Academic Appointments

All Publications

  • Minimal dose of cryoballoon ablation leading to atrioesophageal fistula formation. HeartRhythm case reports Su, W., Zhang, Q., Reichert, W., Ahmad, Z., Tomaiko, E., Su, X. 2021; 7 (3): 148–49

    View details for DOI 10.1016/j.hrcr.2020.11.019

    View details for PubMedID 33786308

  • A Second Cryoballoon System- new and improved? Journal of cardiovascular electrophysiology Su, W. W. 2021


    Generations of cryoballoon transformed the atrial fibrillation ablation landscape. New advancements continue to make cryoballoon more successful and safer treatment. A new cryoballoon PolaRx from Boston Scientific has unique features compared to that of the Medtronic Arctic Front Advance system. Comparison of the two available cryoballoons will require ongoing larger trial and clinical experience. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/jce.14953

    View details for PubMedID 33590586

  • De novo subcutaneous implantable cardioverter-defibrillator in patient with left ventricular assist device. HeartRhythm case reports Reichert, W., Tomaiko, E., Kalya, A., Kusne, S., Lockhart, C., Su, W. 2020; 6 (10): 774–76

    View details for DOI 10.1016/j.hrcr.2020.07.020

    View details for PubMedID 33101953

  • Focal cryoablation of atrioventricular node reentrant tachycardia: a review and comparison of data. Current opinion in cardiology Tomaiko, E. n., Liao, Y. C., Reichert, W. B., Su, W. n. 2020


    Atrioventricular node reentrant tachycardia (AVNRT) is the most common mechanism of supraventricular tachycardia. Radiofrequency ablation has been the most prevalent method for slow pathway ablation but carries risk of atrioventricular node injury. Focal cryoablation has been utilized as an alternative ablation modality; however, there has been concern about decreased efficacy, resulting in a higher rate of recurrence postablation. We also report outcomes from two international centers using an 8-mm cryocatheter and complete a thorough comparison of existing data on ablation of AVNRT.Previous reviews included studies from 2006 onward. These studies included use of the 4 mm focal cryocatheter, which has largely been abandoned in current adult practice. We will cite more contemporary studies within the past 10 years, which also includes use of the 6 and 8 mm cryocatheter.The use of focal cryoablation allows for reversible injury during AVNRT ablation, providing safety from permanent atrioventricular node injury. With the appropriate ablation endpoints, 8 mm focal cryoablation is more effective for permanent lesion formation, leading to lower recurrences.

    View details for DOI 10.1097/HCO.0000000000000820

    View details for PubMedID 33093311

  • Radiofrequency versus cryoballoon ablation for atrial fibrillation: an argument for a 'cryo-first' approach. Current opinion in cardiology Tomaiko, E., Tseng, A., Su, W. 2019


    PURPOSE OF REVIEW: Radiofrequency and cryoballoon ablation are the two most common modalities for catheter ablation of atrial fibrillation. Radiofrequency, being more prevalent and having existed for a longer period, is often utilized for patients' first ablations, despite the efficiency and efficacy of the cryoballoon tool. Here we examine the advantages of the cryoballoon for its use in first-time ablation of atrial fibrillation.RECENT FINDINGS: The FIRE & ICE trial is established as conclusive evidence of the noninferiority of cryoballoon ablation to radiofrequency ablation in terms of efficacy. Since the study, cryoballoon has evolved in both form and technique, suggesting need for repeat consideration of the advantages of cryoablation over radiofrequency ablation. The second-generation cryoballoon has led to greater efficiency in achieving permanent pulmonary vein isolation, reducing complications, and reducing procedure times.SUMMARY: There are advantages to the use of cryoballoon which could increase success of first-time ablations, delaying need for repeat procedure and lowering overall burden on patients and the healthcare system. Cryoballoon ablation should be considered for first-time ablation in patients with paroxysmal or persistent atrial fibrillation.

    View details for DOI 10.1097/HCO.0000000000000700

    View details for PubMedID 31688135

  • Approach and Strategy for Repeat Catheter Ablation of Recurrent Atrial Fibrillation. Journal of cardiovascular electrophysiology Tomaiko, E., Tseng, A., Reichert, W. B., Su, W. W. 2019


    Patients with atrial fibrillation (AF) often undergo repeat catheter ablation for recurrence of tachyarrhythmia. If the pulmonary veins were isolated in prior procedure, the operator should focus on substrate homogenization with identification and ablation of only arrhythmogenic areas. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/jce.14238

    View details for PubMedID 31626351

  • Delineating the Physiology of Cryoballoon Ablation. Journal of cardiovascular electrophysiology Su, W., Tomaiko, E., Tseng, A. 2019


    Since the introduction of the cryoballoon catheter for atrial fibrillation, dosing practice has undergone frequent changes to maximize efficacy while mitigating complications. Purely time-based dosing was the standard during the introduction of the cryoballoon, when only guidewire support was available [1]. Following the introduction of the second-generation cryoballoon (Arctic Front Advance), practice called for a 240 second freeze-thaw-refreeze strategy. This article is protected by copyright. All rights reserved.

    View details for DOI 10.1111/jce.14096

    View details for PubMedID 31379039

  • A Review of the Use of Cryoballoon Ablation for the Treatment of Persistent Atrial Fibrillation CURRENT CARDIOVASCULAR RISK REPORTS Tomaiko, E., Bhatia, N., Su, W. 2019; 13 (5)
  • Comparing radiofrequency and cryoballoon technology for the ablation of atrial fibrillation CURRENT OPINION IN CARDIOLOGY Tomaiko, E., Su, W. W. 2019; 34 (1): 1–5
  • Comparing radiofrequency and cryoballoon technology for the ablation of atrial fibrillation. Current opinion in cardiology Tomaiko, E., Su, W. 2018


    PURPOSE OF REVIEW: With the growing popularity of the cryoballoon tool for catheter ablation of atrial fibrillation, there has been discussion of whether cryothermal energy is just as or more effective than traditional radiofrequency. This review will compare both thermal energies for the treatment of atrial fibrillation.RECENT FINDINGS: Although the FIRE and ICE trial established that cryoballoon technology is noninferior to radiofrequency ablation for the treatment of atrial fibrillation, both thermal technologies have undergone advancement. This review intends to explore recent changes in technology and catheter ablation technique to improve outcomes for patients with atrial fibrillation.SUMMARY: Catheter ablation is standard treatment for patients with atrial fibrillation, which primarily focuses on electrical isolation of the pulmonary veins. Radiofrequency is the most common approach at present times; however, over time, new technology has developed. Most successful among these is the cryoballoon tool. Although the FIRE and ICE trial indicated radiofrequency and cryothermal energy to be approximately equal in efficacy and safety, there are advantages and disadvantages to both. This review seeks to address the value of each tool, as well as further development needed to better address atrial fibrillation while improving procedural safety.

    View details for PubMedID 30444763

  • Esophageal Re-Warming Profile During Cryoballoon Ablation Why We Should Avoid the Freeze Thaw Refreeze Technique Tomaiko, E. D., Orme, J., Habib, A., Su, W., Wang, P. J., Jaskanawal, B., Su, S. LIPPINCOTT WILLIAMS & WILKINS. 2018
  • Cryoballoon Best Practices II: Practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective of experienced users. Heart rhythm Su, W., Aryana, A., Passman, R., Singh, G., Hokanson, R., Kowalski, M., Andrade, J., Wang, P. 2018


    Since the evaluation of the cryoballoon in the Sustained Treatment Of Paroxysmal Atrial Fibrillation trial, more than 350,000 patients with atrial fibrillation have been treated. Several studies have reported improved outcomes using the second-generation cryoballoon, and recent publications have evaluated modifications, refinements, and improvements in procedural techniques. Here, peer-reviewed articles published since the first cryoballoon best practices review were summarized against the technical practices of physicians with a high level of experience with the cryoballoon (average ≥6 years of experience in ≥900 cases). This summary includes a comprehensive literature review along with practical usage guidance from physicians using the cryoballoon to facilitate safe, efficient, and effective outcomes for patients with atrial fibrillation.

    View details for DOI 10.1016/j.hrthm.2018.04.021

    View details for PubMedID 29684571

  • Retrospective review of Arctic Front Advance Cryoballoon Ablation: a multicenter examination of second-generation cryoballoon (RADICOOL trial) JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY Su, W., Orme, G., Hoyt, R., Baker, J., Compton, S., Fellows, C., Harding, J., Svinarich, J., Kowalski, M., Piedad, B., Kenigsberg, D., Seger, J., Ahmad, Z. K., Wang, P. 2018; 51 (3): 199–204


    Pulmonary vein isolation (PVI) via catheter ablation is an approved therapy for patients with drug-refractory and symptomatic atrial fibrillation (AF). Furthermore, cryoballoon is now considered to be as effective as focal radiofrequency catheter ablation. This study examines the second-generation cryoballoon performance in a US multicenter review of real-world practices.By retrospective chart collections, the long-term efficacy and safety of the cryoballoon procedure were assessed in 15 US centers. All patients had a history of drug-refractory symptomatic paroxysmal AF and were treated with a cryoballoon PVI strategy at the index ablation.Four hundred fifty-two patients were evaluated, and acute PVI was achieved in 99% of patients by cryoballoon catheter ablation. In 0.88% of patients (4/452), an additional focal ablation catheter was used to achieve acute PVI during the ablation procedure. Average procedure time was 128 (range 82 to 260) min, using an average of 17 (range 1 to 19) min of fluoroscopy. The most frequent adverse event was transient phrenic nerve injury (1.5%; 7/452 patients) which all resolved by the end of the procedure with no diaphragmatic dysfunction at discharge. There were no strokes, transient ischemic attacks, cardiac tamponade, atrioesophageal fistulas, or deaths during the study. At the 12-month efficacy endpoint, single-procedure success of freedom from atrial arrhythmia was 87% (393/452 patients).This real-world examination of the US practice demonstrates that second-generation cryoballoon ablation by PVI strategy is safe and effective among patients with paroxysmal AF.

    View details for PubMedID 29478173

  • Novel usage of the cryoballoon catheter to achieve large area atrial substrate modification in persistent and long-standing persistent atrial fibrillation JOURNAL OF INTERVENTIONAL CARDIAC ELECTROPHYSIOLOGY Su, W. W., Alzubaidi, M., Tseng, R., Jebaily, N., Lin, Y., Wang, P. J. 2016; 46 (3): 275-285


    The cryoballoon catheter has proven to be both safe and effective when used for pulmonary vein (PV) isolation in patients with paroxysmal atrial fibrillation (AF). More recently, the cryoballoon catheter has demonstrated the ability to create durable, transmural, and large areas of PV ablation. However, persistent and long-standing persistent AF can require additional cardiac substrate modification(s) before a patient is returned to normal sinus rhythm. Yet, no study has reported the techniques necessary to achieve extra-PV lesion sets using the cryoballoon catheter.Cryoballoon ablation was completed in 225 patients with varying degrees of AF disease. In several cases, the balloon was used for more than PV isolation. This study examines the 11 anatomical cardiac locations where extra-PV lesion sets were utilized.This study demonstrates that these extra-PV ablations can be done safely with the balloon catheter (3.6 % total complication rate). The 12-month efficacy (freedom from all atrial arrhythmia) using these techniques was 88 % in 88 patients with paroxysmal AF, 71 % in 75 patients with persistent AF, and 55 % in 62 patients with long-standing persistent AF. While using this protocol, mean procedure time was 2.2 ± 0.6 h, and average fluoroscopy time was 4.2 ± 2.2 min.The cryoballoon catheter can be used to make effective and safe extra-PV lesions. However, these techniques will need to be validated in more multi-center studies with review of complication rates and long-term freedom from AF.

    View details for DOI 10.1007/s10840-016-0120-y

    View details for Web of Science ID 000387109800010

    View details for PubMedID 26936265

  • 2015 ACC/AHA/HRS Advanced Training Statement on Clinical Cardiac Electrophysiology (A Revision of the ACC/AHA 2006 Update of the Clinical Competence Statement on Invasive Electrophysiology Studies, Catheter Ablation, and Cardioversion) CIRCULATION-ARRHYTHMIA AND ELECTROPHYSIOLOGY Zipes, D. P., Calkins, H., Daubert, J. P., Ellenbogen, K. A., Field, M. E., Fisher, J. D., Fogel, R. I., Frankel, D. S., Gupta, A., Indik, J. H., Kusumoto, F. M., Lindsay, B. D., Marine, J. E., Mehta, L. S., Mendes, L. A., Miller, J. M., Munger, T. M., Sauer, W. H., Shen, W., Stevenson, W. G., Su, W. W., Tracy, C. M., Tsiperfal, A., Williams, E. S., Halperin, J. L., Arrighi, J. A., Awtry, E. H., Bates, E. R., Brush, J. E., Costa, S., Daniels, L., Desai, A., Drachman, D. E., Fernandes, S., Freeman, R., Ijioma, N., Khan, S. S., Kuvin, J. T., Marine, J. E., McPherson, J. A., Mendes, L. A., Sivaram, C. A., Spicer, R. L., Wang, A., Weitz, H. H. 2015; 8 (6): 1522-1551

    View details for DOI 10.1161/HAE.0000000000000014

    View details for Web of Science ID 000366604600034

    View details for PubMedID 26386016

  • Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures HEART RHYTHM Su, W., Kowal, R., Kowalski, M., Metzner, A., Svinarich, J. T., Wheelan, K., Wang, P. 2015; 12 (7): 1658-1666


    Since the release of the second-generation cryoballoon (CB2; Arctic Front Advance(TM), Medtronic Inc) and its design modifications with improved cooling characteristics, the technique, dosing, and complication profile is significantly different from that of the first-generation cryoballoon. A comprehensive report of CB2 procedural recommendations has not been reported.The purpose of this study was to review the current best practices from a group of experienced centers to create a user's consensus guide for CB2 ablation.High-volume operators with a combined experience of more than 3000 CB2 cases were interviewed, and consensus for technical and procedural best practice was established.Comprehensive review of the CB2 ablation best practice guide will provide a detailed technique for achieving safer and more effective outcomes for CB2 atrial fibrillation ablation.

    View details for DOI 10.1016/j.hrthm.2015.03.021

    View details for Web of Science ID 000356766500043

    View details for PubMedID 25778428

  • Reduction of Iatrogenic Atrial Septal Defects with an Anterior and Inferior Transseptal Puncture Site when Operating the Cryoballoon Ablation Catheter. Journal of visualized experiments : JoVE Rich, M. E., Tseng, A., Lim, H. W., Wang, P. J., Su, W. W. 2015


    The cryoballoon catheter ablates atrial fibrillation (AF) triggers in the left atrium (LA) and pulmonary veins (PVs) via transseptal access. The typical transseptal puncture site is the fossa ovalis (FO) - the atrial septum's thinnest section. A potentially beneficial transseptal site, for the cryoballoon, is near the inferior limbus (IL). This study examines an alternative transseptal site near the IL, which may decrease the frequency of acute iatrogenic atrial septal defect (IASD). Also, the study evaluates the acute pulmonary vein isolation (PVI) success rate utilizing the IL location. 200 patients were evaluated by retrospective chart review for acute PVI success rate with an IL transseptal site. An additional 128 IL transseptal patients were compared to 45 FO transseptal patients by performing Doppler intracardiac echocardiography (ICE) post-ablation to assess transseptal flow after removal of the transseptal sheath. After sheath removal and by Doppler ICE imaging, 42 of 128 (33%) IL transseptal patients demonstrated acute transseptal flow, while 45 of 45 (100%) FO transseptal puncture patients had acute transseptal flow. The difference in acute transseptal flow detection between FO and IL sites was statistically significant (P <0.0001). Furthermore, 186 of 200 patients (with an IL transseptal puncture) did not need additional ablation(s) and had achieved an acute PVI by a "cryoballoon only" technique. An IL transseptal puncture site for cryoballoon AF ablations is an effective location to mediate PVI at all four PVs. Additionally, an IL transseptal location can lower the incidence of acute transseptal flow by Doppler ICE when compared to the FO. Potentially, the IL transseptal site may reduce later IASD complications post-cryoballoon procedures.

    View details for DOI 10.3791/52811

    View details for PubMedID 26132435

  • Safety and Effectiveness of Atrial Fibrillation Ablation Using the Arctic Front Advance Cryoballoon With Reduced Dosing Al-Zubaidi, M., Whittington, W., Tseng, A., Wang, P., Su, W. LIPPINCOTT WILLIAMS & WILKINS. 2013
  • Second Generation Cryoballoon Ablation With Improved Freezing Results in Pulmonary Injury and Unexpected Late Adhesion Whittington, W. W., Al-Zubaidi, M., Tseng, R., Wang, P., Su, W. LIPPINCOTT WILLIAMS & WILKINS. 2013
  • Novel Utilization of Cryoballoon for Ablation of Coumadin Ridge, Left and Right Atrial Appendage for Atrial Fibrillation Whittington, W. W., Al-Zubaidi, M., Tseng, R., Wang, P., Su, W. LIPPINCOTT WILLIAMS & WILKINS. 2013