Posterior Wall Isolation Via a Multi-electrode Radiofrequency Balloon Catheter: Feasibility, Technical Considerations, Endoscopic Findings and Comparison with Cryoballoon Technologies

Overview

Journal J Interv Card Electrophysiol

Publisher Springer

Date 2023 Apr 27

PMID 37103590

Authors

Alvise Del Monte

Gian Battista Chierchia

Domenico Giovanni Della Rocca

Luigi Pannone

Antonio Sorgente

Gezim Bala

Cinzia Monaco

Sahar Mouram

Lucio Capulzini Cremonini

Charles Audiat

Joke Praet

Robbert Ramak

Ingrid Overeinder

Erwin Stroker

Juan Sieira

Mark La Meir

Pedro Brugada

Andrea Sarkozy

Carlo de Asmundis

Alexandre Almorad

Affiliations

Soon will be listed here.

Abstract

Background: Posterior wall (PW) isolation is an important adjunctive ablation target in patients with non-paroxysmal atrial fibrillation (AF). Traditionally performed with point-by-point radiofrequency (RF) ablation, PW isolation has also been performed with different cryoballoon technologies. We aimed at assessing the feasibility of PW isolation with the novel RF balloon catheter Heliostar™ (Biosense Webster, CA, USA).

Methods: We prospectively enrolled 32 consecutive patients with persistent AF scheduled for first-time ablation with the Heliostar™ device. Procedural data were compared with those from 96 consecutive persistent AF patients undergoing pulmonary vein (PV) plus PW isolation with a cryoballoon device. The ratio RF balloon/cryoballoon was 1:3 for each operator involved in the study, aiming at avoiding any imbalance related to different experience.

Results: Single-shot PV isolation was documented in a significantly higher number of cases with the RF balloon technology compared to cryoballoon ablation (89.8% vs. 81.0%; p = 0.02, respectively). PW isolation was achieved with a similar number of balloon applications between the two groups (11 ± 4 with the RF balloon versus 11 ± 2 with the cryoballoon; p = 0.16), but in a significantly shorter time among RF balloon patients (228 ± 72 s versus 1274 ± 277 s with cryoballoon; p < 0.001). Primary safety endpoint occurred in none of the RF balloon patients versus 5 (5.2%) patients in the cryoballoon group (p = 0.33). Primary efficacy endpoint was achieved in all (100%) RF balloon patients versus 93 (96.9%) cryoballoon ones (p = 0.57). Oesophageal endoscopy did not show any signs of thermal lesions in RF balloon patients with luminal temperature rise.

Conclusions: RF balloon-based PW isolation was safe and promoted shorter procedure times compared to similar cryoballoon-based ablation procedures.

Citing Articles

Multielectrode catheter-based pulsed electric field vs. cryoballoon for atrial fibrillation ablation: a systematic review and meta-analysis.

Vetta G, Della Rocca D, Parlavecchio A, Magnocavallo M, Sorgente A, Pannone L Europace. 2024; 26(12).

PMID: 39579376 PMC: 11641428. DOI: 10.1093/europace/euae293.

Pulsed electric field, cryoballoon, and radiofrequency for paroxysmal atrial fibrillation ablation: a propensity score-matched comparison.

Della Rocca D, Marcon L, Magnocavallo M, Mene R, Pannone L, Mohanty S Europace. 2024; 26(1).

PMID: 38245007 PMC: 10823352. DOI: 10.1093/europace/euae016.

Atrial Fibrillation Ablation with a Novel Fully 3D-Mapping-Integrated Multi-Electrode Radiofrequency Balloon Catheter.

Teumer Y, Miesbichler C, Hauke A, Katov L, Bothner C, Pott A J Clin Med. 2024; 13(1).

PMID: 38202216 PMC: 10779570. DOI: 10.3390/jcm13010207.

Implementation of the multielectrode radiofrequency-balloon in real-world clinical practice-operator learning curve and procedural outcome at a high-volume center.

Zylla M, Starrach L, Rahm A, Thomas D, Frey N, Lugenbiel P Front Cardiovasc Med. 2023; 10:1208250.

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Twenty-five years of research in cardiac imaging in electrophysiology procedures for atrial and ventricular arrhythmias.

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