Ablation of Atrial Fibrillation using the second-generation Cryoballoon

Student thesis: Doctoral Thesis

Abstract

The second-generation Cryoballoon (CB-Adv) is a safe and highly effective tool in achieving both acute PVI and favorable clinical outcome in the treatment of atrial fibrillation (AF). The incidence of spontaneous and adenosine-induced PV reconnection is very low occurring in 4% of initially isolated veins. Nadir temperature <-51°C and re-warming time >28 seconds are significantly associated with successful ablation and absence of PV reconnection, suggesting that a prolonged waiting time and adenosine challenge might not be necessary in such cases. A single 3-minutes application per vein is highly effective in achieving acute PVI, determining AF freedom of 80.4% at 1-year follow-up, showing equal efficacy as compared to the conventional 4-minutes plus bonus freeze approach at 2-year follow-up. These findings question the need of further applications if PVI is already achieved during the first freeze. At 1-year follow-up, freedom from arrhythmic recurrences following PersAF ablation using the CB-Adv is 60% after the index procedure, demonstrating similar outcome as compared to conventional point-bypoint RFCA. The incidence of late PV reconnection is very low following CB-Adv ablation as compared with CF catheter ablation. Faster time to isolation and achievement of -40°C within 60 seconds independently predicted durable PVI. In addition, 60 seconds cut-off for time to PVI indicates persistent isolation with 96.4% NPV. These parameters may be a marker of an effective ablation and could also guide the operator whether to perform further applications in order to ensure a long-lasting PVI. The future research in this field will focus on the adequate duration and the total number of cryo-applications necessary to achieve and maintain a favourable clinical outcome and to minimize the risk of complications.
Date of Award27 Apr 2017
Original languageEnglish
Awarding Institution
  • Vrije Universiteit Brussel
SupervisorPedro Brugada (Promotor), Gian Battista Chierchia (Co-promotor), Carlo De Asmundis (Co-promotor), Bernard Cosyns (Jury), Mark La Meir (Jury), Steven Droogmans (Jury), Luc Jordaens (Jury), Antonio Curnis (Jury), Luigi Di Bias (Jury) & Wyn Davies (Promotor)

Keywords

  • Ablation
  • Atrial Fibrillation
  • second-generation Cryoballoon

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