Smart Touch Radiofrequency Catheter Ablation versus Cryoballoon Ablation of Pulmonary Veins in Patients with Paroxysmal Atrial Fibrillation

Walid Shehata Hassan; Sherief Hamed Zaky; Khaled Hussein Mohamed; Moataz Mohammed Ibrahim

doi:10.3889/oamjms.2020.4447

Authors

Walid Shehata Hassan Department of Critical Care Medicine, Cairo University, Giza, Egypt
Sherief Hamed Zaky Department of Critical Care Medicine, Cairo University, Giza, Egypt
Khaled Hussein Mohamed Department of Critical Care Medicine, Cairo University, Giza, Egypt
Moataz Mohammed Ibrahim Department of Critical Care Medicine, Cairo University, Giza, Egypt

DOI:

https://doi.org/10.3889/oamjms.2020.4447

Keywords:

Radiofrequency, Atrial fibrillation, Cryoballoon ablation, Pulmonary veins isolation, Safety, Efficacy

Abstract

AIM: Evaluation of the safety and efficacy of pulmonary veins isolation in patients with paroxysmal atrial fibrillation (AF) using two new different technologies, cryoballoon (CB) ablation and radiofrequency ablation with contact force (CF)-sensing catheters.

METHODS: Prospective single-center evaluation, carried out from January 2016 to June 2018 in Critical Care Medicine Department – Cairo University, comparing CF radiofrequency (Thermocool^®SmartTouch, Biosense Webster, Inc.) (CF group) with CB ablation (Arctic Front Advance 28 mm CB, Medtronic, Inc.) (CB group), in regards to procedural safety and efficacy, as well as recurrence at 12 months. Overall, 50 consecutive patients were enrolled (25 in each group).

RESULTS: The characteristics of patients of both the groups were similar (46.9 ± 11.2 years, the proportion of women 36%, mean documented AF duration 3 ± 2.3 years, mean CHA2DS2-VASc score 1.4 ± 1.3, and mean HAS-BLED 1.4 ± 0.6). Duration of the procedure was significantly lower in the CB group (171.7 ± 15.24 vs. 199.3 ± 18.94 min, p = 0.002), with a longer duration of fluoroscopy and X-ray exposure in the CB group than the CF group but statistically non-significant difference (58.60 ± 11.57 vs. 48.7 ± 13.86 min and 6273 ± 4934 cGy cm² vs. 6853 ± 5069 cGy cm², p = 0.1 and p = 0.2, respectively). Overall complication rate was similar in both groups: 2 (8%) in each group. At 12 months, AF recurrence occurred in 7 patients (28%) in the CF group and in 9 patients (36%) in the CB group (log rank p = 0.682).

CONCLUSION: Pulmonary vein isolation using CF-guided RF and second-generation CB leads to comparable single-procedure arrhythmia-free survival at up to 12 months with similar overall complication rate.

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References

Feinberg WM, Blackshear JL, Laupacis A, Kronmal R, Hart RG. Prevalence, age distribution, and gender of patients with atrial fibrillation. Analysis and implications. Arch Intern Med. 1995;155(5):469-73. https://doi.org/10.1001/ archinte.1995.00430050045005 PMid:7864703

Wilber DJ, Pappone C, Neuzil P, De Paola A, Marchlinski F, Natale A, et al. Comparison of antiarrhythmic drug therapy and radiofrequency catheter ablation in patients with paroxysmal atrial fibrillation: A randomized controlled trial. JAMA. 2010;303(4):333-40. https://doi.org/10.1001/jama.2009.2029 PMid:20103757

Packer DL, Mark DB, Robb RA, Monahan KH, Bahnson TD, Moretz K, et al. Catheter ablation versus antiarrhythmic drug therapy for atrial fibrillation (CABANA) trial: Study rationale and design. Am Heart J. 2018;199:192-9. https://doi.org/10.1016/j. ahj.2018.02.015 PMid:29754661

Ouyang F, Antz M, Ernst S, Hachiya H, Mavrakis H, Deger FT, et al. Recovered pulmonary vein conduction as a dominant factor for recurrent atrial tachyarrhythmias after complete circular isolation of the pulmonary veins: Lessons from double Lasso technique. Circulation. 2005;111(2):127-35. https://doi. org/10.1016/j.accreview.2005.04.043

Verma A, Kilicaslan F, Pisano E, Marrouche NF, Fanelli R, Brachmann J, et al. Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction. Circulation. 2005;112(5):627-35. https://doi.org/10.1161/circulationaha.104.533190 PMid:16061753

Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: Lessons from a 5-year follow-up. Circulation. 2010;122(23):2368-77. https://doi.org/10.1161/ circulationaha.110.946806 PMid:21098450

Yokoyama K, Nakagawa H, Shah DC, Lambert H, Leo G, Aeby N, et al. Novel contact force sensor incorporated in irrigated radiofrequency ablation catheter predicts lesion size and incidence of steam pop and thrombus. Circ Arrhythm Electrophysiol. 2008;1(5):354-62. https://doi.org/10.1161/ circep.108.803650 PMid:19808430

Shah DC, Lambert H, Nakagawa H, Langenkamp A, Aeby N, Leo G. Area under the real-time contact force curve (force-time integral) predicts radiofrequency lesion size in an in vitro contractile model. J Cardiovasc Electrophysiol. 2010;21(9):1038- 43. https://doi.org/10.1111/j.1540-8167.2010.01750.x PMid:20367658

Thiagalingam A, D’Avila A, Foley L, Guerrero JL, Lambert H, Leo G, et al. Importance of catheter contact force during irrigated radiofrequency ablation: Evaluation in a porcine ex vivo model using a force-sensing catheter. J Cardiovasc Electrophysiol. 2010;21(7):806-11. https://doi. org/10.1111/j.1540-8167.2009.01693.x PMid:20132400

Squara F, Latcu DG, Massaad Y, Mahjoub M, Bun SS, Saoudi N. Contact force and force-time integral in atrial radiofrequency ablation predict transmurality of lesions. Europace. 2014;16(5):660-7. https://doi.org/10.1093/europace/euu068 PMid:24798957

Kuck KH, Reddy VY, Schmidt B, Natale A, Neuzil P, Saoudi N, et al. A novel radiofrequency ablation catheter using contact force sensing: Toccata study. Heart Rhythm. 2012;9(1):18-23. https://doi.org/10.1016/j.hrthm.2011.08.021 PMid:21872560

Liu CF. Pulmonary vein reconnection after cryoballoon ablation: Back to the drawing board. Heart Rhythm. 2010;7(2):191-2. PMid:20129296

Kubala M, Hermida JS, Nadji G, Quenum S, Traulle S, Jarry G. Normal pulmonary veins anatomy is associated with better AF-free survival after cryoablation as compared to atypical anatomy with common left pulmonary vein. Pacing Clin Electrophysiol. 2011;34(7):837-43. https://doi. org/10.1111/j.1540-8159.2011.03070.x PMid:21418249

Sorgente A, Chierchia GB, de Asmundis C, Sarkozy A, Namdar M, Capulzini L, et al. Pulmonary vein ostium shape and orientation as possible predictors of occlusion in patients with drug-refractory paroxysmal atrial fibrillation undergoing cryoballoon ablation. Europace. 2011;13(2):205-12. https://doi. org/10.1093/europace/euq388 PMid:20974756

Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: An update of the 2010 ESC guidelines for the management of atrial fibrillation-- developed with the special contribution of the European heart rhythm association. Europace. 2012;14(10):1385-413. https:// doi.org/10.3410/f.718304414.793499785 PMid:22923145

Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, et al. Guidelines for the management of atrial fibrillation: The task force for the management of atrial fibrillation of the European society of cardiology (ESC). Eur Heart J. 2010;31(19):2369- 429. https://doi.org/10.12968/bjca.2011.6.5.240 PMid:20802247

Benjamin EJ, Wolf PA, D’Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: The Framingham heart study. Circulation. 1998;98(1):946-52. PMid:9737513

Krahn AD, Manfreda J, Tate RB, Mathewson FA, Cuddy TE. The natural history of atrial fibrillation: Incidence, risk factors, and prognosis in the Manitoba follow-up study. Am J Med. 1995;98(5):476-84. https://doi.org/10.1016/ s0002-9343(99)80348-9 PMid:7733127

January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr., et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society. Heart Rhythm. 2019;16(8):e66-93. https://doi.org/10.1161/ cir.0000000000000719 PMid:30703431

January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr., et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: A report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society. J Am Coll Cardiol. 2014;64(21):e1-76. https://doi.org/10.1161/ cir.0000000000000719 PMid:24685669

Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016;37(38):2893-962.

Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A report of the heart rhythm society (HRS) task force on catheter and surgical ablation of atrial fibrillation. Developed in partnership with the European heart rhythm association (EHRA), a registered branch of the European society of cardiology (ESC) and the European cardiac arrhythmia society (ECAS); and in collaboration with the American college of cardiology (ACC), American heart association (AHA,) the Asia Pacific heart rhythm society (APHRS), and the society of thoracic surgeons (STS). endorsed by the governing bodies of the American college of cardiology foundation, the American heart association, the European cardiac arrhythmia society, the European heart rhythm association, the society of thoracic surgeons, the Asia Pacific heart rhythm society, and the heart rhythm society. Heart Rhythm. 2012;9(4):632-96. https://doi. org/10.1093/europace/eun122 PMid:22386883

Marijon E, Fazaa S, Narayanan K, Guy-Moyat B, Bouzeman A, Providencia R, et al. Real-time contact force sensing for pulmonary vein isolation in the setting of paroxysmal atrial fibrillation: Procedural and 1-year results. J Cardiovasc Electrophysiol. 2014;25(2):130-7. https://doi.org/10.1111/ jce.12303 PMid:24433324

Reddy VY, Shah D, Kautzner J, Schmidt B, Saoudi N, Herrera C, et al. The relationship between contact force and clinical outcome during radiofrequency catheter ablation of atrial fibrillation in the TOCCATA study. Heart Rhythm. 2012;9(11):1789-95. https:// doi.org/10.1016/j.hrthm.2012.07.016 PMid:22820056

Shah D, Lambert H, Langenkamp A, Vanenkov Y, Leo G, Gentil-Baron P, et al. Catheter tip force required for mechanical perforation of porcine cardiac chambers. Europace. 2011;13(2):277-83. https://doi.org/10.1093/europace/euq403 PMid:21084361

Straube F, Dorwarth U, Schmidt M, Wankerl M, Ebersberger U, Hoffmann E. Comparison of the first and second cryoballoon: High-volume single-center safety and efficacy analysis. Circ Arrhythm Electrophysiol. 2014;7(2):29. https://doi.org/10.1161/ circep.113.000899 PMid:24610739

Straube F, Dorwarth U, Vogt J, Kuniss M, Kuck KH, Tebbenjohanns J, et al. Differences of two cryoballoon generations: Insights from the prospective multicentre, multinational FREEZE cohort substudy. Europace. 2014;16(10):1434-42. https://doi.org/10.1093/europace/euu162 PMid:24994074