhythm.

[39]  Franceschi Frederic,et al.  DIAPHRAGMATIC ELECTROMYOGRAPHY DURING CRYOBALLOON ABLATION: A NOVEL CONCEPT IN THE PREVENTION OF PHRENIC NERVE PALSY , 2011 .

[40]  K. Kuck,et al.  The ‘single big cryoballoon’ technique for acute pulmonary vein isolation in patients with paroxysmal atrial fibrillation: a prospective observational single centre study , 2008, European heart journal.

[41]  S. Ernst,et al.  External and Endoluminal Analysis of Left Atrial Anatomy and the Pulmonary Veins in Three‐Dimensional Reconstructions of Magnetic Resonance Angiography: The Full Insight from Inside , 2006, Journal of cardiovascular electrophysiology.