One-Way Ablation With a Cryoballoon on the Left Atrium Roof Using a Novel Button-on Technique: A Retrospective Study

Area of Science:

• Cardiology
• Medical Devices
• Surgical Techniques

Background:

• Left atrium (LA) roof ablation using cryoballoon ablation (CryoBA) typically involves anchoring the left superior pulmonary vein (LSPV) and right superior pulmonary vein (RSPV) (two-way CryoBA).
• Achieving effective LA roof line creation with CryoBA can be challenging due to temperature variations and catheter stability.
• A novel Button-on Technique was developed to stabilize the cryoballoon (CB) on the LA roof for one-way CryoBA, anchoring only the RSPV.

Purpose of the Study:

• To evaluate the efficacy of a new one-way CryoBA technique using the Button-on Technique compared to the conventional two-way CryoBA for left atrium roof ablation.
• To assess the impact of one-way CryoBA on nadir temperatures and gap formation on the LA roof.

Main Methods:

• A retrospective study involving 80 patients with persistent atrial fibrillation undergoing CryoBA.
• Patients were divided into two groups: one-way CryoBA (n=40) using the Button-on Technique and two-way CryoBA (n=40).
• CryoBA was performed using a 28-mm second-generation CB, with comparisons of nadir temperatures and LA roof gaps after the first ablation pass.

Main Results:

• One-way CryoBA achieved significantly lower nadir temperatures on the LA roof (middle to left side) compared to two-way CryoBA (p < 0.01).
• Fewer touch-up ablations were required in the one-way CryoBA group (2.5%) compared to the two-way CryoBA group (15%) (p = 0.038).
• These findings indicate significantly fewer gaps on the LA roof during the initial ablation pass with the one-way CryoBA technique.

Conclusions:

• One-way CryoBA utilizing the Button-on Technique provides superior cooling on the LA roof compared to two-way CryoBA.
• This improved thermal performance leads to a reduction in gaps on the LA roof after the initial ablation pass.
• The Button-on Technique represents a promising advancement for more effective LA roof ablation in patients with atrial fibrillation.