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Durability of Pulmonary Vein Isolation with Cryoballoon Ablation: Results from the Sustained PV Isolation with Arctic Front Advance (SUPIR) Study
Author(s) -
REDDY VIVEK Y.,
SEDIVA LUCIE,
PETRU JAN,
SKODA JAN,
CHOVANEC MILAN,
CHITOVOVA ZITA,
DI STEFANO PAOLA,
RUBIN ETHEL,
DUKKIPATI SRINIVAS,
NEUZIL PETR
Publication year - 2015
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/jce.12626
Subject(s) - medicine , pulmonary vein , ablation , surgery , occlusion , catheter ablation , catheter , atrial fibrillation , cardiology
Durability of Pulmonary Vein Isolation with Cryoballoon Ablation Introduction Pulmonary vein (PV) reconnection remains the most important cause of AF recurrence after AF ablation. The second‐generation cryoballoon catheter's ability to achieve durable PV isolation was assessed in a prospective nonrandomized clinical trial. Methods and Results PV isolation was performed by 4‐minute ablations. Following verification of electrical isolation by a multielectrode mapping catheter, 1 additional lesion per PV was applied. Esophageal temperatures were monitored and all patients underwent postprocedure esophageal endoscopy. All patients underwent a second PV remapping procedure at ∼3 months to assess for PVI durability. Eighty‐four (100%) veins were acutely isolated using only the 28 mm cryoballoon in 21 consecutive PAF patients with 2.2 ± 0.6 cryoapplications per vein, with the majority (83%) occurring after a single freeze. One patient presented with hematemesis and an esophageal ulceration that was treated conservatively; there were no episodes of esophageal fistula or phrenic nerve palsy. At 3.4 (2.9–4.1) months postablation, 68/75 veins (91%) remained electrically isolated; all PVs remained durably isolated in 79% of patients. Two patients accounted for 5 of 7 reconducting veins. The most common site for reconnection was the inferior aspect of the RIPV (3/7 reconnections). Reconnected veins had poorer occlusion at the index ablation procedure than veins that maintained chronic isolation (occlusion grade 2.9 ± 0.7 vs. 3.4 ± 0.7, P = 0.001). Clinical AF recurrence was detected in 2 patients (11%) at follow‐up. Conclusions The improved thermodynamic characteristics of the second‐generation cryoballoon led to a high rate of both single‐shot PVI and chronic lesion durability. This high rate of durable PV isolation is anticipated to translate to improved clinical outcome.