Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation
IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the valu...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-11-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2022.985182/full |
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| author | Francesco Spera Maria Lucia Narducci Gianluigi Bencardino Francesco Perna Antonio Bisignani Gaetano Pinnacchio Claudio Tondo Ruggero Maggio Giuseppe Stabile Giuseppe Stabile Saverio Iacopino Fabrizio Tundo Anna Ferraro Antonio De Simone Maurizio Malacrida Federico Pintus Filippo Crea Gemma Pelargonio |
| author_facet | Francesco Spera Maria Lucia Narducci Gianluigi Bencardino Francesco Perna Antonio Bisignani Gaetano Pinnacchio Claudio Tondo Ruggero Maggio Giuseppe Stabile Giuseppe Stabile Saverio Iacopino Fabrizio Tundo Anna Ferraro Antonio De Simone Maurizio Malacrida Federico Pintus Filippo Crea Gemma Pelargonio |
| author_sort | Francesco Spera |
| collection | DOAJ |
| description | IntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair, respectively (p = 0.0068). The mean posterior wall (PW) area was 22.9 ± 2 cm2 and, following PV isolation, 44.8 ± 6% of the PW area was ablated. After CB ablation, complete isolation of each PV was documented by the POLARMap™ catheter in all patients. By contrast, confirmatory UHDM and the Lumipoint™ tool unveiled PV signals in 1 out of 114 of the PVs (0.9%). Over 30-day follow-up, no major procedure-related adverse events were reported. After a mean follow-up of 333 days, 89.7% of patients were free from arrhythmia recurrence.ConclusionThe lesion extension achieved by the new CB ablation system involved the PV antrum, with less than 50% of the PW remaining untouched. The new system, with short tip and circular mapping catheter, failed to achieve PV isolation in only 0.9% of all PVs treated.Clinical trial registration[http://clinicaltrials.gov/], identifier [NCT03793998]. |
| first_indexed | 2024-04-11T07:11:13Z |
| format | Article |
| id | doaj.art-61791f21e78f4b1b8d1a57ece3f1c62d |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-04-11T07:11:13Z |
| publishDate | 2022-11-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-61791f21e78f4b1b8d1a57ece3f1c62d2022-12-22T04:38:13ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2022-11-01910.3389/fcvm.2022.985182985182Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolationFrancesco Spera0Maria Lucia Narducci1Gianluigi Bencardino2Francesco Perna3Antonio Bisignani4Gaetano Pinnacchio5Claudio Tondo6Ruggero Maggio7Giuseppe Stabile8Giuseppe Stabile9Saverio Iacopino10Fabrizio Tundo11Anna Ferraro12Antonio De Simone13Maurizio Malacrida14Federico Pintus15Filippo Crea16Gemma Pelargonio17Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyCentro Cardiologico Monzino IRCCS, Milan, ItalyInfermi Hospital, Rivoli, ItalyLaboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, ItalyMediterranea Cardiocentro, Naples, ItalyMaria Cecilia Hospital, Ravenna, ItalyCentro Cardiologico Monzino IRCCS, Milan, ItalyInfermi Hospital, Rivoli, ItalyLaboratorio di Elettrofisiologia, Clinica San Michele, Maddaloni, ItalyBoston Scientific, Milan, ItalyBoston Scientific, Milan, ItalyInstitute of Cardiology, Catholic University of Sacred Heart, Rome, ItalyDepartment of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Rome, ItalyIntroductionUnrecognized incomplete pulmonary vein (PV) isolation during the index procedure, can be a major cause of clinical recurrences of atrial fibrillation (AF) after cryoballoon (CB) ablation. We aimed to characterize the extension of the lesions produced by CB ablation and to assess the value of using an ultra-high resolution electroanatomic mapping (UHDM) system to detect incomplete CB lesions.Materials and methodsTwenty-nine consecutive patients from the CHARISMA registry undergoing AF ablation at four Italian centers were prospectively evaluated. The Rhythmia™ mapping system and the Orion™ (Boston Scientific) mapping catheter were used to systematically map the left atrium and PVs before and after cryoablation.ResultsA total of 116 PVs were targeted and isolated. Quantitative assessment of the lesions revealed a significant reduction of the antral surface area of the PV, resulting in an ablated area of 5.7 ± 0.7 cm2 and 5.1 ± 0.8 cm2 for the left PV pair and right PV pair, respectively (p = 0.0068). The mean posterior wall (PW) area was 22.9 ± 2 cm2 and, following PV isolation, 44.8 ± 6% of the PW area was ablated. After CB ablation, complete isolation of each PV was documented by the POLARMap™ catheter in all patients. By contrast, confirmatory UHDM and the Lumipoint™ tool unveiled PV signals in 1 out of 114 of the PVs (0.9%). Over 30-day follow-up, no major procedure-related adverse events were reported. After a mean follow-up of 333 days, 89.7% of patients were free from arrhythmia recurrence.ConclusionThe lesion extension achieved by the new CB ablation system involved the PV antrum, with less than 50% of the PW remaining untouched. The new system, with short tip and circular mapping catheter, failed to achieve PV isolation in only 0.9% of all PVs treated.Clinical trial registration[http://clinicaltrials.gov/], identifier [NCT03793998].https://www.frontiersin.org/articles/10.3389/fcvm.2022.985182/fullatrial fibrillationablation < electrophysiologycryoballoon ablationscar ablationelectrograms |
| spellingShingle | Francesco Spera Maria Lucia Narducci Gianluigi Bencardino Francesco Perna Antonio Bisignani Gaetano Pinnacchio Claudio Tondo Ruggero Maggio Giuseppe Stabile Giuseppe Stabile Saverio Iacopino Fabrizio Tundo Anna Ferraro Antonio De Simone Maurizio Malacrida Federico Pintus Filippo Crea Gemma Pelargonio Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation Frontiers in Cardiovascular Medicine atrial fibrillation ablation < electrophysiology cryoballoon ablation scar ablation electrograms |
| title | Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation |
| title_full | Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation |
| title_fullStr | Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation |
| title_full_unstemmed | Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation |
| title_short | Ultra-high-resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation |
| title_sort | ultra high resolution assessment of lesion extension after cryoballoon ablation for pulmonary vein isolation |
| topic | atrial fibrillation ablation < electrophysiology cryoballoon ablation scar ablation electrograms |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2022.985182/full |
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