Reflections on reconduction after pulmonary vein isolation

Open Access
Publisher Website
Google Scholar
Abstract
Cryoballoon has proven to be a formidable competitor in the field of novel technologies for the ablation of atrial fibrillation (AF). Several reports have shown this technique to be safe and effective in treating AF, with 59–74% freedom of paroxysmal AF and 42% of persistent AF, for more than 1 year. Its major complication is temporary phrenic palsy caused by the ablation of the right superior phrenic nerve. 1–3 In contrast to other balloon technologies, it is the only one whose outcome results are currently extensively reported in scientific literatures and seem promising. Two other balloon-based devices, but employing a different energy source, have not proven to live up to safety standards: high-intensity focused ultrasound (HIFU) balloon and endoscopically guided laser balloon. The former was not only reported to have a high percentage of permanent phrenic nerve paralysis (which seems a problem inherent to any balloon concept), 4 but evidence emerged that the dreaded atrio-oesophageal fistula was one of its major complications. 5 After that, the FDA-approved HIFU ablation system study (randomizing ablation against anti-arrhythmic drugs) was suspended. Similarly, the first generation of the endoscopically guided laser balloon did not survive early phase III testing, and the FDA-approved ENABLE study (comparing ablation against anti-arrhythmic drugs) was terminated. Another investigational device (not a balloon catheter, however) showing promising results seems to be the multipolar ablation catheter with duty-cycled bipolar and unipolar radiofrequency energy, which has recently shown to have 83% freedom of AF at 6 months and no major complications. 6 Two studies are currently underway: the TOPP AF trial (multicentre, randomizing ablation against DC cardioversion for permanent AF) and a single-centre trial for paroxysmal AF randomizing against wide circumferential pulmonary vein (PV) isolation. This shows that the current scientific interest in catheters capable of simplifying AF ablation is major and that knowledge on these new devices is still scarce but urgently needed.

This publication has 11 references indexed in Scilit: