BACKGROUND: The novel second-generation cryoballoon (CB) facilitates pulmonary vein isolation (PVI) by improved surface cooling. The impact of this redesign on collateral damage is unknown. OBJECTIVE: To investigate the incidence of esophageal lesions after PVI using the second-generation CB and the role of luminal esophageal temperature (LET) measurement as a predictor of lesion formation. METHODS: Thirty-two consecutive patients underwent PVI using the second-generation 28 mm CB. Target application time was 2 × 240 seconds. Ninety-two percent of the PVs were isolated after 1 cryoenergy application. Complete PVI was achieved in all patients. LET with 3 thermocouples was continuously measured during cryoenergy application. Freezing was interrupted only if weakening/loss of phrenic nerve function or low LET (<5 °C) was observed. RESULTS: The lowest measured LET was-12 °C (despite cryoapplication interruption). Postprocedural gastroesophagoscopy was performed after 1-3 days in all patients and showed lesions in 6 of 32 (19%) patients. A minimum LET of≤12 °C predicted esophageal lesions with 100% sensitivity and 92% specificity (area under the receiver-operator characteristic curve 0.97; 95% CI 0.93-1.02; P = .001). Persistent phrenic nerve palsy occurred in 2 (6%) patients during ablation at the right inferior pulmonary vein. Repeat gastroesophagoscopy confirmed healing of lesions after 16 ± 14 days. CONCLUSIONS: Second-generation 28 mm CB PVI is associated with significant esophageal cooling, resulting in lesion formation in 19% of the patients. LET measurement accurately predicts lesion formation and may enhance the safety of the novel device.
BACKGROUND: The novel second-generation cryoballoon (CB) facilitates pulmonary vein isolation (PVI) by improved surface cooling. The impact of this redesign on collateral damage is unknown. OBJECTIVE: To investigate the incidence of esophageal lesions after PVI using the second-generation CB and the role of luminal esophageal temperature (LET) measurement as a predictor of lesion formation. METHODS: Thirty-two consecutive patients underwent PVI using the second-generation 28 mm CB. Target application time was 2 × 240 seconds. Ninety-two percent of the PVs were isolated after 1 cryoenergy application. Complete PVI was achieved in all patients. LET with 3 thermocouples was continuously measured during cryoenergy application. Freezing was interrupted only if weakening/loss of phrenic nerve function or low LET (<5 °C) was observed. RESULTS: The lowest measured LET was-12 °C (despite cryoapplication interruption). Postprocedural gastroesophagoscopy was performed after 1-3 days in all patients and showed lesions in 6 of 32 (19%) patients. A minimum LET of≤12 °C predicted esophageal lesions with 100% sensitivity and 92% specificity (area under the receiver-operator characteristic curve 0.97; 95% CI 0.93-1.02; P = .001). Persistent phrenic nerve palsy occurred in 2 (6%) patients during ablation at the right inferior pulmonary vein. Repeat gastroesophagoscopy confirmed healing of lesions after 16 ± 14 days. CONCLUSIONS: Second-generation 28 mm CB PVI is associated with significant esophageal cooling, resulting in lesion formation in 19% of the patients. LET measurement accurately predicts lesion formation and may enhance the safety of the novel device.
Authors: Alexander Bohó; Silvia Mišíková; Peter Spurný; Erika Komanová; Michal Kerekanič; Marek Hudák; Branislav Stančák Journal: Wien Klin Wochenschr Date: 2015-07-04 Impact factor: 1.704
Authors: Eberhard Scholz; Patrick Lugenbiel; Patrick A Schweizer; Panagiotis Xynogalos; Claudia Seyler; Edgar Zitron; Rüdiger Becker; Hugo A Katus; Dierk Thomas Journal: J Atr Fibrillation Date: 2016-02-29
Authors: Giacomo Mugnai; Darragh Moran; Erwin Ströker; Diego Ruggiero; Hugo Enrique Coutino-Moreno; Ken Takarada; Valentina De Regibus; Rajin Choudhury; Saverio Iacopino; Pasquale Filannino; Vincent Umbrain; Stefan Beckers; Pedro Brugada; Carlo de Asmundis; Gian-Battista Chierchia Journal: J Interv Card Electrophysiol Date: 2016-08-15 Impact factor: 1.900