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


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Article Info

DATE

2021-03-13

AUTHORS

Jason G. Andrade

ABSTRACT

Purpose 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., < 0–60 s) suggests that the “bonus freeze” may be omitted; (2) In PVs where real-time PVP monitoring is feasible, a late 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 minimum 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 patient outcomes and ensure the procedure is safely and effectively performed. More... »

PAGES

6

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s12170-021-00668-6

DOI

http://dx.doi.org/10.1007/s12170-021-00668-6

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https://app.dimensions.ai/details/publication/pub.1136391615


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