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Purpose: We aimed to investigate whether the sequence of wide circumferential pulmonary vein isolation (PVI) ablation had an effect on the acute reconnection or long-term effectiveness in patients with paroxysmal atrial fibrillation (AF)., Methods: One hundred consecutive paroxysmal AF patients, who were scheduled to accept PVI, were enrolled and randomized into two groups: (1) optimized group. Lesions were first applied to the anterior/posterior carina and the ridge between the left atrial (LA) appendage and the left pulmonary vein (PV). Then both circles were closed with continuous lesions. (2) Sequential group-continuous circular lesions were created counter-clockwise and started from the site of 6 o'clock. The primary endpoint was the freedom from non-blanking period recurrence of any atrial tachyarrhythmias lasting for 30 s or longer during the 1-year follow-up period after a single procedure. The secondary endpoint included safety endpoints, LA dwelling time, and fluoroscopy time/dose., Results: Forty-nine patients in the optimized group and 48 patients in the sequential group were available for analysis. There was no difference between the AF-free rate of the optimized group and the sequential group (75.5% vs. 72.9%, p = 0.7715). Cox regression analysis found that acute reconnection had the potential to predict long-term recurrence at 1 year (Risk ratio 2.175, p = 0.0818). Both groups had similar safety endpoints, LA dwelling time, and fluoroscopy time/dose., Conclusions: Adjusting the ablation sequence of PVI by ablating the anterior/posterior carina and the ridge between the left PV and the LA appendage first did not improve 1-year AF-free rate for paroxysmal AF., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Purpose: We aimed to investigate the characteristics of focal atrial tachycardias (ATs) arising from the pulmonary veins (PVs), as well as the safety and long-term efficacy of cryoballoon (CB) versus radiofrequency (RF) ablation in this population., Methods: Eighty-three patients with ATs arising from PVs from a consecutive series of 487 patients who underwent CB and RF ablation were retrospectively reviewed. Patients who had a prior history of atrial fibrillation (AF) were excluded. The AT origin was confirmed during the conventional electrophysiological study and activation mapping. The ablation approach was at the discretion of the operators., Results: Thirty-five patients were managed with focal ablation, 25 were ablated with unilateral PV isolation (PVI), and the remaining 23 were performed with CB ablation. All procedures were successfully ablated. There was no significant difference in procedure time between CB group and RF focal group (43.7 ± 11.8 min vs. 45.8 ± 11.2 min, P = 0.121), whereas the fluoroscopy time in CB group was longer than in RF PVI group (10.1 ± 2.5 min vs. 8.4 ± 2.8 min, P < 0.001). There was 1 recurrence in CB group, 4 recurrences of AT in RF focal group, and 2 recurrence in RF PVI group (P = 0.643). Repeat ablation was performed in 6 of 7 patients. Seventy-eight patients were available for long-term follow-up. At a mean of 5.4 ± 4.6-year follow-up, 77 of 78 patients were free from AT without antiarrhythmic medication after 1.1 ± 0.3 procedures. No patient had procedural complications and developed AF during the follow-up period., Conclusions: CB ablation is an effective and safe tool to treat ATs originating from the PVs. The ATs originating from the PVs represent an isolated clinical process and are not likely to be the forerunner of a more diffuse process leading to the development of PV AF.

Introduction: The procedural findings and clinical outcome of second-generation cryoballoon (CB2) ablation in patients with variant pulmonary vein (PV) anatomy have not been fully investigated., Methods: A total of 424 consecutive patients who underwent PV isolation with CB2 were included. Computed tomographic (CT) scan was performed in all patients before the procedure. The study population was divided into common PV, accessory PV, and nonvariant PV groups according to the CT scan. Procedural findings and clinical outcome between the three groups were compared., Results: Variant PV anatomy was observed in 118 of 424 (27.8%) patients. PV isolation was successfully achieved in all patients in three groups with low rates of need for touch-up ablation (P = 0.974). Total procedure time was longer in the accessory PV group compared with nonvariant PV group (53.7 ± 12.9 vs 49.5 ± 8.8 minutes; P < 0.001). More number of applications per patient were required in accessory PV group compared with the nonvariant PV and common PV groups (7.5 ± 2.1 vs 6.5 ± 1.6, P < 0.001; 7.5 ± 2.1 vs 6.8 ± 1.4, P = 0.027, respectively). No significant difference in phrenic nerve (PN) injury was observed between the three groups (P = 0.693). During mean follow-up duration of 16.1 ± 3.3 months, there was no significant difference in rates of atrial fibrillation (AF) recurrences in the three groups (13 of 43 common PV group, 21 of 75 accessory PV group, and 80 of 306 nonvariant PV group, P = 0.178)., Conclusion: Variant PV patterns are common in patients undergoing ablation for drug-resistant AF. CB2 ablation appears to be a reasonable strategy in the setting of the variant PV anatomy with a small increase in procedure time and the number of cryoapplications., (© 2018 Wiley Periodicals, Inc.)

Introduction: To assess the predictors of hemoptysis using second-generation cryoballoon (CB)., Methods: Thirty patients with hemoptysis after second-generation CB ablation and 60 age-, gender-, and body mass index-matched controls were recruited. Anatomic parameters were obtained from preprocedural cardiac computed tomography (CT). Pulmonary vein isolation was performed with 28-mm balloon using single 3-minute freeze technique., Results: Clinical and procedural characteristics were similar between the groups. A shorter distance between left superior PV (LSPV) and left main bronchus (LMB) was associated with hemoptysis (7.8 ± 4.3 mm vs. 12.5 ± 3.5 mm, P < 0.001), whereas no significant difference in the distance between right superior PV (RSPV) and right main bronchus (RMB) was found between groups (11.9 ± 3.5 mm vs. 12.9 ± 4.6 mm, P = 0.089). Additionally, the mean thickness of the connective tissue interposed between RSPV and RMB was significantly thicker than that between LSPV and LMB in both groups (both P < 0.001). A stepwise logistic multivariate analysis identified only the LMB-LSPV distance as an independent predictor of hemoptysis (odd ratio [OR] 2.676; 95% CI 1.121-4.843, P < 0.001). A cutoff value ≤ 9.5 mm predicted hemoptysis after CB ablation with 93.8% sensitivity and 75.0% specificity., Conclusion: Hemoptysis is a relatively rare event following second-generation CB ablation. The bronchi location obtained from CT aids in identifying high-risk population for the complication., (© 2018 Wiley Periodicals, Inc.)

Introduction: The "Crosstalk" technique: if pulmonary vein isolation (PVI) of the superior one is not achieved due to a gap in the inferior part, it could be done during inferior vein cryoablation. This maneuver minimizes the total energy delivery time and number of lesions. We aimed to correlate the likelihood of crosstalk phenomenon with certain anatomic characteristics., Methods: A total of 676 patients undergoing a first ablation procedure for paroxysmal or persistent atrial fibrillation (470 first-generation cryoballoon [CB] and 206 second-generation CB) between June 2014 and December 2016 were included., Results: "Crosstalk" phenomenon occurred in 32 patients (18 first-generation CB, 14 second-generation CB). Compared to 54 control patients without crosstalk, the angle between left superior pulmonary vein (LSPV) and left atrial (LA) roof-plane, left pulmonary common ostia were significant parameters associated with crosstalk (odds ratio [OR] = 1.20, ±95% confidence interval [CI]: 1.11-1.31, P < 0.001; OR = 5.67, ±95% CI: 1.08-28.69, P = 0.04). As for angle between LSPV and LA roof-plane, the cut-off value was 28.68° with a sensitivity of 72.22%, a specificity of 81.25%, and an area under the receiver operating characteristic curve of 0.87 to predict the possibility of crosstalk technique application to get isolated in LSPV. Among the crosstalk group, there was no statistical difference between first-generation CB and second-generation CB in pulmonary anatomic characteristics., Conclusion: Crosstalk technique can be effective in patients with AF undergoing CB ablation using with both first and second-generation CBs. Anatomic characteristics predictive of crosstalk include a left common ostia and smaller angle between the LSPV and LA roof-plane., (© 2018 Wiley Periodicals, Inc.)

Objective: The study sought to evaluate the procedural and biophysical factors related to acute pulmonary vein isolation (PVI) guided by real-time pulmonary vein (PV) potential recordings., Methods: A total of 180 consecutive patients with drug-resistant atrial fibrillation (AF) undergoing CB2 (second-generation version of cryoballoon) ablation were enrolled. Real-time monitoring of PV potentials was obtained using an inner lumen spiral mapping catheter., Results: Acute isolation was achieved in all PVs without touch-up ablation. Real-time assessment of PV disconnection was possible in 611 of 711 (85.9%) PVs. A total of 617 (86.8%) PVs were isolated during the initial freeze. Longer time cycle integration (TCI) (TTI * freeze cycle, TCI) (254.6 ± 112.8 seconds vs 74.1 ± 59.7 seconds, P < 0.001), time to isolation (TTI) (94.3 ± 34.0 seconds vs 46.3 ± 26.2 seconds, P < 0.001), higher nadir temperature (-45.5 ± 5.3°C vs -50.4 ± 5.5°C, P < 0.001), longer time to -40°C (77.3 ± 22.7 seconds vs 55.7 ± 23.2 seconds, P < 0.001), faster interval rewarming time at 0°C (9.4 ± 4.3 seconds vs 12.4 ± 4.9 seconds, P = 0.008), and total balloon rewarming time (38.1 ± 11.6 seconds vs 47.7 ± 14.0 seconds, P = 0.003) were observed in PVs with acute reconduction. TTI ≤ 65 seconds predicted absence of acute reconnection with 84.2% sensitivity and 75.7% specificity, whereas TCI ≤ 119 seconds presented 94.7% sensitivity and 80.2% specificity. At a mean follow-up of 4.7 ± 1.4 months, 82.2% of patients were free of AF. None of those with PV reconnections suffered from AF recurrences., Conclusions: The ablation using CB2 is effective in achieving acute PVI. Real-time assessment of PVI could be achieved during CB application in 86% of PVs. The incidence of spontaneous PV reconnection is very low, observed in just 3% of isolated PVs. TTI ≤ 65 seconds and TCI ≤ 119 seconds predicted absence of acute PV reconnection. Although they may identify effective cryoapplications in the acute phase, their performance still needs to be verified in the long term., (© 2017 Wiley Periodicals, Inc.)

Background: Cryoballoon ablation is an alternative for the treatment of atrial fibrillation (AF). We assess the relationship among pulmonary vein (PV) electrophysiology, balloon temperature, and persistent PV isolation (PVI), and report procedural properties, safety, and efficacy of this technique in a Chinese center for the first time., Methods: A total of 70 patients with paroxysmal (n = 57) and persistent (n = 13) AF were consecutively enrolled. PVI was performed with cryoballoon catheter. Real-time recording of dissociation of PV potentials was attempted using a circumferential mapping catheter., Results: Successful PVI was achieved in 274 of 282 (97.2%) PVs. Procedural duration was 115.2 ± 24.8 minutes and fluoroscopy time was 29.6 ± 8.9 minutes. Real-time PV potential recording was achieved in 232 (84.3%) PVs. Regarding time to isolation, a cut-off value of less than 60 seconds was predictive of persistent PVI with a sensitivity of 0.76 and specificity of 0.82 (area under curve = 0.835; P < 0.0001). The nadir balloon temperature was significantly lower in PVs without early reconduction (-46.3 ± 0.5°C vs -40.2 ± 1.3°C, P < 0.0001). However, there was an insignificant trend that the balloon temperature at isolation was higher in PVs without reconduction (-33.9 ± 0.7°C vs -36.4 ± 2.0°C, P = 0.14). The overall complication rate was 5.7%. After a median follow-up of 6.5 (range 3.2-14.9) months, 76% of patients were free of AF recurrence with a blanking period of 3 months., Conclusions: Real-time PV potentials can be recorded in most PVs. The time to isolation is predictive of the persistency of PVI. The nadir balloon temperature, not the balloon temperature at isolation, is significantly lower in PVs without reconduction., (© 2015 Wiley Periodicals, Inc.)

Background: The safety and efficacy of superior vena cava (SVC) isolation using second‐generation cryoballoon (CB) ablation remain unknown. Methods: A total of 26 (3.2%) patients with SVC‐related paroxysmal atrial fibrillation (AF) from a consecutive series of 806 patients who underwent second‐generation CB were included. Pulmonary vein isolation was initially achieved by CB ablation. If the SVC trigger was determined, the electrical isolation of SVC isolation was performed using the second‐generation CB. Results: Real‐time SVC potential was observed in all patients. Isolation of the SVC was successfully accomplished in 21 (80.8%) patients. The mean number of freeze cycles in each patient was 2.1 ± 1.1. The mean time to isolation and ablation duration were 22.5 ± 14.2 seconds and 94.5 ± 22.3 seconds, respectively. A transient phrenic nerve (PN) injury was observed in five patients (19.2%). There were two patients (7.7%) experienced reversible sinus node injury during the first application. During a mean follow‐up period of 13.2 ± 5.8 months, four patients (15.4%) had atrial arrhythmia recurrences. Conclusion: Isolation of SVC using the second‐generation 28‐mm CB is feasible when SVC driver during AF is identified. Vigilant monitoring of PN function during CB ablation of SVC is needed to avoid PN injury. [ABSTRACT FROM AUTHOR]