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Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes

Previous clinical studies on pulmonary vein isolation (PVI) with radiofrequency balloons (RFB) reported safe and effective procedures for a 20 s RF delivery via posterior electrodes. Recent recommendations from the manufacturer suggest reducing the application time to 15 s on the posterior wall (PW)...

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Autores principales: Almorad, Alexandre, Del Monte, Alvise, Teumer, Yannick, El Haddad, Milad, Pannone, Luigi, Della Rocca, Domenico Giovanni, Audiat, Charles, Cespón-Fernández, María, Mouram, Sahar, Ramak, Robbert, Overeinder, Ingrid, Bala, Gezim, Sorgente, Antonio, Ströker, Erwin, Sieira, Juan, Brugada, Pedro, La Meir, Mark, de Asmundis, Carlo, Chierchia, Gian-Battista
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573603/
https://www.ncbi.nlm.nih.gov/pubmed/37834900
http://dx.doi.org/10.3390/jcm12196256
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author Almorad, Alexandre
Del Monte, Alvise
Teumer, Yannick
El Haddad, Milad
Pannone, Luigi
Della Rocca, Domenico Giovanni
Audiat, Charles
Cespón-Fernández, María
Mouram, Sahar
Ramak, Robbert
Overeinder, Ingrid
Bala, Gezim
Sorgente, Antonio
Ströker, Erwin
Sieira, Juan
Brugada, Pedro
La Meir, Mark
de Asmundis, Carlo
Chierchia, Gian-Battista
author_facet Almorad, Alexandre
Del Monte, Alvise
Teumer, Yannick
El Haddad, Milad
Pannone, Luigi
Della Rocca, Domenico Giovanni
Audiat, Charles
Cespón-Fernández, María
Mouram, Sahar
Ramak, Robbert
Overeinder, Ingrid
Bala, Gezim
Sorgente, Antonio
Ströker, Erwin
Sieira, Juan
Brugada, Pedro
La Meir, Mark
de Asmundis, Carlo
Chierchia, Gian-Battista
author_sort Almorad, Alexandre
collection PubMed
description Previous clinical studies on pulmonary vein isolation (PVI) with radiofrequency balloons (RFB) reported safe and effective procedures for a 20 s RF delivery via posterior electrodes. Recent recommendations from the manufacturer suggest reducing the application time to 15 s on the posterior wall (PW) when facing the esophagus region. Here, we retrospectively assess whether 15 s of RF delivery time on posterior electrodes is safe while still ensuring lesion metrics of sufficient quality. This retrospective study included 133 patients with paroxysmal and persistent atrial fibrillation who underwent PVI using an RFB (Heliostar, Biosense Webster, Inc., Irvine, CA, USA) at two European centers. The ablation protocol was set for an RF duration of 20 s/60 s for the posterior/anterior electrodes. A multielectrode temperature probe was systematically used. In the case of an esophageal temperature rise (ETR) above 42 °C (ETR+), an endoscopic evaluation was performed. All posterior electrode lesion metric dynamics (temperature (T) and impedance (Z)) were collected from the RFB generator and analyzed offline. In total, 2435 posterior electrode applications were analyzed. With an RF delivery of 19.8 (19.7–19.8) s, the median impedance drop was 18.4 (12.2–25.2) Ω, while the temperature rise was 11.1 (7.1–14.9) °C. Accordingly, impedance (84.6 (79.3–90.2) Ω) and temperature plateaus (38 (35.3–41.1) °C) were reached at 13.9 (10.6–16) s and 16.4 (12.6–18.5) s, respectively. Overall, 99.6% and 95.8% of electrodes reached 90% (16.6 Ω) and 95% (17.5 Ω) of their impedance drops within 15 s of RF delivery, while 97.2% and 92.8% achieved 90% (34.2 °C) and 95% (36.1 °C) of their temperature rise to reach the plateaus within 15 s of RF delivery. An ETR >42 °C occurred in 37 (30.1%) patients after 17.7 ± 2.3 s of RF delivery. In the ETR+ group, the impedance drop and temperature rise on the posterior electrodes were higher compared to patients where ETR was <42 °C. Two asymptomatic thermal esophageal injuries were observed. In conclusion, 15 s of RF delivery on the posterior electrodes provides a good balance between safety, with no esophageal temperature rise, and efficacy with high-profile lesion metrics.
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spelling pubmed-105736032023-10-14 Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes Almorad, Alexandre Del Monte, Alvise Teumer, Yannick El Haddad, Milad Pannone, Luigi Della Rocca, Domenico Giovanni Audiat, Charles Cespón-Fernández, María Mouram, Sahar Ramak, Robbert Overeinder, Ingrid Bala, Gezim Sorgente, Antonio Ströker, Erwin Sieira, Juan Brugada, Pedro La Meir, Mark de Asmundis, Carlo Chierchia, Gian-Battista J Clin Med Article Previous clinical studies on pulmonary vein isolation (PVI) with radiofrequency balloons (RFB) reported safe and effective procedures for a 20 s RF delivery via posterior electrodes. Recent recommendations from the manufacturer suggest reducing the application time to 15 s on the posterior wall (PW) when facing the esophagus region. Here, we retrospectively assess whether 15 s of RF delivery time on posterior electrodes is safe while still ensuring lesion metrics of sufficient quality. This retrospective study included 133 patients with paroxysmal and persistent atrial fibrillation who underwent PVI using an RFB (Heliostar, Biosense Webster, Inc., Irvine, CA, USA) at two European centers. The ablation protocol was set for an RF duration of 20 s/60 s for the posterior/anterior electrodes. A multielectrode temperature probe was systematically used. In the case of an esophageal temperature rise (ETR) above 42 °C (ETR+), an endoscopic evaluation was performed. All posterior electrode lesion metric dynamics (temperature (T) and impedance (Z)) were collected from the RFB generator and analyzed offline. In total, 2435 posterior electrode applications were analyzed. With an RF delivery of 19.8 (19.7–19.8) s, the median impedance drop was 18.4 (12.2–25.2) Ω, while the temperature rise was 11.1 (7.1–14.9) °C. Accordingly, impedance (84.6 (79.3–90.2) Ω) and temperature plateaus (38 (35.3–41.1) °C) were reached at 13.9 (10.6–16) s and 16.4 (12.6–18.5) s, respectively. Overall, 99.6% and 95.8% of electrodes reached 90% (16.6 Ω) and 95% (17.5 Ω) of their impedance drops within 15 s of RF delivery, while 97.2% and 92.8% achieved 90% (34.2 °C) and 95% (36.1 °C) of their temperature rise to reach the plateaus within 15 s of RF delivery. An ETR >42 °C occurred in 37 (30.1%) patients after 17.7 ± 2.3 s of RF delivery. In the ETR+ group, the impedance drop and temperature rise on the posterior electrodes were higher compared to patients where ETR was <42 °C. Two asymptomatic thermal esophageal injuries were observed. In conclusion, 15 s of RF delivery on the posterior electrodes provides a good balance between safety, with no esophageal temperature rise, and efficacy with high-profile lesion metrics. MDPI 2023-09-28 /pmc/articles/PMC10573603/ /pubmed/37834900 http://dx.doi.org/10.3390/jcm12196256 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Almorad, Alexandre
Del Monte, Alvise
Teumer, Yannick
El Haddad, Milad
Pannone, Luigi
Della Rocca, Domenico Giovanni
Audiat, Charles
Cespón-Fernández, María
Mouram, Sahar
Ramak, Robbert
Overeinder, Ingrid
Bala, Gezim
Sorgente, Antonio
Ströker, Erwin
Sieira, Juan
Brugada, Pedro
La Meir, Mark
de Asmundis, Carlo
Chierchia, Gian-Battista
Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes
title Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes
title_full Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes
title_fullStr Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes
title_full_unstemmed Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes
title_short Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes
title_sort safety of the radiofrequency balloon for pulmonary vein isolation: a focus on lesion metric analysis of posterior electrodes
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10573603/
https://www.ncbi.nlm.nih.gov/pubmed/37834900
http://dx.doi.org/10.3390/jcm12196256
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