Cryothermal atrial linear ablation in patients with atrial fibrillation: An insight from the comparison with radiofrequency atrial linear ablation.
Action Potentials
Aged
Atrial Fibrillation
/ diagnosis
Case-Control Studies
Catheter Ablation
/ adverse effects
Cryosurgery
/ adverse effects
Disease-Free Survival
Feasibility Studies
Female
Heart Atria
/ physiopathology
Heart Rate
Humans
Male
Middle Aged
Pulmonary Veins
/ physiopathology
Recurrence
Time Factors
atrial fibrillation
catheter ablation
cryoablation
linear ablation
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
15
01
2020
revised:
03
02
2020
accepted:
22
02
2020
pubmed:
29
2
2020
medline:
13
4
2021
entrez:
29
2
2020
Statut:
ppublish
Résumé
Atrial linear lesions are generally created with radiofrequency energy. We sought to evaluate the feasibility of cryothermal atrial linear ablation. Twenty-one atrial fibrillation (AF) patients underwent linear ablation on the left atrial (LA) roof, mitral isthmus (MI), and cavotricuspid isthmus (CTI) with 8-mm-tip cryocatheters following pulmonary vein isolation. The data were compared with those of 31 patients undergoing linear ablation with irrigated-tip radiofrequency catheters. Conduction block was successfully created in 18 of 20 (90%), 9 of 21 (43%), and 20 of 20 (100%) on the LA roof, MI, and CTI by endocardial cryoablation alone with 19.0 (12.0-24.0), 30.0 (23.0-34.0), and 14.0 (14.0-16.0) minute cryo applications, respectively. The presence of either an interposed circumflex artery or pouch at the MI was significantly associated with failed MI block (P = .04). Conduction block was created in 25 of 31 (83.9%), 27 of 31 (87.1%), and 30 of 31 (96.8%) on the roof, MI, and CTI, respectively, by radiofrequency ablation. During the 17.5 (13.0-31.7) months of follow-up, freedom from AF/atrial tachycardia (AT) was significantly higher in the cryo group (P = .05); especially, recurrent AT was more frequent in the RF group (8/31 vs 1/21; P = .03). Conduction block across the roof, MI, and CTI was durable in 6 of 12 (50.0%), 4 of 12 (33.3%), and 9 of 12 (75.0%) patients during second procedures. All nine patients (except one) with recurrent ATs had at least one roof or MI conduction resumption. Cryoablation is effective for creating a roof and CTI linear block, however, creating MI block by endocardial ablation alone was often challenging. Conduction resumption of LA linear block is common and recurrent arrhythmias, especially iatrogenic ATs, are more frequently observed after radiofrequency linear ablation.
Sections du résumé
BACKGROUND
Atrial linear lesions are generally created with radiofrequency energy. We sought to evaluate the feasibility of cryothermal atrial linear ablation.
METHODS AND RESULTS
Twenty-one atrial fibrillation (AF) patients underwent linear ablation on the left atrial (LA) roof, mitral isthmus (MI), and cavotricuspid isthmus (CTI) with 8-mm-tip cryocatheters following pulmonary vein isolation. The data were compared with those of 31 patients undergoing linear ablation with irrigated-tip radiofrequency catheters. Conduction block was successfully created in 18 of 20 (90%), 9 of 21 (43%), and 20 of 20 (100%) on the LA roof, MI, and CTI by endocardial cryoablation alone with 19.0 (12.0-24.0), 30.0 (23.0-34.0), and 14.0 (14.0-16.0) minute cryo applications, respectively. The presence of either an interposed circumflex artery or pouch at the MI was significantly associated with failed MI block (P = .04). Conduction block was created in 25 of 31 (83.9%), 27 of 31 (87.1%), and 30 of 31 (96.8%) on the roof, MI, and CTI, respectively, by radiofrequency ablation. During the 17.5 (13.0-31.7) months of follow-up, freedom from AF/atrial tachycardia (AT) was significantly higher in the cryo group (P = .05); especially, recurrent AT was more frequent in the RF group (8/31 vs 1/21; P = .03). Conduction block across the roof, MI, and CTI was durable in 6 of 12 (50.0%), 4 of 12 (33.3%), and 9 of 12 (75.0%) patients during second procedures. All nine patients (except one) with recurrent ATs had at least one roof or MI conduction resumption.
CONCLUSIONS
Cryoablation is effective for creating a roof and CTI linear block, however, creating MI block by endocardial ablation alone was often challenging. Conduction resumption of LA linear block is common and recurrent arrhythmias, especially iatrogenic ATs, are more frequently observed after radiofrequency linear ablation.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1075-1082Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation: Executive summary. J Arrhythm. 2017;33:369-409.
Jaïs P, Hocini M, Hsu LF, et al. Technique and results of linear ablation at the mitral isthmus. Circulation. 2004;110:2996-3002.
Hocini M, Jaïs P, Sanders P, et al. Techniques, evaluation, and consequences of linear block at the left atrial roof in paroxysmal atrial fibrillation: a prospective randomized study. Circulation. 2005;112:3688-3696.
Matsuo S, Wright M, Knecht S, et al. Peri-mitral atrial flutter in patients with atrial fibrillation ablation. Heart Rhythm. 2010;7:2-8.
Miyazaki S, Shah AJ, Hocini M, Haïssaguerre M, Jaïs P. Recurrent spontaneous clinical perimitral atrial tachycardia in the context of atrial fibrillation ablation. Heart Rhythm. 2015;12:104-110.
Kuck KH, Brugada J, Fürnkranz A, et al. FIRE AND ICE Investigators. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med. 2016;374:2235-2245.
Khairy P, Chauvet P, Lehmann J, et al. Lower incidence of thrombus formation with cryoenergy versus radiofrequency catheter ablation. Circulation. 2003;107:2045-2050.
Eckhardt LL, Leal M, Hollis Z, Tanega J, Alberte C. Cryoablation for AVNRT: importance of ablation endpoint criteria. J Cardiovasc Electrophysiol. 2012;23:729-734.
Andrew P, Hamad Y, Jerat S, Montenero A, O'Connor S. Approaching a decade of cryo catheter ablation for type 1 atrial flutter-a meta-analysis and systematic review. J Interv Card Electrophysiol. 2011;32:17-27.
Miyazaki S, Kuroi A, Hachiya H, et al. Early recurrence after pulmonary vein isolation of paroxysmal atrial fibrillation with different ablation technologies-prospective comparison of radiofrequency vs. second-generation cryoballoon ablation. Circ J. 2016;80:346-353.
Yokokawa M, Sundaram B, Garg A, et al. Impact of mitral isthmus anatomy on the likelihood of achieving linear block in patients undergoing catheter ablation of persistent atrial fibrillation. Heart Rhythm. 2011;8:1404-1410.
Betts TR, Jones M, Wong KC, Qureshi N, Rajappan K, Bashir Y. Feasibility of mitral isthmus and left atrial roof linear lesions using an 8 mm tip cryoablation catheter. J Cardiovasc Electrophysiol. 2013;24:775-780.
Bessière F, Dubuc M, Andrade J, et al. Focal Transcatheter cryoablation: is a four-minute application still required? J Cardiovasc Electrophysiol. 2017;28:559-563.
Becker AE. Left atrial isthmus: anatomic aspects relevant for linear catheter ablation procedures in humans. J Cardiovasc Electrophysiol. 2004;15:809-812.
Fuller IA, Wood MA. Intramural coronary vasculature prevents transmural radiofrequency lesion formation: implications for linear ablation. Circulation. 2003;107:1797-1803.
Hocini M, Shah AJ, Nault I, et al. Mitral isthmus ablation with and without temporary spot occlusion of the coronary sinus: a randomized clinical comparison of acute outcomes. J Cardiovasc Electrophysiol. 2012;23:489-496.
Pilcher TA, Saul JP, Hlavacek AM, Haemmerich D. Contrasting effects of convective flow on catheter ablation lesion size: cryo versus radiofrequency energy. Pacing Clin Electrophysiol. 2008;31:300-307.
Cardoso R, Mendirichaga R, Fernandes G, et al. Cryoballoon versus radiofrequency catheter ablation in atrial fibrillation: a meta-analysis. J Cardiovasc Electrophysiol. 2016;27:1151-1159.
Shah AJ, Pascale P, Miyazaki S, et al. Prevalence and types of pitfall in the assessment of mitral isthmus linear conduction block. Circ Arrhythm Electrophysiol. 2012;5:957-967.
Verma A, Jiang CY, Betts TR, et al. STAR AF II Investigators. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372:1812-1822.