Key result
Fourth-generation cryoballoon ablation with the new spiral mapping catheter had a lower discrepancy rate in detecting incomplete PVI compared to older generations (1.4% vs. 7.6%; P=0.01).
Why the study?
To assess the value of high-density mapping in revealing undetected incomplete pulmonary vein isolation after fourth-generation cryoballoon ablation compared with previous cryoballoon versions.
Does fourth-generation cryoballoon ablation with a new spiral mapping catheter reduce the rate of undetected incomplete pulmonary vein isolation compared to previous generation cryoballoons in patients with atrial fibrillation?
Cohort (n=68)
Does fourth-generation cryoballoon ablation with a new spiral mapping catheter reduce the rate of undetected incomplete pulmonary vein isolation compared to previous generation cryoballoons in patients with atrial fibrillation?
The fourth-generation cryoballoon with a new spiral mapping catheter significantly reduces the rate of undetected incomplete pulmonary vein isolation compared to older generation cryoballoons.
Answers are grounded in this paper and cite their sources.
HDM may detect incomplete PVI missed by CB4G; hypothesis-generating and requires prospective trials before changing ablation practice.
AIMS: To assess the value of high-density mapping (HDM) in revealing undetected incomplete pulmonary vein isolation (PVI) after the fourth-generation cryoballoon (CB4G) ablation compared to the previous cryoballoon's versions. METHODS AND RESULTS: Consecutive patients with paroxysmal or early-persistent atrial fibrillation (AF) undergoing CB ablation as the index procedure, assisted by HDM, were retrospectively included in this study. A total of 68 patients (52 males; mean age: 60 ± 12 years, 58 paroxysmal AF) were included, and a total of 272 veins were mapped. Fourth-generation cryoballoon with the new spiral mapping catheter (SMC) was used in 35 patients (51%). Time to PVI was determined in 102/132 (77%) and in 112/140 (80%) veins during second-generation cryoballoon/third-generation cryoballoon (CB2G/CB3G) and CB4G ablation, respectively (P = 0.66). There was a statistically significant difference in terms of discrepancy rate between the SMC and the mini-basket catheter in PV detection after CB4G and CB2G/CB3G ablation(1.4% vs. 7.6%; P = 0.01). A total of 57 patients (84%) remained free of symptomatic AF during a mean follow-up of 9.8 ± 4.6 months. CONCLUSION: High-density mapping after cryoballoon ablation using CB4G and the new SMC identifies incomplete PVI, not detected by the new SMC, in a significantly lower proportion of veins compared to HDM performed after the other generation CB ablation.
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Conte et al. (2020) conducted a cohort in paroxysmal or early-persistent atrial fibrillation (n=68). Fourth-generation cryoballoon (CB4G) with the new spiral mapping catheter (SMC) vs. Second-generation/third-generation cryoballoon (CB2G/CB3G) was evaluated on Discrepancy rate between the SMC and the mini-basket catheter in PV detection (p=0.01). Fourth-generation cryoballoon ablation with the new spiral mapping catheter had a lower discrepancy rate in detecting incomplete PVI compared to older generations (1.4% vs. 7.6%; P=0.01).
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