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. 2020 Nov-Dec;20(6):273-280.
doi: 10.1016/j.ipej.2020.09.003. Epub 2020 Sep 30.

Learning curves in atrial fibrillation ablation - A comparison between second generation cryoballoon and contact force sensing radiofrequency catheters

Vedran Velagic  1 , Ivan Prepolec  2 , Vedran Pasara  2 , Mislav Puljevic  2 , Davor Puljevic  2 , Ivo Planinc  2 , Jure Samardzic  2 , Davor Milicic  2
Affiliations

Learning curves in atrial fibrillation ablation - A comparison between second generation cryoballoon and contact force sensing radiofrequency catheters

Vedran Velagic et al. Indian Pacing Electrophysiol J. 2020 Nov-Dec.

Abstract

Objective: To examine the learning curves of atrial fibrillation (AF) ablation comparing the cryoballoon (CB) and radiofrequency (RF) catheters.

Methods: We performed a retrospective data analysis from the initiation of AF ablation program in our center. For CB ablation, a second generation 28 mm balloon was utilized and for RF ablation.

Results: A total of 100 consecutive patients (50 in each group) have been enrolled in the study (male 74%, mean age 58.9 ± 10 years, paroxysmal AF 85%). The mean procedure time was shorter for CB (116.6 ± 39.8 min) than RF group (191.8 ± 101.1 min) (p < 0.001). There was no difference in the mean fluoroscopy time, 24.2 ± 10.6 min in RF and 22.4 ± 11.7 min in CB group, (p = 0.422). Seven major complications occurred during the study; 5 in RF group (10%) and 2 in CB group (4%) (p = 0.436). After the mean follow up of 14.5 ± 2.4 months, 15 patients in RF group (30%) and 11 in CB group (26%) experienced AF recurrences (P = 0.300).

Conclusion: When starting a new AF ablation program, our results suggest that CB significantly shortens procedure while fluoroscopy time and clinical outcomes are comparable to RF ablation.

Keywords: Ablation; Atrial fibrillation; Contact force sensing radiofrequency catheters; Second generation cryoballoon.

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Conflict of interest statement

Declaration of competing interest Conflict of interest: VV received an educational grants by St Jude Medical, travel grants and lecture fees from Medtronic and Biosense-Webster. MP received educational and travel grants from Medtronic and Biosense-Webster. Conflict of interest: VV received an educational grants by St Jude Medical, travel grants and lecture fees from Medtronic and Biosense-Webster. MP received educational and travel grants from Medtronic and Biosense-Webster.

Figures

Fig. 1
Fig. 1
Image of the left atrium generated from 3D rotational angiography (posterior-anterior view) LSPV – left superior pulmonary vein, LIPV – left inferior pulmonary vein, RSPV – right superior pulmonary vein, RIPV – right inferior pulmonary vein.
Fig. 2
Fig. 2
Real time pulmonary vein isolation visualized by the Achieve catheter. Please note the typical progressive delay of pulmonary vein potentials (arrows) and final disappearance when achieving the entrance block.
Fig. 3
Fig. 3
Cryoballoon ablation, anterior-posterior view. The CB is positioned at the RSPV antrum/ostium. The optimal pulmonary vein occlusion is documented by contrast injection from the distal tip of the catheter. A) A decapolar catheter in superior vena cava/right v. subclavia junction for the phrenic nerve pacing B) Cryoballoon C) ICE catheter in the right atrium D) Achieve circular catheter in the RSPV CB – Cryoballoon, ICE – intracardiac echo catheter, RSPV – right superior pulmonary vein.
Fig. 4
Fig. 4
Radiofrequency ablation. A) PV potentials before ablation can be seen on circular catheter (20A) and ablation catheter (MAP) located in LSPV (thin arrow). B) After the PV isolation only far field electrograms could be detected on circular catheter (thick arrow). LSPV – left superior pulmonary vein, PV pulmonary vein.
Fig. 5
Fig. 5
Evolution of procedural characteristics during the study period. Panel A – Radiofrequency point by point procedures. Panel B – Cryoballoon procedures. Major complications are denoted on y axis, for the given patient when the complication happened.
Fig. 6
Fig. 6
Kaplan-Meier arrhythmia free survival curves. Blue line - CB group; green line - RF group. Lower, the table indicates the remaining patients free from the AF during the follow up.
See this image and copyright information in PMC

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