We used the Arctic Front Advance cryoballoon (Arctic Front Advance, Medtronic Inc., MN, USA). The 28-mm balloon was used in 21 patients. A multipolar catheter (Achieve, Medtronic Inc., MN, USA) was inserted through the inner lumen of the balloon to assess PV signals before, during and after the ablation and to guide the positioning of the balloon, after which the total assembly was introduced into the LA. After inflation, the cryoballoon was advanced to occlude the PV and a contrast bolus was administered to confirm total occlusion. In general, two consecutive applications were delivered for each PV, varying from 180 to 240 s, depending on temperatures reached. During isolation of the right PVs, the right phrenic nerve was continuously stimulated by a catheter placed in the superior vena cava. If the diaphragm excursions diminished during cryoablation, the ablation was immediately stopped using the double stop technique [15 ]. Bidirectional block was confirmed for each vein. After a 30-minute waiting period, all four PVs were checked for reconduction and adenosine was administered to reveal dormant PV potentials.
Arctic front advance
Manufactured by Medtronic
Sourced in United States
The Arctic Front Advance is a cryoballoon catheter device designed for the treatment of atrial fibrillation. It utilizes freezing temperatures to create lesions and disrupt the electrical pathways that contribute to atrial fibrillation.
Automatically generated - may contain errors
Lab products found in correlation
Flexcath advance, by Medtronic (13 mentions)
Flexcath, by Medtronic (8 mentions)
Thermocool smarttouch, by Johnson & Johnson (4 mentions)
Arctic front, by Medtronic (4 mentions)
Achieve advance, by Medtronic (3 mentions)
Carto 3, by Johnson & Johnson (3 mentions)
Navistar, by Johnson & Johnson (2 mentions)
Satake hotballoon, by Toray (2 mentions)
Circular achieve catheter, by Medtronic (2 mentions)
Tacticath se, by Abbott (2 mentions)
Thermocool, by Johnson & Johnson (2 mentions)
Ensite navx, by Abbott (2 mentions)
Tacticath, by Abbott (2 mentions)
Navistar thermocool, by Johnson & Johnson (1 mentions)
Amplatz super stiff guidewire, by Boston Scientific (1 mentions)
Navx system, by Abbott (1 mentions)
Cartomerge, by Johnson & Johnson (1 mentions)
Carto 3 system, by Johnson & Johnson (1 mentions)
Viewflex, by Abbott (1 mentions)
Acunav, by Siemens (1 mentions)
57 protocols using arctic front advance
1
Cryoballoon Ablation for Pulmonary Vein Isolation
2
Cryoballoon Ablation for Pulmonary Vein Isolation
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After transseptal puncture, the pigtail wire was maintained in the mid left atrium to maintain access. The sheath and dilator were exchanged for the FlexCath (FlexCath Advance, Medtronic, Minneapolis, MN, USA) over the wire. The 10.5-Fr 28-mm cryoballoon (Arctic Front Advance, Medtronic) and an 8-pole circular mapping catheter (Achieve, Medtronic) were placed through the FlexCath sheath into the LA for cryoballoon ablation, as per standard protocol. ICE guidance was used to confirm the alignment of sheath and balloon relative to the PV before cryoenergy application. Doppler imaging as well as hemodynamic pressure monitoring was used to confirm pulmonary vein occlusion.
3
Cryoballoon Ablation Procedure for Atrial Fibrillation
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A transseptal puncture was done for left atrial access, and a 15-F deflectable sheath (FlexCath, Medtronic) was advanced through the left atrium. A circular mapping catheter (Achieve, Medtronic) was used to record pulmonary vein potentials. Cryoenergy was delivered using exclusively the 28 mm balloon (second-generation Arctic Front Advance, Medtronic) which is the only available balloon in Korea. The cryoballoon ablation procedure generally conformed to the guidelines for cryoballoon ablation in AF, but specific approaches and dosing regimens such as energy delivery time, fluoroscopic or intracardiac echocardiographic guidance for balloon positioning and occlusion, decision of applying general anaesthesia, and post-ablation testing were decided upon the operator’s discretion.
During freezing at the right pulmonary veins, continuous phrenic nerve pacing was performed using a diagnostic catheter positioned at the superior cava vein. Phrenic nerve function was monitored with palpation of diaphragmatic contraction by the physician’s hand positioned at the patient’s abdomen. Phrenic nerve injury was defined as transient decrease in diaphragmatic movement as confirmed by fluoroscopy or manual tactile feedback.
During freezing at the right pulmonary veins, continuous phrenic nerve pacing was performed using a diagnostic catheter positioned at the superior cava vein. Phrenic nerve function was monitored with palpation of diaphragmatic contraction by the physician’s hand positioned at the patient’s abdomen. Phrenic nerve injury was defined as transient decrease in diaphragmatic movement as confirmed by fluoroscopy or manual tactile feedback.
4
Cryoballoon Ablation for Pulmonary Vein Isolation
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An octapolar diagnostic catheter (Inquiry, 2-2-2 mm spacing, 6 French, St. Jude Medical) was placed in the coronary sinus from the right femoral vein. The 28 mm CB-G2 (Arctic Front Advance, Medtronic Inc., Minneapolis, MN, USA) was introduced into the left atrium via a long 12 French steerable sheath (FlexCath, Medtronic) after transseptal puncture. Electrograms from the pulmonary veins were mapped before, during and after CB-application with an endoluminal spiral mapping catheter (Achieve, Medtronic). Target application time in this study was 240 s, the freezing cycle was shortened to 180 s in case early isolation (within 60 s) was observed. Successful electrical isolation of the pulmonary veins was confirmed using a spiral mapping catheter (Achieve, Medtronic). During ablation of the right pulmonary vein, the phrenic nerve was electrically stimulated from the superior vena cava. The integrity of the phrenic nerve was monitored via diaphragmatic compound motor action potentials (CMAP) in conjunction with abdominal palpation. The freezing cycle was immediately terminated in cases of a CMAP reduction of 30% or less, loss of phrenic nerve capture or if temperature in the oesophagus dropped below 17°C.
5
Cryoballoon Ablation Protocol for Atrial Fibrillation
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All antiarrhythmics were withheld for five half-lives before the procedure. Each individual received TEE for exclusion of left atrial thrombus before ablation. All patients underwent a cardiac computed tomography scan, and three-dimensional (3D) anatomical models of the LA and PVs were reconstructed. The ablation procedure was performed under general anesthesia and endotracheal intubation. All procedures were performed with the second-generation cryoballoon (Arctic Front Advance, Medtronic, MD, USA). The ostial diameter of each PV was measured to select the balloon size. A 28-mm balloon was used for all PVs.
6
Atrial Fibrillation Ablation Protocol
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Our strategy for CA has been previously described.18 In brief, all patients underwent pulmonary vein isolation (PVI) using radiofrequency energy (Navistar Thermocool™; Biosense Webster, Diamond Bar, CA, USA) or second‐generation cryoballoon energy (Arctic Front Advance, Medtronic, Inc., Minneapolis, MN, USA) using a three‐dimensional electroanatomical mapping system (CARTO, Biosense Webster). Patients with paroxysmal AF underwent radiofrequency or cryoballoon PVI. Patients with persistent AF since October 2015 underwent empiric superior vena cava isolation in addition to PVI. Substrate modification was not performed. Patients who were clinically confirmed to have common/uncommon atrial flutter or atrial tachycardia also underwent ablation targeting the arrhythmia.
7
Cryoballoon Ablation for Pulmonary Vein Isolation
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LA access was achieved directly using a steerable 15F sheath (FlexCath Advance, Medtronic, Minneapolis, MN, USA) or using the modified Brockenbrough technique and a 8.5F transseptal sheath (SL1, St Jude Medical, St Paul, MN, USA) which was then exchanged over the wire for the 15F FlexCath Advance.
An Amplatz Super Stiff Guidewire (Boston Scientific Corporation, Boston, MA, USA)
was used in the inner lumen of the FlexCath and was advanced into each pulmonary vein. A 28-mm Arctic Front Advance cryoballoon (Medtronic, Minneapolis, MN, USA) was positioned in each pulmonary vein ostium and inflated. Complete vessel occlusion was demonstrated by contrast injection with no reflux of contrast into the LA.
Each ablation was performed with a single 3-minute freeze for each vein.
A second freeze using a different balloon angulation was performed if there was contrast backflow into the LA or a temperature of -40C was not reached within 60 seconds.
Prior to ablation of right-sided pulmonary veins, the decapolar catheter was placed in the right subclavian vein or superior vena cava to pace the right phrenic nerve (10-20 mA at 1.0-2.0 msec pulse width at a cycle length of 1000 msec). Ablation was immediately terminated upon any perceived reduction in the strength of diaphragmatic contraction.
An Amplatz Super Stiff Guidewire (Boston Scientific Corporation, Boston, MA, USA)
was used in the inner lumen of the FlexCath and was advanced into each pulmonary vein. A 28-mm Arctic Front Advance cryoballoon (Medtronic, Minneapolis, MN, USA) was positioned in each pulmonary vein ostium and inflated. Complete vessel occlusion was demonstrated by contrast injection with no reflux of contrast into the LA.
Each ablation was performed with a single 3-minute freeze for each vein.
A second freeze using a different balloon angulation was performed if there was contrast backflow into the LA or a temperature of -40C was not reached within 60 seconds.
Prior to ablation of right-sided pulmonary veins, the decapolar catheter was placed in the right subclavian vein or superior vena cava to pace the right phrenic nerve (10-20 mA at 1.0-2.0 msec pulse width at a cycle length of 1000 msec). Ablation was immediately terminated upon any perceived reduction in the strength of diaphragmatic contraction.
8
Cryoballoon Pulmonary Vein Isolation Procedure
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The assigned guidewire (0.032″ in standard group, or ProTrack guidewire in the RF + Pigtail group ) was advanced to the left superior pulmonary vein following confirmation of LA access (contrast media visualization in the LA under fluoroscopy, microbubbles observed in the LA with echocardiographic imaging, and/or left atrial pressure tracing). Once the guidewire was in place, the initial transseptal sheath was removed, and the FlexCath sheath was advanced over the wire into the left atrium and flushed as per standard procedure. Following FlexCath placement, the cryoballoon was prepped and inserted as per standard procedure. After the transseptal puncture was completed, all patients underwent a standard cryoballoon-based pulmonary vein isolation with the Arctic Front Advance (Medtronic) using standard techniques [3 (link)–5 (link)].
9
Cryoballoon Ablation for Pulmonary Vein Isolation
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Cryoablation was performed with a 28-mm cryoballoon catheter (Arctic Front Advance), a 20 mm circular mapping catheter (Achieve Advance), and a steerable sheath (FlexCath Advance; all Medtronic, MN, USA). After successful LA access, the standard transseptal sheath was replaced by the 12-F steerable sheath (FlexCath). The cryoballoon was then introduced and placed at the ostia of each PV to occlude the veins. In case of an effective freeze (judged by the disappearance of all local PV signals before 60 s or reaching a temperature of − 40 °C) cryoablation was continued for two additional minutes after effect (“time-to-effect plus 2-min strategy”) [24 (link)]. In the case of an ineffective freeze, the ablation was stopped and the balloon repositioned, aiming for better occlusion of the PV. Acute PVI was verified at the end of the procedure with the assessment of Entrance- and Exit-Block in all PVs using the circular mapping catheter. No adenosine test was used to detect dormant PV connection.
10
Cryoballoon Ablation Outcomes in Atrial Fibrillation
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This observational study included 531 consecutive patients undergoing index PVI using the 2nd generation 28 mm cryoballoon (Arctic Front Advance, Medtronic, Minneapolis, MN, USA) for catheter ablation of paroxysmal (PAF) and persistent (PERS) AF between January 2013 and February 2020. All patients underwent their index PVI due to recurrent symptomatic episodes of PAF or PERS and failure relative to previous antiarrhythmic drug therapy (AADs).
Patients were divided into two groups (PAF vs. PERS), and the effects of DM on freedom from arrhythmia recurrence were evaluated. The diagnosis of PAF vs. PERS was made using the definition from the ESC guideline for the diagnosis and management of atrial fibrillation [7 (link)]. Arrhythmia recurrence was defined as a documented episode of any AF/atrial tachycardia (AT) > 30 s. DM was previously diagnosed by elevated HbA1C levels > 6.5 mg/dL, fasting glucose values > 126 mg/dl and/or pathological oral glucose tolerance testing values accompanied by typical symptoms of DM. Patients at all levels of the DM stage schedule were included. The presence of antidiabetic medication was not an exclusive inclusion criterion.
Patients were divided into two groups (PAF vs. PERS), and the effects of DM on freedom from arrhythmia recurrence were evaluated. The diagnosis of PAF vs. PERS was made using the definition from the ESC guideline for the diagnosis and management of atrial fibrillation [7 (link)]. Arrhythmia recurrence was defined as a documented episode of any AF/atrial tachycardia (AT) > 30 s. DM was previously diagnosed by elevated HbA1C levels > 6.5 mg/dL, fasting glucose values > 126 mg/dl and/or pathological oral glucose tolerance testing values accompanied by typical symptoms of DM. Patients at all levels of the DM stage schedule were included. The presence of antidiabetic medication was not an exclusive inclusion criterion.
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