Wilber W Su

Interests

Research

Atrial Fibrillation, Cryo ablation, ablation and mappingDefibrillatorPacemakerImplantable devices

Teaching

Cardiology and Cardiac Electrophysiology

Courses

No activities entered.

Scholarly Contributions

Chapters

• Su, W. (2019). Cryoballoon Ablation of Atrial Fibrillation. In Ablation of Cardiac Arrhythmias, Fourth Edition(pp 235-243). Chapter 15: Elsevier.
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  eBook ISBN: 9780323550499
• Su, W. (2017). Balloon Cryo ablation. In Hands-On Ablation.
• Su, W., & Wang, P. (2017). How to Use Balloon Cryoablation for Ablation of Atrial Fibrillation. In Hands-On Ablation The Experts' Approach, 2ed.. Cardiotext Publishing, 2nd ed May 15, 2017.

Journals/Publications

• Ling, T. Y., Chen, L., Su, W. W., & Wu, L. Q. (2021). Cryoballoon ablation for extrapulmonary vein targets. Current opinion in cardiology, 36(1), 22-25.
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  Cryoballoon catheter can create large and contiguous lesions with stable contact during ablation. It has proven to be well tolerated and effective in pulmonary vein isolation. But atrial arrhythmias, including atrial fibrillation, atrial tachycardia, and atrial flutter (AFL), also relate to many extrapulmonary vein targets. It is necessary to understand the current evidence for the use of cryoballoon ablation for targets outside of pulmonary veins.
• Su, W. W. (2021). A Second Cryoballoon System- new and improved?. Journal of cardiovascular electrophysiology.
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  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.
• Tomaiko, E., Liao, Y. C., Reichert, W. B., & Su, W. W. (2021). Focal cryoablation of atrioventricular node reentrant tachycardia: a review and comparison of data. Current opinion in cardiology, 36(1), 17-21.
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  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.
• Reichert, W., Ahmad, Z., & Su, W. (2020). Successful cryoablation of left ventricular summit premature ventricular contractions via the coronary sinus. Pacing and clinical electrophysiology : PACE, 43(8), 894-897.
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  The left ventricular summit (LVS) is a challenging location for catheter-based percutaneous ablation due to its anatomical location. There have been case reports of cryoablations performed in this region, but the technique may be underutilized when radiofrequency ablation fails. A 45-year-old male was found to have 25 000 premature ventricular contractions (PVCs) a day despite previous ablation and a reduced ejection fraction of 40% despite medical therapy. Coronary sinus epicardial mapping revealed the coronary sinus distal region generated activations earlier than the QRS onset by 28 ms. Two separate, 4-minute cryoablations were delivered that suppressed the PVCs within 5 seconds. Alternate energy modalities such as cryo may offer a safer and more viable approach for ablation of LVS in select patients.
• Reichert, W., Tomaiko, E., Kalya, A., Kusne, S., Lockhart, C., & Su, W. (2020). De novo subcutaneous implantable cardioverter-defibrillator in patient with left ventricular assist device. HeartRhythm case reports, 6(10), 774-776.
• Su, W. W., Reddy, V. Y., Bhasin, K., Champagne, J., Sangrigoli, R. M., Braegelmann, K. M., Kueffer, F. J., Novak, P., Gupta, S. K., Yamane, T., Calkins, H., & , S. P. (2020). Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: Results from the multicenter STOP Persistent AF trial. Heart rhythm, 17(11), 1841-1847.
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  Pulmonary vein isolation (PVI) is the cornerstone of catheter ablation to treat patients with symptomatic drug-refractory atrial fibrillation (AF).
• Su, W., Tomaiko, E., & Tseng, A. (2019). Delineating the physiology of cryoballoon ablation. Journal of cardiovascular electrophysiology, 30(10), 2088-2089.
• Tomaiko, E., & Su, W. W. (2019). Comparing radiofrequency and cryoballoon technology for the ablation of atrial fibrillation. Current opinion in cardiology, 34(1), 1-5.
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  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.
• Tomaiko, E., Tseng, A., & Su, W. (2019). Radiofrequency versus cryoballoon ablation for atrial fibrillation: an argument for a 'cryo-first' approach. Current opinion in cardiology.
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  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.
• Tomaiko, E., Tseng, A., Reichert, W. B., & Su, W. W. (2019). Approach and strategy for repeat catheter ablation of recurrent atrial fibrillation. Journal of cardiovascular electrophysiology.
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  Patients with atrial fibrillation often undergo repeat catheter ablation for the 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.
• Flores, E., Patel, M., Orme, G., & Su, W. (2018). Successful implantation of a Micra leadless pacemaker via collateral femoral vein and inferior vena cava filter. Clinical case reports, 6(3), 502-505.
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  This case details the successful implementation of a leadless pacemaker device in a patient with multiple venous occlusions and an IVC filter. As the incidence of IVC filters increases in patients with dysrhythmias, further investigations are required to determine the risk and safety of leadless pacemaker placement in this population.
• Kulkarni, N., Su, W., & Wu, R. (2018). How to Prevent, Detect and Manage Complications Caused by Cryoballoon Ablation of Atrial Fibrillation. Arrhythmia & electrophysiology review, 7(1), 18-23.
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  Atrial fibrillation is the most common cardiac arrhythmia and the prevalence is increasing every year. Patients who fail to maintain sinus rhythm with use of anti-arrhythmic drug therapy are referred for catheter ablation. Cryoballoon (CB) ablation has emerged as an effective and alternative treatment option to traditional point-by-point radiofrequency ablation, but there can be complications. This article reviews the incidence, presentation, risk factors, management and preventative strategies of three major complications associated with CB ablation: phrenic nerve injury, atrial oesophageal fistula and bronchial injury. Although these complications are rare, electrophysiologists should institute measures to identify high-risk patients, implement best-practice techniques to minimise risks and maintain a high index of suspicion to recognise the complications quickly and implement correct treatment strategies.
• Morris, M. F., Verma, D. R., Sheikh, H., Su, W., & Pershad, A. (2018). Outcomes after magnetic resonance imaging in patients with pacemakers and defibrillators and abandoned leads. Cardiovascular revascularization medicine : including molecular interventions, 19(6), 685-688.
• Orme, G. J., Mendenhall, C., Blair, F., Wen Chen, S. Y., Rhee, E., & Su, W. (2018). Percutaneous transhepatic approach for cryoballoon pulmonary vein isolation in a patient with persistent atrial fibrillation and interruption of the inferior vena cava. HeartRhythm case reports, 4(8), 332-335.
• Su, W. (2016). Time-to-effect Dosing of the Arctic Front Advance Cryoballoon Catheter in Canine Model. Manuscript.
• Su, W., Aryana, A., Passman, R., Singh, G., Hokanson, R., Kowalski, M., Andrade, J., & Wang, P. (2018). Cryoballoon Best Practices II: Practical guide to procedural monitoring and dosing during atrial fibrillation ablation from the perspective of experienced users. Heart rhythm, 15(9), 1348-1355.
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  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.
• Su, W., Coulombe, N., Kirchhof, N., Grassl, E., & Wittenberger, D. (2018). Dosing of the second-generation cryoballoon using acute time-to-pulmonary vein isolation as an indicator of durable ablation in a canine model. Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 53(3), 293-300.
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  Rigid time-based dosing protocol(s) currently used in the clinic for cryoballoon ablation of atrial fibrillation may be inadequate to guide the circumferential and transmural cryothermal energy transfer across the pulmonary vein (PV) and may result in injury to collateral tissues or electrical gaps between the PV and left atrium (LA).
• Su, W., Orme, G. J., Hoyt, R., Baker, J., Compton, S., Fellows, C., Harding, J., Svinarich, J. T., Kowalski, M., Piedad, B., Kenigsberg, D., Seger, J., Ahmad, Z. K., & Wang, P. (2018). Retrospective review of Arctic Front Advance Cryoballoon Ablation: a multicenter examination of second-generation cryoballoon (RADICOOL trial). Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 51(3), 199-204.
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  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.
• Wilber, S. u. (2017). LEFT ATRIAL TACHYCARDIA ABLATION DURING PREGNANCY: A SUCCESSFUL ABLATION WITH NEAR- ZERO FETAL RADIATION EXPOSURE. Journal of the American College of Cardiology.
• Wilber, S. u. (2017). P2669Application and validation of CAAP-AF score to predict ablation outcome in cryoballoon ablation dataset. European Heart Journal.
• Wilber, S. u. (2017). PROSPECTIVE CRYOBALLOON DOSING STUDY BASED ON TIME-TO-ISOLATION. Journal of the American College of Cardiology.
• Su, W. W., Alzubaidi, M., Tseng, R., Jebaily, N., Lin, Y. J., & Wang, P. J. (2016). 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 : an international journal of arrhythmias and pacing, 46(3), 275-85.
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  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.
• Wilber, S. u. (2016). 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). Heart Rhythm.
• Wilber, S. u. (2016). 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.
• 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. K., , Stevenson, W. G., et al. (2016). 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). Heart rhythm, 13(1), e3-e37.
• Rich, M. E., Tseng, A., Lim, H. W., Wang, P. J., & Su, W. W. (2015). 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, e52811.
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  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
• Su, W., Kowal, R., Kowalski, M., Metzner, A., Svinarich, J. T., Wheelan, K., & Wang, P. (2015). Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures. Heart rhythm, 12(7), 1658-66.
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  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.
• Wilber, S. u. (2015). 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.
• Wilber, S. u. (2015). 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). Journal of the American College of Cardiology.
• Wilber, S. u. (2015). Best practice guide for cryoballoon ablation in atrial fibrillation: The compilation experience of more than 3000 procedures. Heart Rhythm.
• Wilber, S. u. (2015). Reduction of iatrogenic atrial septal defects with an anterior and inferior transseptal puncture site when operating the cryoballoon ablation catheter. Journal of Visualized Experiments.
• 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. K., , Stevenson, W. G., et al. (2015). 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, 8(6), 1522-51.
• 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. K., , Stevenson, W. G., et al. (2015). 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). Journal of the American College of Cardiology, 66(24), 2767-802.
• McDonnell, K., Rhee, E., Srivathsan, K., & Su, W. (2014). Novel utility of cryoablation for ventricular arrhythmias arising from the left aortic cusp near the left main coronary artery: a case series. Heart rhythm, 11(1), 34-8.
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  Ablation of ventricular tachycardia and premature ventricular contraction arising at the aortic root has been described. The use of radiofrequency ablation energy has been associated with life-threatening collateral damage. The use of cryoablation as a safer alternative energy source at the aortic root has not been previously described.
• Wilber, S. u. (2014). Novel utility of cryoablation for ventricular arrhythmias arising from the left aortic cusp near the left main coronary artery: A case series. Heart Rhythm.
• Coulombe, N., Paulin, J., & Su, W. (2013). Improved in vivo performance of second-generation cryoballoon for pulmonary vein isolation. Journal of cardiovascular electrophysiology, 24(8), 919-25.
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  A novel cryoballoon with improved refrigerant distribution promises better pulmonary vein (PV) isolation success rate without sacrificing the technology's safety profile. This study aimed to compare the Arctic Front® (AF) balloon to the new Arctic Front Advance™ (AFA).
• Wilber, S. u. (2013). Improved in vivo performance of second-generation cryoballoon for pulmonary vein isolation. Journal of Cardiovascular Electrophysiology.
• Vashist, S., Silva, J. N., Van Hare, G. F., Papez, A. L., Su, W. W., & Rhee, E. K. (2012). Unusually high association of hypertrophic cardiomyopathy and complex heart defects in children with fasciculoventricular pathways. Pacing and clinical electrophysiology : PACE, 35(3), 308-13.
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  Fasciculoventricular pathways (FVPs) are rare causes of preexcitation that do not mediate tachycardias. We report a two-center experience of pediatric patients with FVP and an unexpectedly high association of complex congenital heart defects (CHDs), chromosomal anomalies, and hypertrophic cardiomyopathy.
• Wilber, S. u. (2012). Unusually High Association of Hypertrophic Cardiomyopathy and Complex Heart Defects in Children with Fasciculoventricular Pathways. Pacing and Clinical Electrophysiology.
• Leite, L., Su, W., Johnson, S. B., Milton, M., Henz, B., Sarabanda, A., Santos, S. N., & Packer, D. L. (2009). Utility of intracardiac ultrasound imaging to guide pulmonary vein ablation using laser balloon catheter. Arquivos brasileiros de cardiologia, 93(6), 616-21, 666-71.
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  Pulmonary vein isolation (PVI) with balloon catheter has been used as the endpoint for AF ablation.
• Wilber, S. u. (2009). Utility of intracardiac ultrasound imaging to guide pulmonary vein ablation using laser balloon catheter | Utilidade do ultrassom intracardíaco no isolamento de Veias Pulmonares usando cateter-balão a laser. Arquivos Brasileiros de Cardiologia.
• Su, W. W., Johnson, S. B., Jain, M. K., Hall, J., & Packer, D. L. (2005). Creating continuous linear lesions in the atria: a comparison of the multipolar ablation technique versus the conventional drag-and-burn. Journal of cardiovascular electrophysiology, 16(8), 905-11.
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  Catheter-based treatment of atrial fibrillation (AF) requires the isolation of the triggering foci as well as modification of the atria with substrate that sustains AF. The creation of linear lesions in the left atrium with standard radiofrequency ablative methods requires long procedural times with unpredictable results.
• Wilber, S. u. (2005). Correlation of impedance changes and microbubble patterns during cooled-tip ablation at the pulmonary vein ostium: An in vivo canine model. Heart Rhythm.
• Wilber, S. u. (2005). Creating continuous linear lesions in the atria: A comparison of the multipolar ablation technique versus the conventional drag-and-burn. Journal of Cardiovascular Electrophysiology.
• Wilber, S. u. (2005). Relevance of the carinal line created in conjunction with wide area circumferential ablation in patients undergoing intervention for atrial fibrillation. Heart Rhythm.
• Wilber, S. u. (1999). Dysarthria associated with giant cell arteritis. Journal of Rheumatology.
• Wilber, S. u. (1997). Combined Radiofrequency Ablation-Cooling Catheter for Reversible Cryothermal Mapping and Ablation. Journal of Interventional Cardiac Electrophysiology.
• Wilber, S. u. (1996). Combined radiofrequency ablation-cooling catheter for reversible mapping and ablation. Journal of the American College of Cardiology.

Presentations

• Su, W. (2017, August). Invited Faculty. Stanford University- Clinical Professor of Medicine.
• Su, W. (2017, TBD). 3 Presentations. American College of Cardiology Meeting in Washington.
• Su, W. (2017, TBD). 5 Presentations. Heart Rhythm Society Meeting. Chicago.
• Ahmad, Z., Williams, A., Olson, M., Kusne, S., & Su, W. (2016, November). Elimination of Inappropriate Subcutaneous ICD Shocks by using a Non-absorbable Pouch when Non-invasive Reprogramming Fails. American Heart Association 87th Annual Scientific Sessions. New Orleans.
• Harding, J., Sangrigoli, R., Al-Zubaidi, M., Williams, A., Tseng, R., & Su, W. (2016, November). Etiology of Atrial Fibrillation Recurrence after Previous Successful Pulmonary Vein Isolation with Cryoablation; a Two-center Review of Redo AF Ablation Data. American Heart Association 87th Annual Scientific Sessions. New Orleans.
• Su, W. (2016, November). Time-to-Effect Based Cryoballoon Dosing to Achieve Permanent Pulmonary Vein Isolation -The First Chronic Study in Canine Model. American Heart Association 87th Annual Scientific Sessions. New Orleans.
• Su, W., Yang, B., Xie, X., Alzubaidi, M., Tseng, R., Zhang, T., Ju, W., Chen, H., Yang, G., Li, M., Gu, K., & Chen, M. (2016, January). Procedural and Dimension Differences Between First and Second Generation Cryoballoon Ablation, Presented at 21st Annual Atrial Fibrillation. Annual Atrial Fibrillation Symposium 2016. Orlando, FL.
• Williams, A., Zeshan, A., Al-Zubaidi, M., & Su, W. (2016, November). Incidence of Atrial-Esophageal Fistula in Cryoballoon Ablation for Atrial Fibrillation is Dose Dependent. American Heart Association 87th Annual Scientific Sessions. New Orleans.
• Zeshan, A., & Su, W. (2016, November). Multi-center Experience in Reduction of Phrenic Nerve Injury with Second Generation Cryoballoon Ablation Using the Proximal Seal Method. American Heart Association 87th Annual Scientific Sessions. New Orleans.

Poster Presentations

• Su, W. (2018, May 2018). 2 abstracts presentations. American Heart Association.

Reviews

• Su, W. (2016. Heart rhythm.
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  Invited reviewer
• Su, W. (2016. Journal of Atrial Fibrillation.
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  Invited reviewer
• Su, W. (2016. Journal of Cardiac Electrophysiology.
• Su, W. (2016. Journal of Interventional Cardiac Electrophysiology.
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  Invited reviewer

Others

• Su, W. (2016, Summer). Invited Faculty and speaker. Stanford Technology forum.
• Su, W. (2017, August). Invited Faculty. August Napa Atrial Fibrillation Forum.