Methods to Optimize Cryoballoon Ablation for Atrial Fibrillation to Minimize Risk of Adverse Outcomes and Arrhythmia Recurrences

AbstractPurpose of ReviewAtrial fibrillation (AF) is a chronic and progressive disorder, associated with effort intolerance, impairments in quality of life, and reduced survival. In patients with symptomatic atrial fibrillation, pulmonary vein isolation is an important treatment modality to reduce recurrent arrhythmia and improve quality of life. The purpose of this paper is to review practical considerations of the cryoballoon ablation procedure in order to minimize the risk of adverse procedural outcomes and arrhythmia recurrences.Recent FindingsEmerging evidence with respect to cryoablation dosing has beneficially refined the cryoballoon ablation procedure. In aggregate, dose limitation can be achieved by the following: (1) If real-time pulmonary vein potential (PVP) monitoring is feasible, an early time to isolation (TTI, e.g.,60 –90 s) or a balloon temperature warmer than −35 °C at 60 s suggests that the lesion be abandoned and the balloon repositioned; (3) The minimum cryoablation duration should be 2 min for the right-sided PVs, in order to balance clinical efficacy with the risk of phrenic nerve injury; (4) The mini mum cryoablation duration should be 3 min (ideally 4 min) for the left-sided PVs, in order to maximize efficacy; (5) No more than one “bonus freeze” should be delivered.SummaryPractical procedural considerations focused on cryoballoon positioning, pulmonary vein monitoring, and ablation duration can be utilized to optimize patie...
Source: Current Cardiovascular Risk Reports - Category: Cardiology Source Type: research

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Atrial fibrillation (AF) is the most common clinically significant arrhythmia, and it increases stroke risk. A preventive approach to AF is needed because virtually all treatments such as cardioversion, antiarrhythmic drugs, ablation, and anticoagulation are associated with high cost and carry significant risk. A systematic review was performed to identify effective lifestyle-based strategies for reducing primary and secondary AF. A PubMed search was performed using articles up to March 1, 2021.
Source: The American Journal of Cardiology - Category: Cardiology Authors: Source Type: research
Recently, we have read with great interest Dr. Yano and colleagues' [1] article that published in International Journal of Cardiology. In this article, they reported that paroxysmal atrial fibrillation (PAF) patients who underwent laser balloon ablation (LBA) had stronger inflammation after ablation than patients who underwent cryoballoon ablation (CBA). They further showed that LBA group had a significantly greater risk of short-term arrhythmia recurrence than CBA group. It indicated that inflammatory markers might be used to predict early arrhythmia recurrence after atrial fibrillation ablation.
Source: International Journal of Cardiology - Category: Cardiology Authors: Tags: Letter to the Editor Source Type: research
ConclusionWe found no associations between markers of immunothrombosis and new-onset AF in the general population. Inflammation and immunothrombosis may be associated with AF through other cardiovascular risk factors or predisposing conditions of AF. Our findings challenge the added value of biomarkers in AF risk prediction.Graphic abstract
Source: Clinical Research in Cardiology - Category: Cardiology Source Type: research
This study included 136 patients from two randomized studies, who underwent CBA for paroxysmal AF for the first time. Patients were randomly assigned to the EP-guided and conventional CBA groups in each study. In the EP-guided CBA group, we pressed a balloon against the EP site when the time-to-isolation (TTI) after cryoapplication exceeded 60  and 45 s in the first and second studies, respectively. We compared the clinical outcomes for 1 year after the procedure between the EP-guided CBA group (68 patients) and the conventional CBA group (68 patients). The primary endpoint was the recurrence of atrial arrhythm...
Source: Journal of Cardiovascular Electrophysiology - Category: Cardiology Authors: Tags: ORIGINAL ARTICLE Source Type: research
CONCLUSIONS: Regrettably, this study failed to reproduce persistent AF, but succeeded in creating an arrhythmic substrate that causes sustained AT in WT mice.PMID:34544960 | DOI:10.1253/circj.CJ-20-1286
Source: Circulation Journal - Category: Cardiology Authors: Source Type: research
Int Heart J. 2021 Sep 17. doi: 10.1536/ihj.21-108. Online ahead of print.ABSTRACTEsophageal injury is a rare but serious complication of atrial fibrillation (AF) ablation. To minimize esophageal injury, our persistent AF (PerAF) protocol involves complete left atrial posterior wall (LAPW) and pulmonary vein (PV) isolation (box isolation), with a centerline away from the esophagus. However, there has been a concern that extensive LA isolation might deteriorate LA function. There has been a paucity of data on LA remodeling after box isolation. Therefore, we compared LA size pre- and post-box isolation with an LAPW centerline...
Source: International Heart Journal - Category: Cardiology Authors: Source Type: research
CONCLUSIONS: Regrettably, this study failed to reproduce persistent AF, but succeeded in creating an arrhythmic substrate that causes sustained AT in WT mice.PMID:34544960 | DOI:10.1253/circj.CJ-20-1286
Source: Circulation Journal - Category: Cardiology Authors: Source Type: research
Int Heart J. 2021 Sep 17. doi: 10.1536/ihj.21-108. Online ahead of print.ABSTRACTEsophageal injury is a rare but serious complication of atrial fibrillation (AF) ablation. To minimize esophageal injury, our persistent AF (PerAF) protocol involves complete left atrial posterior wall (LAPW) and pulmonary vein (PV) isolation (box isolation), with a centerline away from the esophagus. However, there has been a concern that extensive LA isolation might deteriorate LA function. There has been a paucity of data on LA remodeling after box isolation. Therefore, we compared LA size pre- and post-box isolation with an LAPW centerline...
Source: International Heart Journal - Category: Cardiology Authors: Source Type: research
Tawney Chronic stress, which has been exacerbated worldwide by the lingering COVID pandemic, has been strongly linked to cardiovascular disease (CVD). In addition, autonomic dysregulation via sustained sympathetic activity has been shown to increase the risk of arrhythmias, platelet aggregation, acute coronary syndromes and heart failure. Fortunately, effective coping strategies have been shown to attenuate the magnitude of hyperarousal associated with the stress response, including moderate-to-vigorous lifestyle activity and/or structured exercise. A good-to-excellent level of cardiorespiratory fitness also appears t...
Source: International Journal of Environmental Research and Public Health - Category: Environmental Health Authors: Tags: Review Source Type: research
This study intended to compare the efficacy and safety of RA in elderly and young patients with AF.METHODS: Forty patients with drug-naïve AF who underwent RA at our hospital were retrospectively evaluated, of whom 20 were
Source: American Journal of Translational Research - Category: Research Authors: Source Type: research
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