Hot Balloon Versus Cryoballoon Ablation for Atrial Fibrillation: Lesion Characteristics and Middle-Term Outcomes

Background: Hot balloon ablation (HBA) and cryoballoon ablation (CBA) were developed to simplify ablation for atrial fibrillation. Because the lesion characteristics and efficacy of these balloon modalities have not been clarified, we compared lesion characteristics and outcomes of HBA and CBA. Methods: Of 165 consecutive patients who underwent initial catheter ablation for atrial fibrillation, 74 propensity scorematched (37 HBA and 37 CBA) patients were included in our study. Results: Patients’ clinical characteristics, including age, sex, body mass index, atrial fibrillation subtype, CHA2DS2-VASc score, and left atrial dimension, were similar between the 2 groups. Touch-up radiofrequency ablation was required for residual/dormant pulmonary vein conduction in 52% of the patients with HBA versus 24% of the patients with CBA (P=0.02) and often in the anterior aspect of the left superior pulmonary vein after HBA (41%) versus the inferior aspect of the inferior pulmonary veins after CBA (22%). HBA lesions were smaller than CBA lesions (23.8±7.9 versus 33.5±14.5 cm2; P=0.0007). Similar results were observed when lesions in each pulmonary vein were compared between groups. Twenty-four hours after the procedure, serum levels of the cardiac biomarkers, including troponin-T, creatine kinase, and creatine kinase-MB, were lower in the HBA group than in the CBA group. Atrial fibrillation recurrence did not differ between the groups within 6 (3% versus 11%; P=0.36) or 12 months (16% versus 16%; P=1.00). Conclusions: Although HBA lesions appear to be smaller than CBA lesions, middle-term outcomes are not statistically different between these balloon modalities.

[1]  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.

[2]  M. Shoda,et al.  HotBalloon Ablation of the Pulmonary Veins for Paroxysmal AF: A Multicenter Randomized Trial in Japan. , 2016, Journal of the American College of Cardiology.

[3]  S. Matsuo,et al.  Adenosine testing during cryoballoon ablation and radiofrequency ablation of atrial fibrillation: A propensity score-matched analysis. , 2016, Heart rhythm.

[4]  H. Hachiya,et al.  Quantitative Analysis of the Isolation Area During the Chronic Phase After a 28-mm Second-Generation Cryoballoon Ablation Demarcated by High-Resolution Electroanatomic Mapping , 2016, Circulation. Arrhythmia and electrophysiology.

[5]  S. Pocock,et al.  Cryoballoon or Radiofrequency Ablation for Paroxysmal Atrial Fibrillation. , 2016, The New England journal of medicine.

[6]  Y. Okumura,et al.  Pulmonary vein distention explaining cryoballoon lesion efficacy. , 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.

[7]  H. Takeda,et al.  Long‐Term Results of Radiofrequency Hot Balloon Ablation in Patients With Paroxysmal Atrial Fibrillation: Safety and Rhythm Outcomes , 2015, Journal of cardiovascular electrophysiology.

[8]  K. Kuck,et al.  Once Isolated, Always Isolated?: Incidence and Characteristics of Pulmonary Vein Reconduction After Second-Generation Cryoballoon-Based Pulmonary Vein Isolation , 2015, Circulation. Arrhythmia and electrophysiology.

[9]  W. Dassen,et al.  Adenosine testing after second-generation cryoballoon ablation (ATSCA) study improves clinical success rate for atrial fibrillation. , 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.

[10]  K. Ellenbogen,et al.  Quantification of the cryoablation zone demarcated by pre- and postprocedural electroanatomic mapping in patients with atrial fibrillation using the 28-mm second-generation cryoballoon. , 2015, Heart rhythm.

[11]  M. Ezekowitz,et al.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. , 2014, Circulation.

[12]  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.

[13]  N. Nagasu,et al.  Prevalence of Esophageal Ulceration After Atrial Fibrillation Ablation with the Hot Balloon Ablation Catheter: What is the Value of Esophageal Cooling? , 2014, Journal of cardiovascular electrophysiology.

[14]  Hugh Calkins,et al.  2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. , 2014, Journal of the American College of Cardiology.

[15]  M. Wright,et al.  Controversies in cardiovascular medicine Drugs vs . ablation for the treatment of atrial fibrillation : the evidence supporting catheter ablation , 2010 .

[16]  H. Ueno,et al.  Feasibility of the Radiofrequency Hot Balloon Catheter for Isolation of the Posterior Left Atrium and Pulmonary Veins for the Treatment of Atrial Fibrillation , 2009, Circulation. Arrhythmia and electrophysiology.