Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation

• Published in: Heart Rhythm
• Main Authors: Martins, Raphaël, Hamon, David, Césari, Olivier, Behaghel, Albin, Behar, Nathalie, Sellal, Jean-Marc, Daubert, Jean-Claude, Mabo, Philippe, Pavin, Dominique
• Other Authors: Service de cardiologie et maladies vasculaires Rennes = Cardiac, Thoracic, and Vascular Surgery Rennes, Centre Hospitalier Universitaire de Rennes CHU Rennes = Rennes University Hospital, Laboratoire Traitement du Signal et de l'Image (LTSI), Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM), CIC-IT Rennes, Hôpital Pontchaillou-Institut National de la Santé et de la Recherche Médicale (INSERM), Clinique Saint Gatien
• Format: Article in Journal/Newspaper
• Language: English
• Published: HAL CCSD 2014
• Subjects: Cryoablation; Paroxysmal atrial fibrillation; Cryoballoon ablation; Pulmonary vein; Pulmonary vein isolation; Phrenic nerve palsy; [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology; Arctic; Human health
• Online Access: https://hal.univ-lorraine.fr/hal-03233143; https://doi.org/10.1016/j.hrthm.2014.01.002

International audience BACKGROUND: Compared with the first-generation Arctic Front cryoballoon (ARC-CB), the new Arctic Front Advance cryoballoon (ARC-Adv-CB) increases the efficient CB-tissue contact surface during freezing, which may increase the incidence of phrenic nerve (PN) palsy (PNP). OBJECTIVE: To evaluate the safety and efficacy of paroxysmal atrial fibrillation (AF) ablation with the ARC-Adv-CB as well as the merits of a predictor of PNP. METHODS: AF ablation was performed by using a "single 28-mm big CB" approach. The rate of pulmonary vein (PV) isolation with a first cryoapplication was measured. The distance between the CB and a PN pacing catheter in the superior vena cava was measured to predict PNP during freezing. RESULTS: In 147 patients, PV were isolated with a single cryoapplication in 205 (81.3%) of 252 PV treated with the ARC-CB and in 280 (90.3%) of 310 PV treated with the ARC-Adv-CB (P = .003). The mean time to PV isolation was 52 ± 34 seconds and 40 ± 25 seconds (P < .001) and the temperature at the time of isolation was -36.1 ± 10.3°C and -32.3 ± 10.2°C (P = .001) in the ARC-CB and ARC-Adv-CB groups, respectively. Mean procedure and fluoroscopy durations were significantly shorter in the ARC-Adv-CB group. Transient PNP was observed in 7(10.6%) and 20(24.4%) of the patients treated with the ARC-CB and ARC-Adv-CB, respectively (P = .048). The distance between the lateral edge of the CB and a vertical line through the tip of the pacing catheter accurately predicted PNP (P < .001). CONCLUSIONS: The 28-mm ARC-Adv-CB enabled more efficient ablation of paroxysmal AF and shorter procedures than did the ARC-CB. This higher performance was associated with a higher incidence of PNP, which was predicted by the distance between the CB and the PN.