Cryoballoon ablation of atrial fibrillation is effectively feasible without previous imaging of pulmonary vein anatomy: insights from the 1STOP project.
AF recurrences
Cardio imaging
Cryoballoon
Outcomes
Paroxysmal atrial fibrillation
Journal
Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing
ISSN: 1572-8595
Titre abrégé: J Interv Card Electrophysiol
Pays: Netherlands
ID NLM: 9708966
Informations de publication
Date de publication:
Sep 2019
Sep 2019
Historique:
received:
01
10
2018
accepted:
17
12
2018
pubmed:
5
1
2019
medline:
6
2
2020
entrez:
5
1
2019
Statut:
ppublish
Résumé
Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF); however, PVI-C can become a challenging procedure due to the anatomy of the left atrium and pulmonary veins (PVs). Importantly, the utility of imaging before the procedure is still unknown regarding the long-term clinical outcomes following PVI-C. The aim of the analysis is to evaluate the impact of imaging before PVI-C on procedural data and AF recurrence. Patients with paroxysmal AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were divided into two groups according to the utilization of pre-procedural imaging of PV anatomy (via CT or MRI) or the non-usage of pre-procedural imaging. Out of 912 patients, 461 (50.5%) were evaluated with CT or MRI before the PVI-C and denoted as the imaging group. Accordingly, 451 (49.5%) patients had no pre-procedural imaging and were categorized as the no imaging group. Patient baseline characteristics were comparable between the two cohorts, but the ablation centers that comprised the imaging group had fewer PVI-C cases per year than the no imaging group (p < 0.001). The procedure, fluoroscopy, and left atrial dwell times were significantly shorter in the no imaging cohort (p < 0.001). The rates of complications were significantly greater in the imaging group compared to the no imaging group (6.9% vs. 2.7%; p = 0.003); this difference was attributed to differences in transient diaphragmatic paralysis. The 12-month freedom from AF was 76.2% in the imaging group and 80.0% in the no imaging group (p = 0.390). In our analysis, PVI-C was effective regardless of the availability of imaging data on PV anatomy.
Sections du résumé
BACKGROUND
BACKGROUND
Pulmonary vein isolation by cryoablation (PVI-C) is a standard therapy for the treatment of atrial fibrillation (AF); however, PVI-C can become a challenging procedure due to the anatomy of the left atrium and pulmonary veins (PVs). Importantly, the utility of imaging before the procedure is still unknown regarding the long-term clinical outcomes following PVI-C. The aim of the analysis is to evaluate the impact of imaging before PVI-C on procedural data and AF recurrence.
METHODS
METHODS
Patients with paroxysmal AF underwent an index PVI-C. Data were collected prospectively in the framework of 1STOP ClinicalService® project. Patients were divided into two groups according to the utilization of pre-procedural imaging of PV anatomy (via CT or MRI) or the non-usage of pre-procedural imaging.
RESULTS
RESULTS
Out of 912 patients, 461 (50.5%) were evaluated with CT or MRI before the PVI-C and denoted as the imaging group. Accordingly, 451 (49.5%) patients had no pre-procedural imaging and were categorized as the no imaging group. Patient baseline characteristics were comparable between the two cohorts, but the ablation centers that comprised the imaging group had fewer PVI-C cases per year than the no imaging group (p < 0.001). The procedure, fluoroscopy, and left atrial dwell times were significantly shorter in the no imaging cohort (p < 0.001). The rates of complications were significantly greater in the imaging group compared to the no imaging group (6.9% vs. 2.7%; p = 0.003); this difference was attributed to differences in transient diaphragmatic paralysis. The 12-month freedom from AF was 76.2% in the imaging group and 80.0% in the no imaging group (p = 0.390).
CONCLUSIONS
CONCLUSIONS
In our analysis, PVI-C was effective regardless of the availability of imaging data on PV anatomy.
Identifiants
pubmed: 30607667
doi: 10.1007/s10840-018-0500-6
pii: 10.1007/s10840-018-0500-6
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
267-275Subventions
Organisme : Medtronic
ID : This research was performed within the framework of the Italian ClinicalService, a project funded by Medtronic Italy, an affiliate of Medtronic Inc
Références
J Cardiovasc Electrophysiol. 2004 Apr;15(4):387-93
pubmed: 15089984
Circulation. 2006 Jul 11;114(2):119-25
pubmed: 16818816
Stroke. 1991 Aug;22(8):983-8
pubmed: 1866765
Circ Arrhythm Electrophysiol. 2010 Feb;3(1):32-8
pubmed: 19995881
J Cardiovasc Comput Tomogr. 2010 Nov-Dec;4(6):407.e1-33
pubmed: 21232696
Heart Rhythm. 2011 Sep;8(9):1444-51
pubmed: 21457789
J Am Coll Cardiol. 2011 Nov 29;58(23):2380-5
pubmed: 22115643
Europace. 2014 Feb;16(2):202-7
pubmed: 23813452
Can J Cardiol. 2014 Apr;30(4):405-12
pubmed: 24582725
Circ Arrhythm Electrophysiol. 2014 Apr;7(2):293-9
pubmed: 24610739
Circ Res. 2014 Apr 25;114(9):1453-68
pubmed: 24763464
Europace. 2015 May;17(5):718-24
pubmed: 25840289
Pacing Clin Electrophysiol. 2016 Feb;39(2):182-9
pubmed: 26592985
J Interv Card Electrophysiol. 2016 Aug;46(2):89-96
pubmed: 26810707
N Engl J Med. 2016 Jun 9;374(23):2235-45
pubmed: 27042964
Eur Radiol. 2017 Feb;27(2):660-670
pubmed: 27229337
Europace. 2016 Nov;18(11):1609-1678
pubmed: 27567465
Pacing Clin Electrophysiol. 2017 Jan;40(1):46-56
pubmed: 27862043
Eur Heart J. 2017 May 1;38(17):1303-1316
pubmed: 28104790
Europace. 2017 Feb 1;19(2):241-249
pubmed: 28172794
Heart Rhythm. 2017 Oct;14(10):e275-e444
pubmed: 28506916
World J Cardiol. 2017 Oct 26;9(10):773-786
pubmed: 29104737
Heart Rhythm. 2018 Mar;15(3):363-368
pubmed: 29107190
Eur Heart J Cardiovasc Imaging. 2018 Mar 1;19(3):253-261
pubmed: 29236953
Int J Cardiol. 2018 Dec 1;272:130-136
pubmed: 30045822