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4. Advances in Cardiac Electrophysiology

Author

Piccini, Jonathan P., Russo, Andrea M., Sharma, Parikshit S., Kron, Jordana, Tzou, Wendy, Sauer, William, Park, David S., Birgersdotter-Green, Ulrika, Frankel, David S., Healey, Jeff S., Hummel, John, Koruth, Jacob, Linz, Dominik, Mittal, Suneet, Nair, Devi G., Nattel, Stanley, Noseworthy, Peter A., Steinberg, Benjamin A., Trayanova, Natalia A., Wan, Elaine Y., Wissner, Erik, Zeitler, Emily P., and Wang, Paul J.

Published
2022
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5. Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry

Author

Heeger, Christian-H., Sohns, Christian, Pott, Alexander, Metzner, Andreas, Inaba, Osamu, Straube, Florian, Kuniss, Malte, Aryana, Arash, Miyazaki, Shinsuke, Cay, Serkan, Ehrlich, Joachim R., El-Battrawy, Ibrahim, Martinek, Martin, Saguner, Ardan M., Tscholl, Verena, Yalin, Kivanc, Lyan, Evgeny, Su, Wilber, Papiashvili, Giorgi, Botros, Maichel Sobhy Naguib, Gasperetti, Alessio, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga, Chun, Julian K.R., Aytemir, Kudret, Jędrzejczyk-Patej, Ewa, Kuck, Karl-Heinz, Dahme, Tillman, Steven, Daniel, Sommer, Philipp, and Richard Tilz, Roland

Published
2022
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7. Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis

Author

Heeger, Christian-H, Popescu, Sorin Stefan, Sohns, Christian, Pott, Alexander, Metzner, Andreas, Inaba, Osamu, Straube, Florian, Kuniss, Malte, Aryana, Arash, Miyazaki, Shinsuke, Cay, Serkan, Ehrlich, Joachim R., El-Battrawy, Ibrahim, Martinek, Martin, Saguner, Ardan M., Tscholl, Verena, Yalin, Kivanc, Lyan, Evgeny, Su, Wilber, Papiashvili, Giorgi, Botros, Maichel Sobhy Naguib, Gasperetti, Alessio, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga, Chun, Julian K. R., Aytemir, Kudret, Jedrzejczyk-Patej, Ewa, Kuck, Karl-Heinz, Dahme, Tillman, Steven, Daniel, Sommer, Philipp, Tilz, Roland Richard, Heeger, Christian-H, Popescu, Sorin Stefan, Sohns, Christian, Pott, Alexander, Metzner, Andreas, Inaba, Osamu, Straube, Florian, Kuniss, Malte, Aryana, Arash, Miyazaki, Shinsuke, Cay, Serkan, Ehrlich, Joachim R., El-Battrawy, Ibrahim, Martinek, Martin, Saguner, Ardan M., Tscholl, Verena, Yalin, Kivanc, Lyan, Evgeny, Su, Wilber, Papiashvili, Giorgi, Botros, Maichel Sobhy Naguib, Gasperetti, Alessio, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga, Chun, Julian K. R., Aytemir, Kudret, Jedrzejczyk-Patej, Ewa, Kuck, Karl-Heinz, Dahme, Tillman, Steven, Daniel, Sommer, Philipp, and Tilz, Roland Richard

Abstract

Aims Cryoballoon (CB)-based pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF). The most frequent complication during CB-based PVI is right-sided phrenic nerve injury (PNI) which is leading to premature abortion of the freeze cycle. Here, we analysed reconnection rates after CB-based PVI and PNI in a large-scale population during repeat procedures. Methods and results In the YETI registry, a total of 17 356 patients underwent CB-based PVI in 33 centres, and 731 (4.2%) patients experienced PNI. A total of 111/731 (15.2%) patients received a repeat procedure for treatment of recurrent AF. In 94/111 (84.7%) patients data on repeat procedures were available. A total of 89/94 (94.7%) index pulmonary veins (PVs) have been isolated during the initial PVI. During repeat procedures, 22 (24.7%) of initially isolated index PVs showed reconnection. The use of a double stop technique did non influence the PV reconnection rate (P = 0.464). The time to PNI was 140.5 +/- 45.1 s in patients with persistent PVI and 133.5 +/- 53.8 s in patients with reconnection (P = 0.559). No differences were noted between the two populations in terms of CB temperature at the time of PNI (P = 0.362). The only parameter associated with isolation durability was CB temperature after 30 s of freezing. The PV reconnection did not influence the time to AF recurrence. Conclusion In patients with cryoballon application abortion due to PNI, a high rate of persistent PVI rate was found at repeat procedures. Our data may help to identify the optimal dosing protocol in CB-based PVI procedures.

Published
2023

10. Impact of cryoballoon application abortion due to phrenic nerve injury on reconnection rates: a YETI subgroup analysis

Author

Heeger, Christian-H, primary, Popescu, Sorin Ștefan, additional, Sohns, Christian, additional, Pott, Alexander, additional, Metzner, Andreas, additional, Inaba, Osamu, additional, Straube, Florian, additional, Kuniss, Malte, additional, Aryana, Arash, additional, Miyazaki, Shinsuke, additional, Cay, Serkan, additional, Ehrlich, Joachim R, additional, El-Battrawy, Ibrahim, additional, Martinek, Martin, additional, Saguner, Ardan M, additional, Tscholl, Verena, additional, Yalin, Kivanc, additional, Lyan, Evgeny, additional, Su, Wilber, additional, Papiashvili, Giorgi, additional, Botros, Maichel Sobhy Naguib, additional, Gasperetti, Alessio, additional, Proietti, Riccardo, additional, Wissner, Erik, additional, Scherr, Daniel, additional, Kamioka, Masashi, additional, Makimoto, Hisaki, additional, Urushida, Tsuyoshi, additional, Aksu, Tolga, additional, Chun, Julian K R, additional, Aytemir, Kudret, additional, Jędrzejczyk-Patej, Ewa, additional, Kuck, Karl-Heinz, additional, Dahme, Tillman, additional, Steven, Daniel, additional, Sommer, Philipp, additional, and Tilz, Roland Richard, additional

Published
2022
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12. MAGNETIC VT study: a prospective, multicenter, post-market randomized controlled trial comparing VT ablation outcomes using remote magnetic navigation-guided substrate mapping and ablation versus manual approach in a low LVEF population

Author

Di Biase, Luigi, Tung, Roderick, Szili-Torok, Tamás, Burkhardt, J. David, Weiss, Peter, Tavernier, Rene, Berman, Adam E., Wissner, Erik, Spear, William, Chen, Xu, Neužil, Petr, Skoda, Jan, Lakkireddy, Dhanunjaya, Schwagten, Bruno, Lock, Ken, Natale, Andrea, and on behalf of MAGNETIC VT investigators

Published
2017
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19. Bonus-freeze: benefit or risk? Two-year outcome and procedural comparison of a “bonus-freeze” and “no bonus-freeze” protocol using the second-generation cryoballoon for pulmonary vein isolation

Author

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

Published
2016
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23. PO-651-01 THE YETI REGISTRY: RESULTS OF A WORLD-WIDE ANALYSIS OF PHRENIC NERVE INJURY DURING CRYOBALOON BASED PULMONARY VEIN ISOLATION

Author

Heeger, Christian H., primary, Sohns, Christian, additional, Pott, Alexander, additional, Metzner, Andreas, additional, Inaba, Osamu, additional, Straube, Florian, additional, Kuniss, Malte, additional, Aryana, Arash, additional, Miyazaki, Shinsuke, additional, CAY, SERKAN, additional, Ehrlich, Joachim R., additional, Martinek, Martin, additional, Saguner, Ardan, additional, Tscholl, Verena, additional, Yalin, Kivanc, additional, Lyan, Evgeny, additional, Su, Wilber W., additional, Papiashvili, Giorgi, additional, Sobhy naguib Botros, MAICHEL, additional, Gasperetti, Alessio, additional, Proietti, Riccardo, additional, Wissner, Erik, additional, Scherr, Daniel, additional, Kamioka, Masashi, additional, Makimoto, Hisaki, additional, Aksu, Tolga, additional, Kyoung-Ryul Chun, Julian, additional, AYTEMIR, KUDRET, additional, Kuck, Karl-Heinz, additional, Dahme, Tillman, additional, Steven, Daniel, additional, Sommer, Philipp, additional, and Tilz, Roland R., additional

Published
2022
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24. Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry

Author

Heeger, Christian-H, Sohns, Christian, Pott, Alexander, Metzner, Andreas, Inaba, Osamu, Straube, Florian, Kuniss, Malte, Aryana, Arash, Miyazaki, Shinsuke, Cay, Serkan, Ehrlich, Joachim R., El-Battrawy, Ibrahim, Martinek, Martin, Saguner, Ardan M., Tscholl, Verena, Yalin, Kivanc, Lyan, Evgeny, Su, Wilber, Papiashvili, Giorgi, Botros, Maichel Sobhy Naguib, Gasperetti, Alessio, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga, Chun, Julian K. R., Aytemir, Kudret, Jedrzejczyk-Patej, Ewa, Kuck, Karl-Heinz, Dahme, Tillman, Steven, Daniel, Sommer, Philipp, Tilz, Roland Richard, Heeger, Christian-H, Sohns, Christian, Pott, Alexander, Metzner, Andreas, Inaba, Osamu, Straube, Florian, Kuniss, Malte, Aryana, Arash, Miyazaki, Shinsuke, Cay, Serkan, Ehrlich, Joachim R., El-Battrawy, Ibrahim, Martinek, Martin, Saguner, Ardan M., Tscholl, Verena, Yalin, Kivanc, Lyan, Evgeny, Su, Wilber, Papiashvili, Giorgi, Botros, Maichel Sobhy Naguib, Gasperetti, Alessio, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga, Chun, Julian K. R., Aytemir, Kudret, Jedrzejczyk-Patej, Ewa, Kuck, Karl-Heinz, Dahme, Tillman, Steven, Daniel, Sommer, Philipp, and Tilz, Roland Richard

Abstract

Background: Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. Methods: The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. Results: A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7 +/- 50.4 seconds, and the mean temperature at the time of PNI was -49 +/- 8 degrees C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. Conclusions: The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cry

Published
2022

25. Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry

Author

Heeger, Christian-H; https://orcid.org/0000-0002-9014-8097, Sohns, Christian; https://orcid.org/0000-0003-0490-5862, Pott, Alexander, Metzner, Andreas, Inaba, Osamu; https://orcid.org/0000-0003-2179-3786, Straube, Florian; https://orcid.org/0000-0002-4491-5224, Kuniss, Malte; https://orcid.org/0000-0002-1593-9657, Aryana, Arash; https://orcid.org/0000-0003-0932-8400, Miyazaki, Shinsuke; https://orcid.org/0000-0002-0230-0934, Cay, Serkan; https://orcid.org/0000-0002-5476-1214, Ehrlich, Joachim R; https://orcid.org/0000-0002-5803-9843, El-Battrawy, Ibrahim; https://orcid.org/0000-0002-0139-1045, Martinek, Martin; https://orcid.org/0000-0002-8895-8488, Saguner, Ardan M; https://orcid.org/0000-0003-1896-0803, Tscholl, Verena; https://orcid.org/0000-0003-2748-2540, Yalin, Kivanc; https://orcid.org/0000-0001-5602-0711, Lyan, Evgeny; https://orcid.org/0000-0001-9696-9227, Su, Wilber; https://orcid.org/0000-0002-0639-6822, Papiashvili, Giorgi; https://orcid.org/0000-0002-6183-6683, Botros, Maichel Sobhy Naguib; https://orcid.org/0000-0003-1521-1495, Gasperetti, Alessio; https://orcid.org/0000-0003-3432-070X, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi; https://orcid.org/0000-0001-6588-0764, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga; https://orcid.org/0000-0001-8061-9660, Chun, Julian K R; https://orcid.org/0000-0002-2355-6015, Aytemir, Kudret; https://orcid.org/0000-0001-9279-8424, et al, Heeger, Christian-H; https://orcid.org/0000-0002-9014-8097, Sohns, Christian; https://orcid.org/0000-0003-0490-5862, Pott, Alexander, Metzner, Andreas, Inaba, Osamu; https://orcid.org/0000-0003-2179-3786, Straube, Florian; https://orcid.org/0000-0002-4491-5224, Kuniss, Malte; https://orcid.org/0000-0002-1593-9657, Aryana, Arash; https://orcid.org/0000-0003-0932-8400, Miyazaki, Shinsuke; https://orcid.org/0000-0002-0230-0934, Cay, Serkan; https://orcid.org/0000-0002-5476-1214, Ehrlich, Joachim R; https://orcid.org/0000-0002-5803-9843, El-Battrawy, Ibrahim; https://orcid.org/0000-0002-0139-1045, Martinek, Martin; https://orcid.org/0000-0002-8895-8488, Saguner, Ardan M; https://orcid.org/0000-0003-1896-0803, Tscholl, Verena; https://orcid.org/0000-0003-2748-2540, Yalin, Kivanc; https://orcid.org/0000-0001-5602-0711, Lyan, Evgeny; https://orcid.org/0000-0001-9696-9227, Su, Wilber; https://orcid.org/0000-0002-0639-6822, Papiashvili, Giorgi; https://orcid.org/0000-0002-6183-6683, Botros, Maichel Sobhy Naguib; https://orcid.org/0000-0003-1521-1495, Gasperetti, Alessio; https://orcid.org/0000-0003-3432-070X, Proietti, Riccardo, Wissner, Erik, Scherr, Daniel, Kamioka, Masashi; https://orcid.org/0000-0001-6588-0764, Makimoto, Hisaki, Urushida, Tsuyoshi, Aksu, Tolga; https://orcid.org/0000-0001-8061-9660, Chun, Julian K R; https://orcid.org/0000-0002-2355-6015, Aytemir, Kudret; https://orcid.org/0000-0001-9279-8424, and et al

Abstract

BACKGROUND Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. METHODS The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. RESULTS A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was -49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. CONCLUSIONS The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI

Published
2022

31. Abstract 11351: Efficacy of Catheter Ablation for Atrial Fibrillation Across Race-Ethnicity

Author

Al-azzam, Bahaa, primary, Diaz, Annette, additional, Tso, Taylor, additional, Barney, Miles, additional, Sreepathy, Pranati, additional, Ali, Mustafa, additional, Aggarwal, Ishita, additional, Perez, Miguel, additional, Qiao, Victor, additional, Ongtengco, Ana, additional, Konda, Sreenivas, additional, Wissner, Erik, additional, and Darbar, Dawood, additional

Published
2021
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42. Complications and mortality after catheter ablation of ventricular arrhythmias

Author

Mathew, Shibu (Dr.), Fink, Thomas (Dr. med.), Feickert, Sebastian (Dr. med.), Inaba, Osamu (MD), Hashiguchi, Naotaka, Schlüter, Michael (Dr. med.), Wohlmuth, Peter (Dr,), Wissner, Erik, Tilz, Roland Richard (Prof. Dr. med.), Heeger, Christian‑Hendrik, Rottner, Laura, Reißmann, Bruno (Dr. med.), Rillig, Andreas, Metzner, Andreas (Dr. med.), Maurer, Tilman (Dr. med.), Kuck, Karl‑Heinz, and Ouyang, Feifan

Subjects
ddc:610
Abstract

\(\bf Aims\) Catheter ablation of ventricular arrhythmias (VA) has proven to be an effective therapeutic option for secondary arrhythmia prophylaxis. We sought to assess the procedural efficacy, safety and in-hospital mortality of a large patient cohort with and without structural heart disease undergoing VA ablation. \(\bf Methods\) A total of 1417 patients (804 patients with structural heart disease) undergoing 1792 endo- and epicardial procedures were analyzed. Multivariable risk factor analysis for occurrence of major complications and intrahospital mortality was obtained and a score to allow preprocedural risk assessment for patients undergoing VA ablation procedures was established. \(\bf Results\) Major complication occurred in 4.4% of all procedures and significantly more often in patients with structural heart disease than in structurally normal hearts (6.0 vs. 1.8%). The frequency of these periprocedural complications was significantly different between procedures with sole right ventricular and a combination of RV and LV access (0.5 vs. 3.1%). The most common complication was cardiac tamponade in 46 cases (3.0%). Intrahospital death was observed in 32 patients (1.8%). Logistic regression model revealed presence of ischemic heart disease, epicardial ablation, presence of oral anticoagulation or dual antiplatelet therapy as independent risk factors for the occurrence of complications or intrahospital death, while a history of previous heart surgery was an independent predictor with a decreased risk. Based on this analysis a risk score incorporating 5 standard variables was established to predict the occurrence of complications and intrahospital mortality. \(\bf Conclusions\) Safety of VA catheter ablation mainly relies on patient baseline characteristics and the type of access into the ventricles or epicardial space.

Published
2021

47. MRI Assessment of Ablation-Induced Scarring in Atrial Fibrillation: Analysis from the DECAAF Study

Author

AKOUM, NAZEM, WILBER, DAVID, HINDRICKS, GERHARD, JAIS, PIERRE, CATES, JOSH, MARCHLINSKI, FRANCIS, KHOLMOVSKI, EUGENE, BURGON, NATHAN, HU, NAN, MONT, LLUIS, DENEKE, THOMAS, DUYTSCHAEVER, MATTIAS, NEUMANN, THOMAS, MANSOUR, MOUSSA, MAHNKOPF, CHRISTIAN, HUTCHINSON, MATHEW, HERWEG, BENGT, DAOUD, EMILE, WISSNER, ERIK, BRACHMANN, JOHANNES, and MARROUCHE, NASSIR F.

Published
2015
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