{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:34:57Z","timestamp":1760150097937,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T00:00:00Z","timestamp":1695859200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u00b0C (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\u201319.8) s, the median impedance drop was 18.4 (12.2\u201325.2) \u03a9, while the temperature rise was 11.1 (7.1\u201314.9) \u00b0C. Accordingly, impedance (84.6 (79.3\u201390.2) \u03a9) and temperature plateaus (38 (35.3\u201341.1) \u00b0C) were reached at 13.9 (10.6\u201316) s and 16.4 (12.6\u201318.5) s, respectively. Overall, 99.6% and 95.8% of electrodes reached 90% (16.6 \u03a9) and 95% (17.5 \u03a9) of their impedance drops within 15 s of RF delivery, while 97.2% and 92.8% achieved 90% (34.2 \u00b0C) and 95% (36.1 \u00b0C) of their temperature rise to reach the plateaus within 15 s of RF delivery. An ETR &gt;42 \u00b0C occurred in 37 (30.1%) patients after 17.7 \u00b1 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 &lt;42 \u00b0C. 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.<\/jats:p>","DOI":"10.3390\/jcm12196256","type":"journal-article","created":{"date-parts":[[2023,9,28]],"date-time":"2023-09-28T07:50:26Z","timestamp":1695887426000},"page":"6256","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Safety of the Radiofrequency Balloon for Pulmonary Vein Isolation: A Focus on Lesion Metric Analysis of Posterior Electrodes"],"prefix":"10.3390","volume":"12","author":[{"given":"Alexandre","family":"Almorad","sequence":"first","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6672-4931","authenticated-orcid":false,"given":"Alvise","family":"Del Monte","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yannick","family":"Teumer","sequence":"additional","affiliation":[{"name":"Department of Medicine II, Ulm University Medical Center, 89070 Ulm, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9436-7820","authenticated-orcid":false,"given":"Milad","family":"El Haddad","sequence":"additional","affiliation":[{"name":"Independent Researcher, 00790 Helsinki, Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Pannone","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3837-3462","authenticated-orcid":false,"given":"Domenico Giovanni","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5777-139X","authenticated-orcid":false,"given":"Charles","family":"Audiat","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6549-4994","authenticated-orcid":false,"given":"Mar\u00eda","family":"Cesp\u00f3n-Fern\u00e1ndez","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sahar","family":"Mouram","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3157-9281","authenticated-orcid":false,"given":"Robbert","family":"Ramak","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ingrid","family":"Overeinder","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gezim","family":"Bala","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0078-9393","authenticated-orcid":false,"given":"Antonio","family":"Sorgente","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erwin","family":"Str\u00f6ker","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Sieira","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Brugada","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark","family":"La Meir","sequence":"additional","affiliation":[{"name":"Cardiac Surgery Department, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carlo","family":"de Asmundis","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gian-Battista","family":"Chierchia","sequence":"additional","affiliation":[{"name":"Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, European Reference Networks Guard-Heart, Universitair Ziekenhuis Brussel-Vrije Universiteit Brussel, 1090 Brussels, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/S0140-6736(14)61774-8","article-title":"50 Year Trends in Atrial Fibrillation Prevalence, Incidence, Risk Factors, and Mortality in the Framingham Heart Study: A Cohort Study","volume":"386","author":"Schnabel","year":"2015","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e275","DOI":"10.1016\/j.hrthm.2017.05.012","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation","volume":"14","author":"Calkins","year":"2017","journal-title":"Heart Rhythm."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1466","DOI":"10.1093\/eurheartj\/ehu001","article-title":"The Atrial Fibrillation Ablation Pilot 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Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2640","DOI":"10.1111\/jce.15697","article-title":"Effectiveness and Safety of a Time to Isolation Strategy of Cryoballoon Ablation of Atrial Fibrillation: A Systematic Review and Meta-Analysis","volume":"33","author":"Tsiachris","year":"2022","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.hrthm.2014.12.026","article-title":"Single 3-Minute Freeze for Second-Generation Cryoballoon Ablation: One-Year Follow-up after Pulmonary Vein Isolation","volume":"12","author":"Ciconte","year":"2015","journal-title":"Heart Rhythm."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1002\/joa3.12504","article-title":"Safety and Efficacy of Cryoballoon Ablation for the Treatment of Paroxysmal and Persistent AF in a Real-World Global Setting: Results from the Cryo AF Global Registry","volume":"37","author":"Chun","year":"2021","journal-title":"J. Arrhythm."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1007\/s10840-021-01094-9","article-title":"The Optimized Clinical Workflow for Pulmonary Vein Isolation with the Radiofrequency Balloon","volume":"64","author":"Almorad","year":"2021","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"896","DOI":"10.1093\/europace\/euad017","article-title":"Pulmonary Vein Isolation with the Radiofrequency Balloon Catheter: A Single Centre Prospective Study","volume":"25","author":"Monte","year":"2023","journal-title":"Europace"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e007541","DOI":"10.1161\/CIRCEP.119.007541","article-title":"Pulmonary Vein Isolation With a Novel Multielectrode Radiofrequency Balloon Catheter That Allows Directionally Tailored Energy Delivery: Short-Term Outcomes from a Multicenter First-in-Human Study (RADIANCE)","volume":"12","author":"Reddy","year":"2019","journal-title":"Circ. Arrhythm. Electrophysiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1111\/jce.14476","article-title":"Use of a Multi-Electrode Radiofrequency Balloon Catheter to Achieve Pulmonary Vein Isolation in Patients with Paroxysmal Atrial Fibrillation: 12-Month Outcomes of the RADIANCE Study","volume":"31","author":"Dhillon","year":"2020","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_11","first-page":"851","article-title":"Safety, Effectiveness, and Quality of Life Following Pulmonary Vein Isolation with a Multi-Electrode Radiofrequency Balloon Catheter in Paroxysmal Atrial Fibrillation: 1-Year Outcomes from SHINE","volume":"23","author":"Schilling","year":"2021","journal-title":"EP Eur."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e006690","DOI":"10.1161\/CIRCEP.118.006690","article-title":"Effect of Baseline Impedance on Ablation Lesion Dimensions","volume":"11","author":"Barkagan","year":"2018","journal-title":"Circ. Arrhythm. 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