How to perform effective cryoballooon ablation of the left atrial roof: Considerations after experiencing more than 1000 cases

• Published in: Journal of Cardiovascular Electrophysiology Vol. 34; no. 12; pp. 2484 - 2492
• Main Authors: Shigeta, Takatoshi, Okishige, Kaoru, Murata, Kazuya, Oda, Atsuhito, Arai, Hirofumi, Sagawa, Yuichiro, Kurabayashi, Manabu, Goya, Masahiko, Sasano, Tetsuo, Yamauchi, Yasuteru
• Format: Journal Article
• Language: English
• Published: United States Wiley 01.12.2023; Wiley Subscription Services, Inc
• Subjects: Ablation; Arrhythmia; Atrial Fibrillation; Atrial Fibrillation - diagnosis; Atrial Fibrillation - surgery; Atrioventricular Block; Balloon treatment; Catheter Ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Catheters; Clinical outcomes; complete conduction block; cryoballoon; Cryosurgery; Cryosurgery - adverse effects; Cryosurgery - methods; Heart Atria; Heart Atria - surgery; Humans; Mapping; Multivariate analysis; Pulmonary Veins; Pulmonary Veins - surgery; Recurrence; roof line; Treatment Outcome; atrial fibrillation; roof line; complete conduction block; ablation; cryoballoon
• ISSN: 1045-3873; 1540-8167; 1540-8167
• DOI: 10.1111/jce.16082

Introduction Cryoballoon ablation (CBA) of the left atrial (LA) roof in addition to a pulmonary vein isolation has been expected to improve the clinical outcomes post‐atrial fibrillation (AF) ablation. We demonstrated the characteristics and efficacy of CBA of the LA roof through our experience with a large volume of procedures. Methods Among 1036 AF ablation procedures with CBA of the LA roof, 834 patients who underwent a de novo ablation were analyzed. Results Complete LA roof line conduction block was obtained in 767 patients (92.0%) solely by CBA (Group A). Compared with the other patients (Group B), the mean nadir balloon temperature during CBA of the LA roof (−44.5 ± 5.6°C for Group A vs. −40.5 ± 7.5°C for Group B, p < .01) and number of cryoballoon applications during the LA roof ablation with a circular mapping catheter located in the left superior pulmonary vein (1.3 ± 0.8 for Group A vs. 1.6 ± 1.0 for Group B, p = .02) were significantly lower in Group A. A multivariate analysis revealed that those were predictors of a complete LA roof conduction block after only CBA. The 1‐year Kaplan–Meier atrial arrhythmia free rate estimates were 80.6% for Group A and 59.0% for Group B (p < .01). Conclusion Complete LA roof line conduction block could be obtained with a cryoballoon without touch‐up ablation in most cases. The LA roof CBA with a circular mapping catheter located in the right superior pulmonary vein was preferable to obtaining complete LA roof conduction block, which was important with regard to the clinical outcomes.