BACKGROUND: The mechanism explaining the efficacy of cryoballoon ablation (CBA) for atrial fibrillation has not been clarified. METHODS AND RESULTS: We compared lesion characteristics between patients in whom pulmonary vein isolation (PVI) was performed by CBA (n=56) and those by contact force (CF)-based RF ablation (n=56). We evaluated the 3-dimensional PV morphology before and after cryoballoon inflation. After PVI, a 3D left atrial voltage map was created. Pacing (10 mA and 2 ms) was performed within the low voltage area from the ablation line, and electrically unexcitable ablated tissue was identified. ATP-provoked dormant conduction after PVI occurred in 9 of the 224 (4%) PVs in the CBA group and in 13 of the 224 (6%) PVs in the CF group (P=0.3935). The inflated balloon stretched the PV from the original PV ostial surface by 7.1±3.5 mm, but at sites with (vs, sites without) residual PV potential/dormant conduction, the extent of the PV distension was reduced (4.0±4.0 mm vs. 7.2±3.4 mm, P<0.0001). The unexcitable ablated tissue around the PVs was significantly wider in CB patients than in CF patients (16.7±5.1 mm vs. 5.3±2.3 mm, P<0.0001). CONCLUSIONS: Use of the cryoballoon significantly distends the PV. Without this extensive distention, PVI may not be successful. CBA seems to yield wide unexcitable ablation zones. These factors seem to explain the durability of CBA lesions.
BACKGROUND: The mechanism explaining the efficacy of cryoballoon ablation (CBA) for atrial fibrillation has not been clarified. METHODS AND RESULTS: We compared lesion characteristics between patients in whom pulmonary vein isolation (PVI) was performed by CBA (n=56) and those by contact force (CF)-based RF ablation (n=56). We evaluated the 3-dimensional PV morphology before and after cryoballoon inflation. After PVI, a 3D left atrial voltage map was created. Pacing (10 mA and 2 ms) was performed within the low voltage area from the ablation line, and electrically unexcitable ablated tissue was identified. ATP-provoked dormant conduction after PVI occurred in 9 of the 224 (4%) PVs in the CBA group and in 13 of the 224 (6%) PVs in the CF group (P=0.3935). The inflated balloon stretched the PV from the original PV ostial surface by 7.1±3.5 mm, but at sites with (vs, sites without) residual PV potential/dormant conduction, the extent of the PV distension was reduced (4.0±4.0 mm vs. 7.2±3.4 mm, P<0.0001). The unexcitable ablated tissue around the PVs was significantly wider in CB patients than in CF patients (16.7±5.1 mm vs. 5.3±2.3 mm, P<0.0001). CONCLUSIONS: Use of the cryoballoon significantly distends the PV. Without this extensive distention, PVI may not be successful. CBA seems to yield wide unexcitable ablation zones. These factors seem to explain the durability of CBA lesions.
Authors: Jason G Andrade; George Monir; Scott J Pollak; Paul Khairy; Marc Dubuc; Denis Roy; Mario Talajic; Marc Deyell; Léna Rivard; Bernard Thibault; Peter G Guerra; Stanley Nattel; Laurent Macle Journal: Heart Rhythm Date: 2014-07-25 Impact factor: 6.343
Authors: Gian B Chierchia; Carlo de Asmundis; Antonio Sorgente; Gaetano Paparella; Andrea Sarkozy; Stephan-Andreas Müller-Burri; Lucio Capulzini; Yoshinao Yazaki; Pedro Brugada Journal: J Cardiovasc Med (Hagerstown) Date: 2011-03 Impact factor: 2.160
Authors: Chan-Il Park; Heiko Lehrmann; Cornelius Keyl; Reinhold Weber; Jochen Schiebeling; Juergen Allgeier; Patrick Schurr; Ashok Shah; Franz-Josef Neumann; Thomas Arentz; Amir S Jadidi Journal: J Cardiovasc Electrophysiol Date: 2014-04-02
Authors: Alexander Fürnkranz; Stefano Bordignon; Boris Schmidt; Melanie Gunawardene; Britta Schulte-Hahn; Verena Urban; Frank Bode; Bernd Nowak; Julian K R Chun Journal: J Cardiovasc Electrophysiol Date: 2013-02-11
Authors: Douglas L Packer; Robert C Kowal; Kevin R Wheelan; James M Irwin; Jean Champagne; Peter G Guerra; Marc Dubuc; Vivek Reddy; Linda Nelson; Richard G Holcomb; John W Lehmann; Jeremy N Ruskin Journal: J Am Coll Cardiol Date: 2013-03-21 Impact factor: 24.094
Authors: Arash Aryana; Deep K Pujara; Shelley L Allen; James H Baker; Martin A Espinosa; Eric F Buch; Uma Srivatsa; Ethan Ellis; Kevin Makati; Marcin Kowalski; Sung Lee; Thomas Tadros; Tina Baykaner; Amin Al-Ahmad; André d'Avila; Luigi Di Biase; Kaoru Okishige; Andrea Natale Journal: J Interv Card Electrophysiol Date: 2020-10-03 Impact factor: 1.900