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ABSTRACT Background Methods Results Conclusions An indicator of successful cryoballoon (CB)‐assisted pulmonary vein (PV) isolation is complete PV occlusion. However, CBs may exhibit a weaker freezing effect on the equatorial plane. This study investigates the predictors of failed left superior PV (LSPV) isolation despite complete occlusion with novel CBs.This retrospective analysis enrolled 300 consecutive patients who underwent first‐time ablation with POLARx or POLARxFIT between November 2021 and October 2023. Of the total, complete occlusion of the LSPV was achieved in 200 patients. Patients in whom LSPV isolation was achieved with additional nonocclusive freezing of the LSPV roof due to nonisolation of LSPV despite complete occlusion (Group A) were compared with those in whom isolation was achieved with complete PV occlusion alone (Group B).Group A had a larger LSPV diameter (21.5 ± 4.6 mm vs. 18.8 ± 3.3 mm, p = 0.052), larger left atrial volume on CT (142.3 ± 47.8 cc vs. 117.8 ± 39.0 cc, p = 0.028), higher nadir temperature (−54.1 ± 5.1°C vs. −60.2 ± 4.4°C, p < 0.001), and smaller northern latitude of the balloon contact site on the LSPV roof side (20.9° ± 3.8° vs. 38.9° ± 6.7°, p < 0.001) compared with Group B. A 27.5° north latitude was observed in most of Group A (sensitivity, 100%; specificity, 96%).Adequate contact positioning of the northern hemisphere to the LSPV is critical for effective isolation, particularly when isolation is challenging despite complete occlusion. In such cases, nonocclusive cryoablation against the LSPV roof might be effective. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusions Cryoballoon ablation has been widely performed in patients with paroxysmal atrial fibrillation (AF). In some challenging pulmonary veins (PVs), the procedure requires additional touch‐up applications against the residual conduction gaps. It implies that there could exist difficult sites to cover with standard cryoballoon applications (CBAs), resulting in resistant conduction gaps (RCGs). This study aims to characterize the RCGs after initial CBAs.We retrospectively enrolled 90 consecutive paroxysmal AF patients in our institute from January 2018 to December 2021 (66.5 ± 8.9 [SD] year‐old, male/female 58/32). The RCGs after initial CBAs were mapped and analyzed with a high‐resolution mapping (HRM) catheter. The PVs isolated using HRM were classified as HRM group. The PVs isolated without HRM, if isolated with a total of one or two CBAs, were classified as Control group.Whereas 325 PVs were isolated without HRM, 29 PVs had RCGs which were mapped and identified with HRM (HRM group): 15 right inferior pulmonary veins (RIPVs), 11 left superior PVs (LSPVs), and 3 left inferior PVs (LIPVs). In HRM group, the rate of broad RCGs in each PV extending over 2 or 3 segments of PV was almost double that of one‐segment RCGs. The width of RCGs significantly correlated with nadir balloon temperature (R = 0.42; p = 0.021) and iTT15 (R = −0.44; p = 0.015).After standard CBAs, most RCGs were demonstrated to spread from the bottom to the posterior wall of RIPV and from the roof to the anterior wall of LSPV. The width of the RCGs was found to be correlated with parameters of balloon temperature, such as Tnadir and iTT15. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods and Results Conclusion Catheter ablation (CA) is the first‐line treatment with a high success rate for patients with symptomatic Wolff–Parkinson–White syndrome, while three‐dimensional (3D) mapping systems enable the identification of accessory pathways (APs). We aimed to develop a novel mapping method using wave‐speed mapping (WSM) to determine AP locations and CA outcomes.This study included 19 patients diagnosed with atrioventricular (AV) reciprocating tachycardia. We compared local activation time (LAT) mapping and WSM, and analyzed the relationship between the “high‐speed islets” in WSM and successful ablation sites. Sixteen APs were located on the left, three on the septum, and one on the right side. The median number of mapping points and mapping time were 1451 points and 14.6 min, respectively. All 20 APs in the 19 patients were eliminated using “high‐speed islets” in WSM. Eleven APs (55%) were eliminated after the first ablation application. One patient with an anteroseptal AP close to the AV node underwent cryoablation to avoid an AV block. The AP width in the 3D mapping system was significantly narrower in WSM than in LAT mapping (5.8 ± 4.0 mm vs. 10.4 ± 3.2 mm, p < .001). One patient experienced an AP recurrence, successfully eliminated using WSM‐guided CA in a repeat procedure. During 13.1 ± 8.3 months of follow‐up, all patients remained free of any supraventricular tachycardias.WSM is a novel mapping method for visualizing APs as “high‐speed islets” and guides a more precise ablation site than LAT mapping. [ABSTRACT FROM AUTHOR]

Background: Atrial fibrillation (AF) inducibility with burst pacing (BP) after radiofrequency ablation (RFA) has been reported to be associated with AF recurrence. In contrast, the relevance of inducibility and recurrence after cryoablation (CRA) is unclear. Methods: We investigated 367 patients undergoing initial ablation for paroxysmal AF (RFA: 174, CRA: 193). Propensity score matching was conducted, retaining 134 patients in each group. Following pulmonary vein isolation (PVI), the inducibility by BP was tested. Inductions at 250 ppm were defined as low‐frequency burst pacing (LFBP) positive, and those at 300 ppm were classified as medium‐frequency burst pacing (MFBP) positive. They were followed for 600 days. Results: Forty‐eight patients (18%) had AF recurrence. There was no significant difference in the recurrence rate between RFA and CRA (17% vs. 19%, Log‐rank p = 0.79). In RFA, significant differences were observed for both LFBP (Log‐rank p < 0.001) and MFBP (Log‐rank p < 0.001). In contrast, in CRA, there were no significant differences for either LFBP (Log‐rank p = 0.39) or MFBP (Log‐rank p = 0.19). Multivariable analysis revealed that LFBP‐positive (hazards ratio [HR] = 5.75, 95% confidence interval [CI] 2.41–13.7, p < 0.001) was an independent predictor for recurrence with RFA. Acute reconnection (HR = 2.73, 95% CI 1.13–6.56, p = 0.025) was an independent predictor for recurrence with CRA. Conclusion: The inducibility by BP after RFA predicted recurrence at both low and medium frequencies. LFBP‐positive was an independent predictor of recurrence in multivariable analysis. In contrast, the inducibility by BP after CRA was not a predictor of recurrence. Trail Registration: This study did not require clinical trial registration. [ABSTRACT FROM AUTHOR]

Background and Aims: Optimization of fluoroscopic image quality for reducing radiation exposure in cryoballoon pulmonary vein isolation (CB‐PVI) has not yet been fully investigated. Therefore, we tried to compare the radiation doses among three different X‐ray system settings. Methods: Consecutive 148 patients scheduled for their first CB‐PVI were prospectively enrolled: low dose with the use of an anti‐scatter grid for the first 51 patients (LD + G group), low dose without an anti‐scatter grid for the subsequent 46 patients (LD‐G group), and ultralow dose (ULD group) with an anti‐scatter grid for the remaining 51 patients. We compared the radiation doses required to complete CB‐PVI procedures among the groups. There were 27 patients for whom CB‐PVI was performed without cine acquisition, but with fluoroscopy only, and the radiation doses were also compared. Results: The median procedure time and fluoroscopy time were 119 and 35.5 min, respectively, with no significant differences among the groups. The median cumulative air Kerma (AK) decreased in both the LD‐G group (71.8 mGy, p <.001) and the ULD group (73.0 mGy, p <.001), compared to the LD + G group (145.0 mGy). Among 27 patients who underwent CB‐PVI without cine acquisition, the median cumulative AK further decreased in both the LD‐G group (31.4 mGy, p <.05) and the ULD group (22.7 mGy, p <.01), compared to the LD + G group (64.6 mGy). Conclusion: Using an ULD X‐ray setting and avoiding cine acquisition, we can reduce radiation exposure, while ensuring the necessary fluoroscopy time for the CB‐PVI procedure. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To define the natural history, patterns of recurrence and treatment modalities for local prostate cancer (PCa) recurrence following radical prostatectomy (RP) and radiation therapy (RT), and to investigate factors that could predict metastasis‐free survival (MFS) in this unique patient population.We queried a prospectively maintained PCa registry to identify men developing in‐field recurrence (IFR) following RP and RT from 2008 to 2021 at a single institution. IFR was defined as biopsy‐proven recurrent PCa or the presence of persistent positron emission tomography‐avid lesions in the prior radiation field without evidence of metastasis. Cox regression was conducted to determine predictors of MFS. Kaplan–Meier methods were used to calculate MFS, cancer‐specific survival (CSS) and overall survival (OS) for patients in three primary therapy categories: cryoablation, androgen deprivation therapy (ADT) alone, and surveillance.Of 4575 patients from our registry, 108 (2.3%) with IFR were identified. The median (interquartile range [IQR]) time to IFR from salvage treatment was 78 (50–126) months. A total of 29 patients (26%) were managed with cryoablation, 23 (21%) with ADT, and 28 (25%) with surveillance. The median (IQR) follow‐up was 76 (48–100) months. There were no statistically significant differences in MFS (P = 0.67) or OS (P = 0.07) among the three primary treatment cohorts. Patients treated with ADT or cryoablation had longer CSS compared to patients managed with surveillance (P = 0.047).We found that IFR may present years after completion of primary treatment for PCa. While curative management strategies may be attempted, local and distant metastatic recurrence is common and often requires systemic therapy. [ABSTRACT FROM AUTHOR]

Introduction: Atrial fibrillation (AF) is the most common sustained arrhythmia, and catheter ablation (CA) is a primary therapeutic option. However, the 30‐day all‐cause mortality risk associated with CA for AF may be underestimated due to selection bias. Our study aimed to assess 30‐day mortality in an unselected cohort of patients. Methods: Data from the National Health Fund‐Poland covered over 99% of nationwide radiofrequency ablation (RF) or cryoballoon ablation for AF, with 100% recorded deaths. The study included consecutive CA procedures in adult patients between 2012 and 2019. Thirty‐day mortality rates were calculated for each age group. Results: A total of 31 214 CAs for AF were performed on 26 767 patients (34.8% female). Forty‐four percent of patients had hypertension, 31.2% had coronary artery disease, 14.4% had heart failure, 11% had diabetes mellitus, 5.6% had malignant neoplasms, 2.7% had a previous myocardial infarction, 2.5% had a previous stroke, and 2.2% had kidney disease. Thirty‐two deaths (0.1%) occurred within 30 days, with the highest mortality in the oldest age group (>80 years). Statistical analysis revealed higher incidences of kidney disease (p < 0.001) and heart failure (p = 0.001) in patients who died within 30 days. Mortality risk did not significantly differ between cryoballoon and RF ablation, as well as first and subsequent ablation for AF. The risk of death within 7 days postablation for AF was 1 in 2750 procedures, while the risk of death on the same day postablation was 1 in 6250 procedures. Conclusions: The 30‐day mortality rate in a large, unselected AF ablation cohort, covering 99% of procedures in the country, is low except for the oldest patients. This factor should be taken into consideration when offering CA for AF. [ABSTRACT FROM AUTHOR]

Introduction: The novel cryoballoon with 28 mm or 31 mm adjustable diameters, aims to achieve a wide antral pulmonary vein isolation (PVI). However, the distribution of antral lesions and their variations based on left atrial (LA) remodeling require further clarification. Methods: We evaluated 22 patients (67 [59.5–74.8] years, 19 males) who underwent PVI of atrial fibrillation (AF) (13 paroxysmal AF [PAF] and 9 non‐PAF) using size‐adjustable cryoballoons. LA electro‐anatomical mapping was performed post‐PVI with three‐dimensional mapping systems. We assessed the shapes of the LA and pulmonary veins (PVs) and the distribution of isolated areas (IAs), comparing the results between PAF and non‐PAF patients. Results: In the left PVs (LPVs), the distance between the PV orifice and IA edge (PVos‐IA) was larger on the roof and posterior segments (~15 mm) but relatively smaller on the anterior segment near the PV ridge (<10 mm). For the right PVs (RPVs), it was more extensive in the posterior segment (10–15 mm). Comparing PAF and non‐PAF, there were no significant differences in the PVos‐IA except for the right posterior‐carina segment, antrum IA (LPVs: 5.9 ± 1.6 vs. 5.8 ± 0.8 cm², p =.81; RPVs: 4.8 ± 2.3 vs. 4.8 ± 1.2 cm², p =.81), distances between the right and left IAs on the LA posterior wall (LAPW), and un‐isolated LAPW area (9.0 ± 4.9 vs. 9.9 ± 2.5 cm², p =.62). No individual PVIs were observed in either group. Two patients exhibited overlapping IAs on the roof, and one patient who underwent 31 mm balloon applications for all PVs exhibited an LAPW isolation. Conclusion: The size‐adjustable cryoballoon achieved a wide antral PVI even in non‐PAF patients. [ABSTRACT FROM AUTHOR]

We present a rare case of tracheal schwannoma, the first reported in Hong Kong, emphasizing the diagnostic challenges and treatment outcomes. A 54‐year‐old woman with respiratory symptoms underwent evaluations revealing a tracheal mass causing luminal narrowing. Emergency operation with rigid bronchoscopy and cryoablation successfully removed the tumor. Follow‐up bronchoscopies showed a gradual reduction in residual tumor size, with no evidence of recurrence after 3.5 years postoperation. Tracheal schwannomas are exceedingly rare, often resulting in delayed diagnosis. Clinicians should maintain a high suspicion of tracheal tumors in patients with unexplained respiratory symptoms. Spirometry and flow volume loop analysis aid in identifying upper airway obstruction. Rigid bronchoscopy is preferred for diagnosis and treatment, ensuring airway stability and obtaining tissue samples. Surgical resection remains the mainstay, but observation after endoscopic resection may be considered. This case highlights the successful management of tracheal schwannoma through endoscopic resection and cryoablation, emphasizing the need for further studies and case reports on this rare entity. [ABSTRACT FROM AUTHOR]

Background and aims: Successful left atrial posterior wall isolation (LAPWI) using only the cryoballoon (CB) is technically challenging for the treatment of atrial fibrillation (AF). This study aimed to evaluate the efficacy of the cross‐over technique, wherein an overlapped ablation is performed by placing the CB from both directions in contact with the LAPW. Methods: This was a single‐center, retrospective, observational study of 194 consecutive patients with persistent atrial fibrillation (PerAF) who underwent a first‐time procedure of pulmonary vein isolation (PVI) + PWI (108 patients) or PVI‐only (86 patients) using the CB. The cross‐over technique was applied in all LAPWI. Results: For ablation of the LA roof and bottom, respectively, a mean of 8.6 ± 1.0 (right to left [R→L] 4.3 ± 1.1 and left to right [L→R] 4.3 ± 1.1) and 9.1 ± 1.2 (R→L 4.6 ± 1.6 and L→R 4.5 ± 1.2) CB applications were delivered. LAPW was successfully isolated solely using the CB in 99.1% of patients. Although the PVI + PWI group had significantly longer procedure time, no severe adverse events were observed in either group. During a median follow‐up of 19 months, freedom from recurrence of all atrial tachyarrhythmias was achieved in 93.5% of the PVI + PWI group and 72.9% of the PVI‐only group (p =.011). Conclusions: LAPWI performed solely with the CB using the cross‐over technique is feasibly, safe, and was independently associated with a significantly higher freedom from recurrence of atrial tachyarrhythmias compared with PVI alone in patients with PerAF. [ABSTRACT FROM AUTHOR]

Macrophages (MΦ) play pivotal roles in tissue homeostasis and repair. Their mechanical environment has been identified as a key modulator of various cell functions, and MΦ mechanosensitivity is likely to be critical – in particular in a rhythmically contracting organ such as the heart. Cultured MΦ, differentiated in vitro from bone marrow (MΦBM), form a popular research model. This study explores the activity of mechanosensitive ion channels (MSC) in murine MΦBM and compares it to MSC activity in MΦ enzymatically isolated from cardiac tissue (tissue‐resident MΦ; MΦTR). We show that MΦBM and MΦTR have stretch‐induced currents, indicating the presence of functional MSC in their plasma membrane. The current profiles in MΦBM and in MΦTR show characteristics of cation non‐selective MSC such as Piezo1 or transient receptor potential channels. While Piezo1 ion channel activity is detectable in the plasma membrane of MΦBM using the patch‐clamp technique, or by measuring cytosolic calcium concentration upon perfusion with the Piezo1 channel agonist Yoda1, no Piezo1 channel activity was observed in MΦTR. The selective transient receptor potential vanilloid 4 (TRPV4) channel agonist GSK1016790A induces calcium entry in MΦTR and in MΦBM. In MΦ isolated from left‐ventricular scar tissue 28 days after cryoablation, stretch‐induced current characteristics are not significantly different compared to non‐injured control tissue, even though scarred ventricular tissue is expected to be mechanically remodelled and to contain an altered composition of pre‐existing cardiac and circulation‐recruited MΦ. Our data suggest that the in vitro differentiation protocols used to obtain MΦBM generate cells that differ from MΦ recruited from the circulation during tissue repair in vivo. Further investigations are needed to explore MSC identity in lineage‐traced MΦ in scar tissue, and to compare mechanosensitivity of circulating monocytes with that of MΦBM. Key points: Bone marrow‐derived (MΦBM) and tissue resident (MΦTR) macrophages have stretch‐induced currents, indicating expression of functional mechanosensitive channels (MSC) in their plasma membrane.Stretch‐activated current profiles show characteristics of cation non‐selective MSC; and mRNA coding for MSC, including Piezo1 and TRPV4, is expressed in murine MΦBM and in MΦTR.Calcium entry upon pharmacological activation of TRPV4 confirms functionality of the channel in MΦTR and in MΦBM.Piezo1 ion channel activity is detected in the plasma membrane of MΦBM but not in MΦTR, suggesting that MΦBM may not be a good model to study the mechanotransduction of MΦTR.Stretch‐induced currents, Piezo1 mRNA expression and response to pharmacological activation are not significantly changed in cardiac MΦ 28 days after cryoinjury compared to sham operated mice. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris poses a significant dermatological challenge, necessitating alternative treatments due to limitations and side effects associated with current therapies. This pilot clinical trial investigated the feasibility and efficacy of precision cryotherapy for acne vulgaris. Methods: A total of 20 volunteers underwent targeted precision cryotherapy using a carbon dioxide‐based device. Treatment outcomes were assessed using various parameters, including Investigator Global Assessment (IGA) score, acne lesion count, erythema index (EI), global evaluation score, and participant satisfaction. Safety monitoring included adverse event reporting and physical examination. Results: Precision cryotherapy demonstrated a significant reduction (90.25%) in the acne lesion count by week 4, with clinical improvement indicated by IGA score reduction (p < 0.001). The EI showed notable improvements at weeks 1, 2, and 4. The global evaluation score demonstrated a 75%–100% clinical improvement at Visit 4. Participants reported high satisfaction (6.75 ± 0.79) with the procedure. No adverse event or discomfort was reported. Conclusion: Precision cryotherapy effectively improved acne lesions, which was safe and satisfactory for participants. These findings suggest its potential as an alternative therapeutic modality, especially for populations with limited treatment options. Further research is needed to validate the results and explore underlying mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: The underlying risks of asymptomatic embolization during high‐power short‐duration (HPSD) ablation for atrial fibrillation remain unclear. We aimed to evaluate microembolic signals (MESs) during HPSD ablation with power settings of 50 and 90 W in comparison with those during cryoballoon (CB) ablation using a novel carotid ultrasound‐Doppler system that classifies solid and air bubble signals using real‐time monitoring. Methods and Results: Forty‐seven patients underwent HPSD ablation using radiofrequency (RF), and 13 underwent CB ablation. MESs were evaluated using a novel pastable soft ultrasound probe equipped with a carotid ultrasound during pulmonary vein isolation. We compared the detailed MESs and their timing between RF and CB ablations. The number of MESs and solid signals were significantly higher in the RF group than in CB group (209 ± 229 vs. 79 ± 32, p =.047, and 83 ± 89 vs. 28 ± 17, p =.032, respectively). In RF ablation, the number of MESs, solid, and bubble signals per ablation point, or per second, was significantly higher at 90 W than at 50 W ablation. The MESs, solid, and bubble signals were detected more frequently in the bottom and anterior walls of the left pulmonary vein (LPV) ablation. In contrast, many MESs were observed before the first CB application and decreased chronologically as the procedure progressed. Signals were more prevalent during the CB interval rather than during the freezing time. Among the 28 patients, 4 exhibited a high‐intensity area on postbrain magnetic resonance imaging (MRI). The MRI‐positive group showed a trend of larger signal sizes than did the MRI‐negative group. Conclusion: The number of MESs was higher in the HPSD RF group than in the CB group, with this risk being more pronounced in the 90 W ablation group. The primary detection site was the anterior wall of the LPV in RF and the first interval in CB ablation. [ABSTRACT FROM AUTHOR]

Introduction: The impact of early recurrence of atrial tachyarrhythmia (ERAT) within the 90‐day blanking period on long‐term outcomes in atrial fibrillation (AF) patients undergoing cryoballoon ablation (CBA) is controversial. This study aimed to assess the relationship between ERAT and late recurrence of atrial tachyarrhythmia (LRAT) post‐CBA. Methods: Utilizing data from a multicenter registry in Korea (May 2018 to June 2022), we analyzed the presence and timing of ERAT (<30, 30–60, and 60–90 days) and its association with LRAT risk after CBA. LRAT was defined as any recurrence of AF, atrial flutter, or atrial tachycardia lasting more than 30 s beyond the 90 days. Results: Out of 2636 patients, 745 (28.2%) experienced ERAT post‐CBA. Over an average follow‐up period of 21.2 ± 10.3 months, LRAT was observed in 874 (33.1%) patients. Patients with ERAT had significantly lower 1‐year LRAT freedom compared to those without ERAT (42.6% vs. 85.5%, p <.001). Multivariate analysis identified ERAT as a potential predictor of LRAT, with a hazard ratio (HR) of 3.98 (95% confidence interval [CI], 3.47–4.57). Significant associations were noted across all examined time frames (HR, 3.84; 95% CI, 3.32–4.45 in <30 days, HR, 5.53; 95% CI, 4.13–7.42 in 30–60 days, and HR, 4.29; 95% CI, 3.12–5.89 in 60–90 days). This finding was consistently observed across all types of AF. Conclusion: ERAT during the 90‐day blanking period strongly predicts LRAT in AF patients undergoing CBA, indicating a need to reconsider the clinical significance of this period. [ABSTRACT FROM AUTHOR]

Introduction: A hybrid convergent approach (endocardial and epicardial ablation) demonstrated superior effectiveness in a recent randomized study for long‐standing persistent atrial fibrillation (LSPAF). Yet, there is a lack of real‐world, long‐term evidence as to which patients are best candidates for a hybrid convergent approach compared to standard endocardial cryoballoon pulmonary vein isolation (CB PVI). Methods and Results: This single‐center, retrospective analysis spanning from 2010 to 2015 compared two distinctly different atrial fibrillation (AF) cohorts; one treated with stand‐alone cryoablation and one treated with a hybrid convergent approach. Baseline characteristics described candidates for each approach. The following criteria were utilized to determine CB PVI candidacy: (1) paroxysmal AF (PAF) (stage 3A) with failed class I/III antiarrhythmic drug (AAD) or (2) persistent/LSPAF (stage 3B/3C/3D) with failed class I/III AAD unwilling to undergo hybrid procedure. Selection criteria for the hybrid procedure included: (1) PAF refractory to both class I/III AAD and prior CB PVI (stage 3D) or (2) persistent/LSPAF (stage 3B/3C/3D) with failed class I/III AAD agreeable to hybrid procedure. Prior sternotomy was excluded. Serial electrocardiograms and continuous monitoring evaluated primary efficacy outcome of time‐to‐first recurrence of atrial arrhythmia after a 90‐day blanking period. Secondary outcomes were procedure‐related complications and AAD use (at discharge, 12, and 36 months). Kaplan‐Meier methods evaluated arrhythmia recurrence. Of 276 patients, 197 (64.2 ± 10.6 years old; 66.5% male; 74.1% 3A‐PAF; 18.3% 3B/3D‐persistent AF; 1.0% 3C‐LSPAF; 6.6% undetermined) underwent CB PVI and 79 (61.4 ± 8.1 years old; 83.5% male; 41.8% 3D‐PAF; 45.5% 3B/3D‐persistent AF; 12.7% 3C/3D‐LSPAF) underwent hybrid procedure. Arrhythmia freedom through 36 months was 55.2% for CB PVI and 50.4% for hybrid (p =.32). Class I AAD utilization at discharge occurred in 38 (19.3%) patients in the CB PVI group and 5 (6.3%) patients in the hybrid group (p =.01). CB PVI class I AAD utilization at 12 months occurred in 14 (9.0) patients versus 0 patients for hybrid convergent (p =.004). Patients with one or more adverse event were as follows: two (1.0%) in the CB PVI group (both transient phrenic nerve palsy) and three (3.7%) in the hybrid group (two with significant bleeding and one with wound infection) (p =.14). Conclusion: This study demonstrated that patients with more complex forms of AF (3D‐PAF or 3B/3C/3D‐persistent/LSPAF) could be well managed with a convergent approach. In a real‐world evaluation, outcomes match safety and efficacy thresholds achieved for patients with earlier, less complex AF etiologies treated by CB PVI alone. [ABSTRACT FROM AUTHOR]

Background: The existing literature regarding the treatment strategy for high‐power short‐duration (HPSD) ablation in patients diagnosed with atrial fibrillation (AF) is currently insufficient. The objective of this study is to perform a comparative analysis evaluating the effectiveness, safety, and procedural efficiency of HPSD versus cryoballoon ablation (CBA) for AF. Methods: A comprehensive search was conducted in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and ClinicalTrials.gov databases to identify trials comparing HPSD with CBA for AF from their inception until December 25, 2023. Treatment effect measures were expressed as odds ratio (OR), mean difference (MD), accompanied by a 95% confidence interval (CI). Results: The analysis comprised six eligible trials involving a total enrollment of 2481 patients. No statistically significant disparities were observed in recurrent atrial arrhythmia (OR 0.90; 95% CI, 0.71–1.16) or total complications (OR 0.65; 95% CI, 0.38–1.12) between the two ablation techniques examined in this study. However, HPSD technique exhibited a significantly prolonged procedure time (MD 27.42; 95% CI, 19.03 to 35.81). Conversely, no significant differences were observed between the two modalities in terms of total fluoroscopy duration (MD −4.37; 95% CI −10.70 to 1.96) and ablation time (MD 7.95; 95% CI −3.97 to 19.88). Furthermore, HPSD demonstrated significantly higher odds of extrapulmonary vein (PV) trigger ablation compared to CBA (OR 18.86; 95% CI, 5.12–69.49). The subgroup analyses revealed that CBA continued to exhibit superior procedure time (except for the paroxysmal AF subgroup: [MD 29.52; 95% CI −4.25 to 63.60]), while no significant differences in safety and efficacy (except for the HPSD ≥ 70 W subgroup: [OR 0.44, 95% CI 0.20–0.97]) outcomes were still observed. Conclusion: Among patients undergoing ablation therapy for AF, both HPSD and CBA demonstrate comparable efficacy and safety profiles; however, HPSD is associated with longer procedural time and higher rates of extra‐PV trigger ablation. [ABSTRACT FROM AUTHOR]

Summary Background Objectives Study design Results Main limitations Conclusions Laser excision is used routinely in the treatment of sarcoids but may be ineffective in cases where complete excision cannot be achieved. A multimodal approach is warranted in these cases. 5‐FU may improve the lethal effect of cryosurgery as an adjunct to laser excision.To compare two treatment protocols for equine sarcoids, laser excision alone versus a combination protocol of laser excision, cryosurgery and 5‐FU chemotherapy. Factors associated with sarcoid recurrence are also investigated.Retrospective case controlled study.Eighty‐four horses with 168 histologically confirmed sarcoids were included, with a median follow‐up time of 39 months (IQR 21–62 months). Sarcoid recurrence at the treated site was reported in 38% of cases and in 23% of any individual sarcoid. No significant difference was demonstrated between treatment categories in either rate of sarcoid recurrence (p = 0.45 for any treated horse, p = 0.63 for individual sarcoid) or time to sarcoid recurrence (p = 0.73). Sarcoid recurrence was higher in horses with a greater number of sarcoids (OR 1.2 (1.0–1.5), p = 0.03); when treatment had been received prior to admission (OR 7.6 (2.0–33), p = 0.004). Horses with urogenital sarcoids or >1 mixed sarcoid experienced more rapid recurrence (HR 3.6 (1.3–10), p = 0.02 and HR 9.9 (3.3–30), p < 0.001) and recurrence was less rapid following the treatment of a horse's first sarcoid (HR 0.3 (0.1–0.7), p = 0.009).Significant differences in case populations in each treatment category. Treatment selection was neither blinded nor randomised and missing data and recall bias limit the study's power. Sarcoid recurrence was owner reported.When assessing the likelihood of sarcoid recurrence, characteristics of both the individual patient and sarcoid phenotype must be considered carefully when selecting a specific treatment protocol. [ABSTRACT FROM AUTHOR]

Background: Currently, two types of cryoballoon (CB) systems are available for catheter ablation of atrial fibrillation (AF). Since the POLARx (Boston Scientific) is softer during freezing than the Arctic Front Advance Pro (AFA‐Pro; Medtronic), it tends to go more deeply into the pulmonary vein (PV), risking PV stenosis. Methods: Ninety‐one patients underwent initial CB ablation for paroxysmal AF (AFA‐Pro 56; POLARx 35). Twenty‐six from each group were extracted using propensity score matching. The PV cross‐sectional area (PVA) was measured by tracing the area within the PV plane at 5‐mm intervals from the PV ostium in a distal direction for 20 mm or to the bifurcation in each PV. The PVA was compared before and 3 months after ablation. Results: Time to balloon temperatures of −30 and − 40°C was significantly shorter and the nadir temperature was significantly lower with POLARx than with AFA‐Pro. In the left inferior (LI) PV and right superior (RS) PV, the freezing balloon position was significantly deeper in POLARx than in AFA‐pro. The freezing position in RSPV with mild to moderate narrowing was deeper than those without (10.2 ± 3.3 mm vs. 8.2 ± 1.8 mm, p =.01). In RSPV, the reduction of PVA tended to be greater with the POLARx than with the AFA‐Pro (26.1% ± 14.1% vs. 19.9% ± 10.3%, p =.07). Conclusion: There was no significant difference in the incidence of PV stenosis between POLARx and AFA‐Pro. However, if POLARx goes deep into the PVs, we will still have to be careful. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown inconsistent results in clinical effectiveness between cryoballoon ablation (CBA) and radiofrequency ablation (RFA), and cost assessment between the procedures is important. The aim of this study was to evaluate the clinical effectiveness and cost‐effectiveness between the procedures in patients with paroxysmal atrial fibrillation (AF) refractory to antiarrhythmic drug therapy. Methods: A systematic review and meta‐analysis were performed. The primary outcome for the meta‐analysis was long‐term AF recurrence. Following the results of the meta‐analysis, the cost‐effectiveness of CBA versus RFA in Japan was assessed. Results: The meta‐analysis included 12 randomized controlled trials and six propensity‐score matching cohort studies. AF recurrence was slightly lower in patients referred for CBA than for RFA, with an integrated risk ratio of 0.93 (95% confidence interval: 0.81–1.07) and an integrated hazard ratio of 0.96 (95% confidence interval: 0.77–1.19), but no significant difference was found. A cost‐minimization analysis was conducted to compare the medical costs of CBA versus RFA because there was no significant difference in the risk of AF recurrence between the procedures. The estimated costs for CBA and RFA were JPY 4 858 544 (USD 32 390) and JPY 4 505 255 (USD 30 035), respectively, with cost savings for RFA of JPY 353 289 (USD 2355). Conclusion: Our meta‐analysis suggests that CBA provides comparable benefits with regard to AF recurrence compared with RFA, as shown in previous studies. Although the choice of treatment should be based on patient and treatment characteristics, RFA was shown that it might be cost saving as compared to CBA. [ABSTRACT FROM AUTHOR]

Introduction: Cryoballoon ablation is a safe and efficient rhythm control strategy in atrial fibrillation (AF) patients. The impact of time from diagnosis to ablation is unclear. The aim of this study was to examine the impact of timing of first‐time cryoballoon ablation on AF recurrence in a nationwide cohort of AF patients. Methods and Results: From nationwide registers, all AF patients ≥18 years of age who underwent first‐time AF cryoballoon ablation in Denmark from 2012 to 2018 were included. The AF patients were stratified by ablation timing: Early group (≤1 year after AF diagnosis), intermediate group (1–3 years after AF diagnosis), and late group (≥3 years after AF diagnosis). By adjusted Cox regression models, the effect of timing on AF recurrence was examined. This study included 1064 AF patients with a median age of 63 years. Most patients were male (66%) and had paroxysmal AF (67%). The 1‐year risk of AF recurrence increased from 31% in the early group to 41% and 44% in the intermediate and late group. The hazard ratios (95% confidence intervals) were 1.28 (0.95, 1.74) in the intermediate group and 1.42 (1.09, 1.86) in the late group when compared to the early group. Continuous diagnosis‐to‐ablation time seemed to have the greatest impact on AF recurrence within the first 2 years. Conclusion: In AF patients undergoing cryoballoon ablation, late timing of ablation was associated with a significantly higher AF recurrence rate when compared to early timing of ablation. These findings support early cryoballoon ablation to improve the outcomes after ablation. [ABSTRACT FROM AUTHOR]

Background: Management of atrial fibrillation (AF) in very severe obese patients is challenging. Cryoballoon ablation (CBA) represents an effective rhythm control strategy. However, data in this patient group were limited. Methods: Highly symptomatic AF patients with body mass index (BMI) ≥ 40 kg/m2 who had failed antiarrhythmic drug therapy and electrocardioversion and failure to achieve targeted body‐weight‐reduction underwent CBA. Results: Data of 72 very severe obese AF patients (Group A) and 129 AF patients with normal BMI (Group B, BMI < 25 kg/m2) were consecutively collected. Group A had significantly younger age (60.6 ± 10.4 vs. 69.2 ± 11.2 years), higher BMI (44.3 ± 4.3 vs. 22.5 ± 1.6 kg/m2). Procedural pulmonary vein isolation (PVI) was successful in all patients (2 touch‐up ablation in Group A). Compared to Group B, Group A had similar procedural (61.3 ± 22.6 vs. 57.5 ± 19 min), similar fluoroscopy time (10.1 ± 5.5 vs. 9.2 ± 4.8 min) but significantly higher radiation dose (2852 ± 2095 vs. 884 ± 732 µGym2). We observed similar rates of real‐time‐isolation (78.6% vs. 78.5%), single‐shot‐isolation (86.5% vs. 88.8%), but significantly longer time‐to‐sustained‐isolation (53.5 ± 33 vs. 43.2 ± 25 s). There was significantly higher rate of puncture‐site‐complication (6.9% vs. 1.6%) in Group A. One‐year clinical success in paroxysmal AF was (Group A: 69.4% vs. Group B: 80.2%; p <.001), in persistent AF was (Group A: 58.1% vs. Group B: 62.8%; p =.889). In Re‐Do procedures Group A had a numerically lower PVI durability (75.0% vs. 83.6%, p =.089). Conclusion: For very severe obese AF patients, CBA appears feasible, leads to relatively good clinical outcome. [ABSTRACT FROM AUTHOR]

Key points: Severe epistaxis occurs in 2% of PNN ablation cases, independent of method or device type.Major epistaxis requiring intervention after PNN ablation can occur on average 20 days post‐procedure. [ABSTRACT FROM AUTHOR]

The article focuses on the study of scar-related ventricular tachycardia (VT) termination mechanisms, particularly through examining the role of circuit entrance sites. Topics include distinctions between fixed and functional lines of block within VT circuits; findings from spontaneous VT termination mapping that emphasize the importance of entrance sites over exit sites; and implications of these insights for refining VT ablation strategies.

Introduction: In cryoballoon ablation (CBA) procedures, transseptal access (TSA) is generally achieved using a standard sheath and needle system that is exchanged for the cryoballoon delivery sheath and dilator over a long wire. Sheath exchange has been related with air embolic events. Recently, an integrated dilator‐needle system assembled to the cryoballoon sheath was introduced. We aimed to evaluate the efficacy and safety of an integrated TSA tool compared with the traditional approach in atrial fibrillation CBA procedures. Methods: Patients scheduled for CBA procedures were randomized 1:1 to traditional TSA (t‐TSA) or integrated TSA (i‐TSA). TSA time was defined as time from superior vena cava to LA insertion of the cryoballoon delivery sheath, after sheath exchange (t‐TSA) or directly (i‐TSA). Results: Ninety‐seven patients (76 males, mean age 59 ± 10 years) were randomized, 48 patients underwent t‐TSA, and 49 i‐TSA. Mean TSA time was 5 min 59 s ± 5 min 36 s in the t‐TSA group and 2 min 59 s ± 2 min 14 s in the i‐TSA group (p <.001). Total fluoroscopy time, skin‐to‐skin procedure time, and LA dwell time were respectively 15 ± 6, 69 ± 16, and 44 ± 12 min in the t‐TSA group and 13 ± 6, 65 ± 15, and 43 ± 11 min in the i‐TSA group (p = ns). No clinically significant acute complications related to TSA were noted in both cohorts. Conclusion: This is the first randomized study comparing both TSA approaches. TSA in CBA procedures using this integrated tool enables a safe and efficient workflow, reducing TSA time and avoiding sheath exchange. [ABSTRACT FROM AUTHOR]

Curettage with or without the use of adjuvants is the standard of care in the treatment of an aneurysmal bone cyst (ABC). Historically, our approach combined curettage, high‐speed burr drilling, and cryoablation. However, treatments varied based on age, tumor location, and surgeon preference. We asked: (1) Does cryoablation in addition to curettage and burr drilling decrease the local recurrence rates? (2) Are there any risk factors for the local recurrence rate? (3) Does cryoablation improve postsurgical functional outcomes in these patients? Patients treated for an ABC, between January 2006 and December 2019 were included in this retrospective analysis. Patient and surgical characteristics, such as age, gender, tumor location, type of treatment, time of follow‐up, recurrence rate, and functional outcome measured by the Musculoskeletal Tumor Society Score 1993 (MSTS93) score were compared between those treated with and without cryoablation. Both groups, without cryoablation (n = 88) and with cryoablation (n = 42), showed no significant difference in local recurrence rates (9.1% vs. 7.1%, p = 0.553) and functional outcomes as measured by the MSTS93 score (28.9 vs. 27.8, p = 0.262). Risk factors analyzed did not significantly affect local recurrence risk, except for secondary ABC diagnosis (p = 0.017). The cryoablation group had a more extended follow‐up (45.6 vs. 73.2 months, p < 0.001), reflecting a shift in practice over time. We found no significant difference in local recurrence rate or functional outcome in patients treated with or without cryoablation. Formal curettage with additional high‐speed burr drilling provides effective tumor control and favorable functional outcomes, negating the need for adjuvant cryoablation. [ABSTRACT FROM AUTHOR]

Background and Objective: Bronchoscopic transbronchial lung cryobiopsy (TBLC) is a guideline‐endorsed alternative to surgical lung biopsy for tissue diagnosis in unclassifiable interstitial lung disease (ILD). The reported incidence of post‐procedural bleeding has varied widely. We aimed to characterize the incidence, severity and risk factors for clinically significant bleeding following TBLC using an expert‐consensus airway bleeding scale, in addition to other complications and diagnostic yield. Methods: A retrospective cohort study of consecutive adult outpatients with unclassifiable ILD who underwent TBLC following multidisciplinary discussion at a single centre in the UK between July 2016 and December 2021. TBLC was performed under general anaesthesia with fluoroscopic guidance and a prophylactic endobronchial balloon. Results: One hundred twenty‐six patients underwent TBLC (68.3% male; mean age 62.7 years; FVC 86.2%; DLCO 54.5%). Significant bleeding requiring balloon blocker reinflation for >20 min, admission to ICU, packed red blood cell transfusion, bronchial artery embolization, resuscitation or procedural abandonment, occurred in 10 cases (7.9%). Significant bleeding was associated with traction bronchiectasis on HRCT (OR 7.1, CI 1.1–59.1, p = 0.042), a TBLC histological pattern of UIP (OR 4.0, CI 1.1–14, p = 0.046) and the presence of medium‐large vessels on histology (OR 37.3, CI 6.5–212, p < 0.001). BMI ≥30 (p = 0.017) and traction bronchiectasis on HRCT (p = 0.025) were significant multivariate predictors of longer total bleeding time (p = 0.017). Pneumothorax occurred in nine cases (7.1%) and the 30‐day mortality was 0%. Diagnostic yield was 80.6%. Conclusion: TBLC has an acceptable safety profile in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding following TBLC. Transbronchial lung cryobiopsy can be performed safely in experienced hands. Radiological traction bronchiectasis and obesity increase the risk of significant bleeding. [ABSTRACT FROM AUTHOR]

Background: Data are lacking on patient‐reported outcomes (PRO) following cryoballoon ablation (CBA) versus radiofrequency ablation (RFA). We sought to evaluate QoL and clinical outcomes of cryoballoon pulmonary vein isolation only (CRYO‐PVI‐ONLY) versus RFA with PVI and posterior wall isolation (RF‐PVI+PWI) in a large prospective PRO registry. Methods: Patients who underwent AF ablation (2013–2016) at our institution were enrolled in an automated, prospectively maintained PRO registry. CRYO‐PVI‐ONLY patients were matched (1:1) with RF‐PVI+PWI patients based on age, gender, and type of AF (paroxysmal vs. persistent). QoL and clinical outcomes were assessed using PRO surveys at baseline and at 1‐year. The atrial fibrillation symptom severity scale (AFSSS) was the measure for QoL. Additionally, we assessed patient‐reported clinical improvement, arrhythmia recurrence, and AF burden (as indicated by AF frequency and duration scores). Results: A total of 296 patients were included (148 in each group, 72% paroxysmal). By PRO, a significant improvement in QoL was observed in the overall study population and was comparable between CRYO‐PVI‐ONLY and RF‐PVI+PWI (baseline median AFSSS of 11.5 and 11; reduced to 2 and 4 at 1 year, respectively; p = 0.44). Similarly, the proportion of patients who reported improvement in their overall QoL and AF related symptoms was high and similar between the study groups [92% (CRYO‐PVI‐ONLY) vs. 92.8% (RF‐PVI+PWI); p = 0.88]. Arrhythmia recurrence was significantly more common in the CRYO‐PVI‐ONLY group (39.7%) compared to RF‐PVI+PWI (27.7 %); p = 0.03. Comparable results were observed in paroxysmal and persistent AF. Conclusion: CRYO‐PVI‐ONLY and RF‐PVI+PWI resulted in comparable improvements in patient reported outcomes including QoL and AF burden; with RF‐PVI+PWI being more effective at reducing recurrences. [ABSTRACT FROM AUTHOR]

Background: Pectus excavatum repair is associated with significant discomfort, and pain is a primary contributor to postoperative hospital length of stay. Recent advances in postoperative pain control include the use of intercostal cryoablation techniques that may now make it possible to discharge patients on the day of surgery. Unnecessary variation in patient care and noncompliance with care bundles may be a factor in extended length of stay. The global aim of this quality improvement initiative was to successfully implement an enhanced recovery after surgery (ERAS) pathway on patients undergoing pectus excavatum repair. The SMART aim was to have a greater than 70% compliance for the perioperative bundle elements within 1 year of the pathway implementation. Methods: Multiple Plan‐Do‐Study‐Act (PDSA) cycles were designed to create and implement an ERAS pathway for patients undergoing a pectus bar insertion procedure. This multidisciplinary pathway was designed, managed, and implemented with key stakeholders from the Departments of Evidence Based Practice, Surgery, Anesthesiology, and Perioperative Nursing. Patient characteristics, outcomes, and compliance with elements of the pathway were measured for analysis for both the baseline and post‐intervention groups with monthly automated reports. Results: After implementation of the ERAS pathway, data on the first 50 patients showed a 90% compliance with the perioperative bundle elements. Mean length of stay was significantly decreased from 33 h (95% CI [28.76, 37.31]) to 18 h (95% CI [14.54, 21.70]). There were zero readmissions within 24 hours for patients who were discharged on the day of surgery. Conclusion: Employing a multidisciplinary approach in both planning and execution that standardized clinician practices and minimized unnecessary variation in patient care, an ERAS pathway for pectus bar insertion has been successfully established at our institution. [ABSTRACT FROM AUTHOR]

Introduction: Cryoablation therapy for pulmonary vein isolation (PVI) to treat paroxysmal atrial fibrillation (PAF) is well established. A novel 28 mm cryoballoon system designed to operate under low pressure to safely reach a lower nadir temperature and maintain constant balloon size during cooling has not been prospectively studied in a large patient population for safety and efficacy. The FROZEN AF (NCT04133168) trial was an international multicenter, open‐label, prospective, single‐arm study on the safety and performance of a novel cryoballoon system for treatment of PAF. Methods and Results: The study enrolled patients at 44 sites in 10 countries across North America, Europe, and Asia. Subjects were indicated for PVI treatment of PAF and had failed or were intolerant of one or more antiarrhythmic drugs. Procedural outcomes were defined based on the 2017 HRS consensus statement. Follow‐up was performed at 7 days, 3, 6, and 12 months. Data are reported as mean ± SD or median (IQR). PVI was performed with a 28 mm cryoballoon in 325 drug refractory PAF patients. Complete PVI was achieved in 95.7% of patients. In cryoablation lesions longer than 60 s, 60.1% of PV isolations required only a single cryoballoon application. Procedure related complications included: phrenic nerve palsy [temporary 4 (1.2%), persistent 0 (0.0%)], cardiac tamponade/perforation 2 (0.6%), and air embolism 1 (0.3%). Freedom from documented atrial arrhythmia recurrence at 12 months was 79.9% (AF 82.7%, AFL 96.5%, AT 98.1%), antiarrhythmic drugs (AAD) were continued or re‐initiated in 26.8% of patients after the 3‐month blanking period. Additionally, an extension arm enrolled 50 pts for treatment with 28/31 mm variable size cryoballoon. A single temporary PNP occurred in this group, which resolved before discharge. Freedom from documented recurrence at 12 months in these pts was 82.0%. Conclusions: This novel cryoballoon may facilitate PVI to treat PAF, providing more options to address the variety of anatomies present in patients with PAF. This cryoballoon system proved to be safe and effective for treatment of patients with drug refractory or drug intolerant PAF. [ABSTRACT FROM AUTHOR]

This document summarizes a study on the use of percutaneous cryoablation (PCA) as a treatment option for renal cell carcinomas (RCCs) in patients with Von Hippel-Lindau (VHL) disease. The study found that PCA was a safe and effective treatment, with no patients requiring more invasive procedures during the follow-up period. The study also reported low rates of complications associated with PCA. Overall, PCA was found to be a viable option for managing RCCs in VHL patients. The study was approved by the Ethics Committee of The Jikei University School of Medicine. [Extracted from the article]

Background: The precise details of atrial activation around the triangle of Koch (ToK) remain unknown. We evaluated the relationship between the atrial-activation pattern around the ToK and success sites for slow-pathway (SP) modification ablation in slowfast atrioventricular reentrant tachycardia (AVNRT). Methods: Thirty patients with slow-fast AVNRT who underwent successful ablation were enrolled. Atrial activation around the ToK during sinus rhythm was investigated using ultra-high-density mapping pre-ablation. The relationships among features of atrial-activation pattern and success sites were examined. Results: Of 30 patients (22 cryoablation; 8 radiofrequency ablation), 26 patients had a collision site of two wavefronts of delayed atrial activation within ToK, indicating a success site. The activation-search function of Lumipoint software, which highlights only atrial activation with a spatiotemporal consistency, showed non-highlighted area on the tricuspid-annulus side of ToK. In 23 of the patients, a spiky potential was recorded at that collision site outside the Lumipoint-highlighted area. Fifteen cryoablation patients with a success site coincident with a collision site outside the Lumipoint-highlighted area had significantly more frequent disappearances of SP after initial cryoablation (46.7% vs. 0%, p = .029), fewer cryoablations (3.7 ± 1.8 vs. 5.3 ± 1.3, p = .045), and shorter procedure times (170 ± 57 vs. 228 ± 91 min, p = .082) compared to the seven cryoablation patients without such sites. Four patients had transient AV block by ablation inside the Lumipoint-highlighted area with fractionated signals, but no patient developed permanent AV block or recurrence post-procedure (median follow-up: 375 days). Conclusions: SP modification ablation at the collision site of atrial activation of the tricuspid-annulus side along with a spiky potential could provide a better outcome. [ABSTRACT FROM AUTHOR]

An editorial is presented which expresses the views on the comparative efficacy and safety of hybrid convergent ablation versus cryoballoon ablation for atrial fibrillation. Topics include the effectiveness of hybrid versus cryoballoon approaches, patient selection criteria for hybrid ablation, and the implications of these findings for future treatment strategies and collaboration between electrophysiologists and surgeons.

Background: Atrial fibrillation (AF) recurrence rates in 1 year after cryoballoon ablation catheter (CBCA) are still high. We purposed to identify strong predictors for AF recurrence after the successful CBCA procedure and develop a new scoring system based only on pre‐procedural parameters. Methods: In the derivation phase, a systematic review and meta‐analysis identified the strong predictors of AF recurrence after the CBCA. The pooled hazard ratio (HR) was used to create the new scoring system. The second phase validated the new scoring system in the cohort population. Results: A meta‐analysis including 29 cohort studies with 16196 participants confirmed that persistent AF, stroke, heart failure, and left atrial diameter (LAD) >40 mm were powerful predictors for AF recurrence after the CBCA procedure. The HeLPS‐Cryo (heart failure [1], left atrial dilatation [1], persistent AF [2], and stroke [2]) was developed based on those pre‐procedural predictors. It was validated in 140 patients receiving CBCA procedures and revealed excellent predictive performance for 1‐year AF recurrence (AUC = 0.8877; 95% CI = 0.8208 to 0.9546). The HeLPS‐Cryo score of ≥3 could predict 1‐year AF recurrence with sensitivity and specificity of 78.9% and 87.9%, respectively. The positive predictive value was 66.7%, and the negative predictive value was 93.1%. Conclusion: The HeLPS‐Cryo score can help the physician estimate the probability of 1‐year AF recurrence after the successful CBCA procedure. Patients with HeLPS‐Cryo score <3 are good candidates for the CBCA procedure. [ABSTRACT FROM AUTHOR]

Introduction: Atrioventricular nodal reentrant tachycardia (AVNRT) is the most common supraventricular tachycardia referred for ablation. Periprocedural conduction system damage was a primary concern during AVNRT ablation. This study aimed to assess the incidence of permanent atrioventricular (AV) block and the success rate associated with different types of catheters in slow pathway ablation. Method: A literature search was performed to identify studies that compared various techniques, including types of radiofrequency ablation (irrigated and nonirrigated) and different sizes of catheter tip cryoablation (4, 6, and 8‐mm), in terms of their outcomes related to permanent atrioventricular block and success rate. To assess and rank the treatments for the different outcomes, a random‐effects model of network meta‐analysis, along with p‐scores, was employed. Results: A total of 27 studies with 5110 patients were included in the analysis. Overall success rates ranged from 89.78% to 100%. Point estimation showed 4‐mm cryoablation exhibited an odds ratio of 0.649 (95%CI: 0.202–2.087) when compared to nonirrigated RFA. Similarly, 6‐mm cryoablation had an odds ratio of 0.944 (95%CI: 0.307–2.905), 8‐mm cryoablation had an odds ratio of 0.848 (95%CI: 0.089–8.107), and irrigated RFA had an odds ratio of 0.424 (95%CI: 0.058–3.121) compared to nonirrigated RFA. Conclusion: Our study found no significant difference in the incidence of permanent AV block between the types of catheters. The success rates were consistently high across all groups. These findings emphasize the potential of both RF ablation (irrigated and nonirrigated catheter) and cryoablation as viable options for the treatment of AVNRT, with similar safety and efficacy profile. [ABSTRACT FROM AUTHOR]

Background: Cryoballoon ablation for atrial fibrillation (AF) requires adequate contact between the pulmonary vein (PV) antrum and cryoballoon. The surge of intraballoon pressure during the initial phase of ablation may change the balloon's shape and compliance, resulting in balloon dislodgement and loss of PV occlusion. Without continuous monitoring, this phenomenon is often undetected but can be associated with incomplete PV isolation (PVI). Methods: Primary cryoablation of AF was performed in 15 patients. PV occlusion status pre‐ and post‐freezing were analyzed with intracardiac echocardiography (ICE) and dielectric imaging‐based occlusion tool (DIOT) to calculate the incidence of expansion dislodgement of cryoballoon. Results: A total of 105 cryoablation applications were performed on 57 veins, including three common ostiums of left pulmonary veins. In the evaluation of PV occlusion, both modalities reported consistent results in 86.7% of the assessments. Despite complete PV occlusion before ablation, peri‐balloon leak after initiation of freezing was detected by ICE in 5/22 (22.7%) applications and by DIOT in 8/25 (32%) applications. Conclusion: Incidence of expansion dislodgement of the cryoballoon was detected in one‐fourth to one‐third of cryoablation applications depending on the imaging modality used, which was clinically frequent and significant. [ABSTRACT FROM AUTHOR]

Balloon‐based catheter ablation including visually guided laser balloon (VGLB) has been adopted a first line therapeutic strategy for the patients with atrial fibrillation (AF). Recently, the roof area ablation beyond pulmonary vein (PV) isolation (PVI) using cryoballoon has been described as an effective therapy for the patients with persistent AF. However, the roof area ablation performed with a VGLB remains unknown. In this case, we report the case of roof area ablation for the patient with persistent AF using a VGLB. [ABSTRACT FROM AUTHOR]

Background: In recent years, aesthetic procedures aiming at body remodeling and have grown exponentially. Cryolipolysis (CLL) has stood out as a noninvasive resource that acts directly on the subcutaneous adipose tissue promoting a significant reduction of adipose tissue through of cooling that could lead to the crystallization cytoplasmic lipids, loss of cellular integrity, apoptosis/necrosis of adipocytes, and local inflammation, producing selective loss of adipose tissue. Thus, the objective of the present study was to evaluate the effects of a specific technique of CLL application on the inflammatory reactions of the target tissue in different post‐application times. Methods: This is a randomized, blind clinical study that evaluated the tissue sample of six patients after 45, 60, and 90 days of an innovative protocol for the application of CLL, with samples collected through abdominoplasty surgeries. The samples were evaluated by immunohistochemical analyses of several markers. Results: A significantly greater increase in fibroblasts was observed at 45 days and greater phagocytic action at 60 days. Regarding the apoptosis process, the expression of caspase 3 and cleaved caspase 3 markers varied at different times, with cleaved caspase 3 being higher at 45 and 90 days after CLL application. Conclusion: The protocol of the CLL presented in this study was able to induce inflammatory responses in addition to confirming the selective apoptotic action at the different times studied. [ABSTRACT FROM AUTHOR]

Introduction: Pulsed field ablation (PFA) represents a novel, nonthermal energy modality that can be applied for single‐shot pulmonary vein isolation (PVI) in atrial fibrillation (AF). Comparative data with regard to deep sedation to established single‐shot modalities such as cryoballoon (CB) ablation are scarce. The aim of this study was to compare a deep sedation protocol in patients receiving PVI with either PFA or CB. Methods: Prospective, consecutive AF patients undergoing PVI with a pentaspline PFA catheter were compared to a retrospective CB‐PVI cohort of the same timeframe. Study endpoints were the requirements of analgesics, cardiorespiratory stability, and sedation‐associated complications. Results: A total of 100 PVI patients were included (PFA n = 50, CB n = 50, mean age 66 ± 10.6, 61% male patients, 65% paroxysmal AF). Requirement of propofol, midazolam, and sufentanyl was significantly higher in the PFA group compared to CB [propofol 0.14 ± 0.04 mg/kg/min in PFA vs. 0.11 ± 0.04 mg/kg/min in CB (p =.001); midazolam 0.00086 ± 0.0004 mg/kg/min in PFA vs. 0.0006295 ± 0.0003 mg/kg/min in CB (p =.002) and sufentanyl 0.0013 ± 0.0007 µg/kg/min in PFA vs. 0.0008 ± 0.0004 µg/kg/min in CB (p <.0001)]. Sedation‐associated complications did not differ between both groups (PFA n = 1/50 mild aspiration pneumonia, CB n = 0/50, p >.99). Nonsedation‐associated complications (PFA: n = 2/50, 4%, CB: n = 1/50, 2%, p >.99) and procedure times (PFA 75 ± 31, CB 84 ± 32 min, p =.18) did not differ between groups. Conclusions: PFA is associated with higher sedation and especially analgesia requirements. However, the safety of deep sedation does not differ to CB ablation. This study sought to compare the requirements and safety of deep sedation in patients undergoing pulmonary vein isolation (PVI) with either a pentaspline pulsed field ablation (PFA) catheter, a novel energy modality, or cryoballoon (CB) ablation, an established energy source. In 100 patients undergoing PVI (PFA: n = 50, CB: n = 50), the requirement of analgosedation was significantly higher in the PFA group compared to CB, especially with regard to analgesics. There was no difference in sedation‐associated and nonsedation‐associated complications between groups. [ABSTRACT FROM AUTHOR]

Introduction: Influence of early atrial fibrillation (AF) ablation, particularly cryoballoon ablation (CBA), on clinical outcome during long‐term follow‐up has not been clarified. The objective was to determine whether an early CBA (diagnosis‐to‐ablation of ≤6 months) strategy could affect freedom from AF recurrence after index CBA. Methods: The study included 2605 patients from Korean CBA registry data with follow‐up >12 months after de novo CBA. The primary outcome was recurrence of atrial tachyarrhythmias (ATs) of ≥30‐s after a 3‐month blanking period. Results: Compared to patients in early CBA group, patients in late CBA group had higher prevalence of diabetes, congestive heart failure, and chronic kidney disease, and higher mean CHA2DS2‐VAS score. During mean follow‐up of >21 months, ATs recurrence was detected in 839 (32.2%) patients. The early CBA group showed a significantly lower 2‐year recurrence rate of ATs than the late CBA group (26.1% vs. 31.7%, p = 0.043). In subgroup analysis, the early CBA group showed significantly higher 1‐year and 2‐year freedom from ATs recurrence than the late CBA group only in paroxysmal atrial fibrillation (PAF) patients in overall and propensity score matched cohorts. Multivariate analysis showed that early CBA was an independent factor for preventing ATs recurrence in PAF (hazard ratio: 0.637; 95% confidence intervals: 0.412–0.984). Conclusion: Early CBA strategy, resulting in significantly lower ATs recurrence during 2‐year follow‐up after index CBA, might be considered as an initial rhythm control therapy in patients with paroxysmal AF. [ABSTRACT FROM AUTHOR]

Introduction: The major limitation of the current cryoballoon (CB) system is a fixed 28 mm balloon‐size. We sought to analyze real‐world early experience with novel‐sized adjustable CB. Methods: This multicenter observational study included 140 consecutive atrial fibrillation patients (71 years, 94 men, 86 paroxysmal) who underwent pulmonary vein (PV) isolation using expandable diameter CB capable of ablation at 28 or 31 mm. Results: Out of 544 targeted PVs, 526 (96.7%) were successfully isolated by a size‐adjustable CB with a 770 [690−870] second median application dose, while the remaining 18 required touch‐up ablation. Among them, 326 (62.0%) PVs were isolated by a 31 mm balloon, and the rate was significantly higher for upper than lower PVs (73.0% vs. 45.7%, p <.0001) and highest for right superior (78.5%) and lowest for right inferior (39.9%) PVs. The biophysical parameters and time to isolation were comparable between the 28 and 31 mm balloons, however, the real‐time PV potential monitoring capability was significantly higher for 31 mm than 28 mm balloons for the left superior PV. The esophageal temperature reached 15°C during left inferior PV ablation significantly more often with 31 mm than 28 mm balloons (43.1% vs. 18.2%, p =.008). Right phrenic nerve injury (PNI) occurred in 9 (6.4%) patients during applications (6 right superior, 2 right inferior PVs), and most occurred with a 31 mm balloon. Conclusions: Our real‐world early data demonstrated high acute efficacy and safety of the novel‐sized adjustable CB. The biophysical parameters were similar between the 28 and 31 mm balloons. No marked decrease in the incidence of PNI was observed even with 31 mm balloons. [ABSTRACT FROM AUTHOR]

Introduction: The circular catheter compatible with current cryoballoon system for atrial fibrillation (AF) ablation is exclusively sensed by impedance‐based electro‐anatomical mapping (EAM) system, limiting the accuracy of maps. We aim to investigate the feasibility and safety of a magnetic‐based circular mapping catheter for AF ablation with cryoballoon. Methods: Nineteen consecutive patients who underwent pulmonary vein isolation (PVI) with cryoballoon for paroxysmal or persistent AF were included. EAMs of left atrium (LA) created by the LASSOSTAR™NAV catheter (Lassostar map) before and after PVI were compared to that generated by a high‐density mapping catheter (Pentaray map) from different aspects including structural similarity, PV angle, LA posterior wall (LAPW) and low voltage areas (LVAs), and the amplitude of far field electrograms (FFEs) recorded by catheters. Results: All patients had successful PVI without major complications. With similar mapping time and density, the LA volume calculated from the Pentaray map and Lassostar map were comparable. There were no significant differences in PV angle of all PVs and PW area (16.8 ± 3.2 vs. 17.1 ± 2.8, p =.516) between Pentaray map and Lassostar map. High structural similarity score was observed between two maps (0.783 in RAO/LAO view and 0.791 in PA view). Lassostar map detected lesser but not statistically significant extension of LVA (13.9% vs. 18.3%, p =.07). Amplitude of FFE was larger at the right superior PV on Lassostar map (0.21 ± 0.16 vs. 0.14 ± 0.11 mV, p =.041) compared to that on the Pentaray map. Conclusion: In our initial experience, PVI with cryoballoon and magnetic‐based circular LASSOSTAR™NAV catheter was safe and effective based on the accurate LA geometry it created. [ABSTRACT FROM AUTHOR]

Background: This meta‐analysis evaluated long‐term efficacy and safety of cryoballoon ablation (CB) of atrial fibrillation (AF). Methods: PubMed, Cochrane Library, and Web of Science were searched until July 31, 2023, for published works investigating efficacy and safety of CB of AF in which mean/median follow‐up time was not less than 36 months. Safety was assessed by adverse events. Efficacy was assessed by AF recurrence, defined as any atrial arrhythmias lasting more than 30 s. Results: A total of 19 clinical studies were included. After an average of 58.1 months of follow‐up, the overall AF recurrence rate was about 37%. The predictors of recurrence were duration of AF (HR 1.00; 95% CI [1.00 ∼ 1.01]), early recurrence of atrial fibrillation (HR 3.96; 95%CI [1.12 ∼ 14.02]), left atrial diameter (HR 1.04; 95%CI [1.02 ∼ 1.06]), and persistent AF (HR1.47; 95% CI [1.19 ∼ 1.82]). In terms of safety, the incidence of transient phrenic paralysis (PNP) was the highest, about 3%; followed by vascular complications (about 2%); pseudoaneurysm, permanent PNP, and all‐cause death was (about 1%); and pericardial effusion and stroke / TIA was very low. Conclusion: CB is associated with low rates of severe complications and reasonable success rates. [ABSTRACT FROM AUTHOR]

Cryoballoon‐based catheter ablation has emerged as an efficacious and safe therapeutic intervention for patients with paroxysmal atrial fibrillation (PAF). PAF is primarily associated with the triggers in the pulmonary vein (PV). However, persistent atrial fibrillation (PeAF) is a complex condition that involves changes in the atrial substrate and the presence of non‐PV triggers. Therefore, a comprehensive treatment approach is necessary for patients with PeAF. Utilizing a 3D electroanatomical map, the radiofrequency‐based ablation technique adeptly identifies and targets the atrial substrate and non‐PV triggers. On the other hand, the cryoballoon‐based AF ablation was initially designed for PV isolation. However, its single‐shot feature makes it a great choice for electrophysiologists looking to address non‐PV triggers. It is possible to target the left atrial appendage (LAA), superior vena cava (SVC), left atrial roof, and posterior wall using the apparatus's unique configuration and ablation abilities. This review focuses on the increasing literature regarding cryoballoon‐based methods for non‐PV trigger ablation. Specifically, it delves into the technical procedures used to isolate the LAA, SVC, and ablate the left atrial roof and posterior wall. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating the safety and efficacy of the PolarX cryoballoon system for treating paroxysmal atrial fibrillation. Topics discussed include the design differences between PolarX and standard cryoablation systems, procedural outcomes, and the need for comparative studies with existing technologies to assess real-world effectiveness and potential risks.

Introduction: Cryoballoon ablation (CBA) of the left atrial (LA) roof in addition to a pulmonary vein isolation has been expected to improve the clinical outcomes post‐atrial fibrillation (AF) ablation. We demonstrated the characteristics and efficacy of CBA of the LA roof through our experience with a large volume of procedures. Methods: Among 1036 AF ablation procedures with CBA of the LA roof, 834 patients who underwent a de novo ablation were analyzed. Results: Complete LA roof line conduction block was obtained in 767 patients (92.0%) solely by CBA (Group A). Compared with the other patients (Group B), the mean nadir balloon temperature during CBA of the LA roof (−44.5 ± 5.6°C for Group A vs. −40.5 ± 7.5°C for Group B, p <.01) and number of cryoballoon applications during the LA roof ablation with a circular mapping catheter located in the left superior pulmonary vein (1.3 ± 0.8 for Group A vs. 1.6 ± 1.0 for Group B, p =.02) were significantly lower in Group A. A multivariate analysis revealed that those were predictors of a complete LA roof conduction block after only CBA. The 1‐year Kaplan–Meier atrial arrhythmia free rate estimates were 80.6% for Group A and 59.0% for Group B (p <.01). Conclusion: Complete LA roof line conduction block could be obtained with a cryoballoon without touch‐up ablation in most cases. The LA roof CBA with a circular mapping catheter located in the right superior pulmonary vein was preferable to obtaining complete LA roof conduction block, which was important with regard to the clinical outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Pulmonary vein isolation (PVI) is a pivotal part of ablative therapy for atrial fibrillation (AF). Currently, there are multiple techniques available to realize PVI, including: manual‐guided cryoballoon (MAN‐CB), manual‐guided radiofrequency (MAN‐RF), and robotic magnetic navigation‐guided radiofrequency ablation (RMN‐RF). There is a lack of large prospective trials comparing contemporary RMN‐RF with the more conventional ablation techniques. This study prospectively compared three catheter ablation techniques as treatment of paroxysmal AF. Methods: This multicenter, prospective study included patients with paroxysmal AF who underwent their first ablation procedure. Procedural parameters (including procedural efficiency), complication rates, and freedom of AF during 12‐month follow‐up, were compared between three study groups which were defined by the utilized ablation technique. Results: A total of 221 patients were included in this study. Total procedure time was significantly shorter in MAN‐CB (78 ± 21 min) compared to MAN‐RF (115 ± 41 min; p <.001) and compared to RMN‐RF (129 ± 32 min; p <.001), whereas it was comparable between the two radiofrequency (RF) groups (p =.062). A 3% complication rate was observed, which was comparable between all groups. At 12‐month follow‐up, AF recurrence was observed in 40 patients (19%) and was significantly lower in the robotic group (MAN‐CB 19 [24%], MAN‐RF 16 [23%], RMN‐RF 5 [8%] AF recurrences, p =.045) (multivariate hazard ratio of RMN‐RF on AF recurrence 0.32, 95% confidence interval: 0.12–0.87, p =.026). Conclusion: RMN‐guided PVI results in high freedom of AF in patients with paroxysmal AF, when compared to cryoablation and manual RF ablation. Cryoablation remains the most time‐efficient ablation technique, whereas RMN nowadays has comparable efficiency with manual RF ablation. [ABSTRACT FROM AUTHOR]

Breast cancer (BC) is the most common cancer and one of the most important causes of death in women. Surgery is the standard therapy for breast cancer and in the last decades evolved towards a more conservative approach, with lumpectomy, followed by radiation therapy, the most common option. Unfortunately, up to 40% of women affected by BC will develop metastases and will receive systemic therapy, which improves survival and quality of life. Interventional oncology (IO), thanks to the improvement in technology and clinical experience, is gaining an important role in the field of breast cancer, both in treating the primary tumour and also in metastasis in well‐selected cases. Percutaneous thermal ablation and more recently cryoablation are reported to achieve promising results in the radical treatment of small breast cancer, with optimal cosmetic outcome and a very high safety profile. Percutaneous ablation as well as intra‐arterial therapies, such as chemoembolization and radioembolization, might also be indicated in metastatic BC patients. In advanced stage disease, breast cancer liver metastases (BCLM) represent the main factor affecting the overall survival. Metastatic breast disease is a systemic disease, with tumour deposits potentially spread into different organs and tissues for which systemic therapy is the standard approach. Local therapies for liver metastases might have an important role in improving survival and quality of life in well‐selected patients. Clinical and technical indications with their limitations, results and potential complications in local IO treatment for BCLM, will be also described. [ABSTRACT FROM AUTHOR]