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Short tip–big difference? First-in-man experience and procedural efficacy of pulmonary vein isolation using the third-generation cryoballoon

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Abstract

Background

The second-generation cryoballoon (CB2) provides effective and durable pulmonary vein isolation (PVI) associated with encouraging clinical outcome data. The novel third-generation cryoballoon (CB3) incorporates a 40 % shorter distal tip. This design change may translate into an increased rate of PVI real-time signal recording, facilitating an individualized ablation strategy using the time to effect (TTE).

Methods and results

Thirty consecutive patients with paroxysmal or short-standing persistent atrial fibrillation underwent CB3-based PVI and were compared to 30 patients treated with the CB2. Individual freeze-cycle duration was set to TTE + 120 s for both groups. A total of 118 (CB3) and 119 (CB2) pulmonary veins (PV) were identified and all PVs successfully isolated utilizing the CB3 and CB2, respectively. The real-time PVI visualization rate was 74 % (CB3) and 40 % (CB2; p = 0.001) and the mean freeze-cycle duration 204 ± 88 s (CB3) and 215 ± 90 s (CB2; p = 0.15). Per individual PV, a shorter mean freeze-duration was found for the CB3 and the right superior PVs (188 ± 92 vs. 211 ± 124 s, p = 0.04) and right inferior PVs (192 ± 75 vs. 200 ± 37 s, p = 0.02). No differences were found for the left-sided PVs.

Conclusions

A higher rate of real-time electrical PV recordings is seen using the novel CB3 as compared to CB2, which may facilitate an individualized ablation strategy using the TTE.

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References

  1. Metzner A, Reissmann B, Rausch P, Mathew S, Wohlmuth P, Tilz R, Rillig A, Lemes C, Deiss S, Heeger C, Kamioka M, Lin T, Ouyang F, Kuck KH, Wissner E (2014) One-year clinical outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol 7:288–292

    Article  PubMed  Google Scholar 

  2. Wissner E, Heeger CH, Grahn H, Reissmann B, Wohlmuth P, Lemes C, Rausch P, Mathew S, Rillig A, Deiss S, Maurer T, Lin T, Tilz RR, Ouyang F, Kuck KH, Metzner A (2015) One-year clinical success of a ‘no-bonus’ freeze protocol using the second-generation 28 mm cryoballoon for pulmonary vein isolation. Europace 17:1236–1240

    Article  PubMed  Google Scholar 

  3. Metzner A, Heeger CH, Wohlmuth P, Reissmann B, Rillig A, Tilz RR, Mathew S, Lemes C, Deiss S, Maurer T, Saguner A, Ouyang F, Kuck KH, Wissner E (2015) Two-year outcome after pulmonary vein isolation using the second-generation 28-mm cryoballoon: lessons from the bonus freeze protocol. Clin Res Cardiol (Epub ahead of print)

  4. Ciconte G, de Asmundis C, Sieira J, Conte G, Di Giovanni G, Mugnai G, Saitoh Y, Baltogiannis G, Irfan G, Coutino-Moreno HE, Hunuk B, Velagic V, Brugada P, Chierchia GB (2015) Single 3-minute freeze for second-generation cryoballoon ablation: one-year follow-up after pulmonary vein isolation. Heart Rhythm 12:673–680

    Article  PubMed  Google Scholar 

  5. Furnkranz A, Bordignon S, Dugo D, Perotta L, Gunawardene M, Schulte-Hahn B, Nowak B, Schmidt B, Chun JK (2014) Improved 1-year clinical success rate of pulmonary vein isolation with the second-generation cryoballoon in patients with paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 25:840–844

    Article  PubMed  Google Scholar 

  6. Lemes C, Wissner E, Lin T, Mathew S, Deiss S, Rillig A, Heeger C, Wohlmuth P, Reissmann B, Tilz R, Ouyang F, Kuck KH, Metzner A (2015) One-year clinical outcome after pulmonary vein isolation in persistent atrial fibrillation using the second-generation 28 mm cryoballoon: a retrospective analysis. Europace (Epub ahead of print)

  7. Ciconte G, Ottaviano L, de Asmundis C, Baltogiannis G, Conte G, Sieira J, Di Giovanni G, Saitoh Y, Irfan G, Mugnai G, Storti C, Montenero AS, Chierchia GB, Brugada P (2015) Pulmonary vein isolation as index procedure for persistent atrial fibrillation: one-year clinical outcome after ablation using the second-generation cryoballoon. Heart Rhythm 12:60–66

    Article  PubMed  Google Scholar 

  8. Heeger CH, Wissner E, Mathew S, Deiss S, Lemes C, Rillig A, Wohlmuth P, Reissmann B, Tilz RR, Ouyang F, Kuck KH, Metzner A (2015) Once isolated, always isolated? Incidence and characteristics of pulmonary vein reconduction after second-generation cryoballoon-based pulmonary vein isolation. Circ Arrhythm Electrophysiol 8:1088–1094

    Article  PubMed  Google Scholar 

  9. Bordignon S, Furnkranz A, Perrotta L, Dugo D, Konstantinou A, Nowak B, Schulte-Hahn B, Schmidt B, Chun KR (2015) High rate of durable pulmonary vein isolation after second-generation cryoballoon ablation: analysis of repeat procedures. Europace 17:725–731

    Article  PubMed  Google Scholar 

  10. Metzner A, Burchard A, Wohlmuth P, Rausch P, Bardyszewski A, Gienapp C, Tilz RR, Rillig A, Mathew S, Deiss S, Makimoto H, Ouyang F, Kuck KH, Wissner E (2013) Increased incidence of esophageal thermal lesions using the second-generation 28-mm cryoballoon. Circ Arrhythm Electrophysiol 6:769–775

    Article  PubMed  Google Scholar 

  11. Furnkranz A, Bordignon S, Bohmig M, Konstantinou A, Dugo D, Perrotta L, Klopffleisch T, Nowak B, Dignass AU, Schmidt B, Chun JK (2015) Reduced incidence of esophageal lesions by luminal esophageal temperature-guided second-generation cryoballoon ablation. Heart Rhythm 12:268–274

    Article  PubMed  Google Scholar 

  12. Metzner A, Rausch P, Lemes C, Reissmann B, Bardyszewski A, Tilz R, Rillig A, Mathew S, Deiss S, Kamioka M, Toennis T, Lin T, Ouyang F, Kuck KH, Wissner E (2014) The incidence of phrenic nerve injury during pulmonary vein isolation using the second-generation 28 mm cryoballoon. J Cardiovasc Electrophysiol 25:466–470

    Article  PubMed  Google Scholar 

  13. Casado-Arroyo R, Chierchia GB, Conte G, Levinstein M, Sieira J, Rodriguez-Manero M, di Giovanni G, Baltogiannis Y, Wauters K, de Asmundis C, Sarkozy A, Brugada P (2013) Phrenic nerve paralysis during cryoballoon ablation for atrial fibrillation: a comparison between the first- and second-generation balloon. Heart Rhythm 10:1318–1324

    Article  PubMed  Google Scholar 

  14. Martins RP, Hamon D, Cesari O, Behaghel A, Behar N, Sellal JM, Daubert JC, Mabo P, Pavin D (2014) Safety and efficacy of a second-generation cryoballoon in the ablation of paroxysmal atrial fibrillation. Heart Rhythm 11:386–393

    Article  PubMed  Google Scholar 

  15. Furnkranz A, Bordignon S, Schmidt B, Gunawardene M, Schulte-Hahn B, Urban V, Bode F, Nowak B, Chun JK (2013) Improved procedural efficacy of pulmonary vein isolation using the novel second-generation cryoballoon. J Cardiovasc Electrophysiol 24:492–497

    Article  PubMed  Google Scholar 

  16. Su W, Kowal R, Kowalski M, Metzner A, Svinarich JT, Wheelan K, Wang P (2015) Best practice guide for cryoballoon ablation in atrial fibrillation: the compilation experience of more than 3000 procedures. Heart Rhythm 12:1658–1666

    Article  PubMed  Google Scholar 

  17. Straube F, Dorwarth U, Vogt J, Kuniss M, Heinz Kuck K, Tebbenjohanns J, Garcia Alberola A, Chun KR, Souza JJ, Ouarrak T, Senges J, Brachmann J, Lewalter T, Hoffmann E (2014) Differences of two cryoballoon generations: insights from the prospective multicentre, multinational FREEZE Cohort Substudy. Europace 16:1434–1442

    Article  PubMed  Google Scholar 

Download references

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Author notes

    Authors and Affiliations

    1. Department of Cardiology, Asklepios Klinik St. Georg, Lohmühlenstr. 5, 20099, Hamburg, Germany

      Christian-H. Heeger, Erik Wissner, Shibu Mathew, Kentaro Hayashi, Christian Sohns, Bruno Reißmann, Christine Lemes, Tilmann Maurer, Thomas Fink, Ardan M. Saguner, Francesco Santoro, Johannes Riedl, Feifan Ouyang, Karl-Heinz Kuck & Andreas Metzner

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    1. Christian-H. Heeger
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    2. Erik Wissner
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    Correspondence to Andreas Metzner.

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    Conflict of interest

    CH Heeger received travel grants by St. Jude Medical, Biotronik and Medtronic. KH Kuck received travel grants and research grants from Biosense Webster, Stereotaxis, Prorhythm, Medtronic, Edwards, Cryocath, and is a consultant to St. Jude Medical, Biosense Webster, Prorhythm, and Stereotaxis. He received speaker’s honoraria from Medtronic. E Wissner received speaker’s honoraria from Medtronic and is member of Medtronic’s advisory board. A Metzner received speaker’s honoraria and travel grants from Medtronic, Biosense Webster and Cardiofocus. All other authors have no relevant disclosures.

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    C.-H. Heeger and E. Wissner contributed equally to the manuscript.

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    Heeger, CH., Wissner, E., Mathew, S. et al. Short tip–big difference? First-in-man experience and procedural efficacy of pulmonary vein isolation using the third-generation cryoballoon. Clin Res Cardiol 105, 482–488 (2016). https://doi.org/10.1007/s00392-015-0944-y

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    • DOI: https://doi.org/10.1007/s00392-015-0944-y

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