Long-term clinical outcomes after single freeze cryoballoon ablation for paroxysmal atrial fibrillation: a 5-year follow-up.
Atrial fibrillation
Catheter ablation
Cryoballoon
Paroxysmal
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:
Jun 2021
Jun 2021
Historique:
received:
13
04
2020
accepted:
20
05
2020
pubmed:
31
5
2020
medline:
19
8
2021
entrez:
31
5
2020
Statut:
ppublish
Résumé
The second-generation cryoballoon ablation (CB-A) has been proven to be safe and effective for pulmonary vein (PV) isolation. Little is known regarding the long-term outcome following CB-A ablation for paroxysmal atrial fibrillation (AF). The aim of the study was to evaluate the freedom from atrial arrhythmias during a 5-year follow-up period among consecutive patients having undergone PV isolation with the CB-A for paroxysmal AF METHODS AND RESULTS: A total of 208 consecutive patients having undergone index PV isolation using CB-A (138 males, 66%; mean age 59.0 ± 12.6 years) were included in our retrospective analysis. Follow-up was based on outpatient clinic visits including Holter electrocardiograms. Recurrence of atrial tachyarrhythmias was defined as a symptomatic or documented episode of > 30 s. At a median follow-up of 62 months, freedom from atrial arrhythmias after a single procedure was achieved in 57.2% of patients. Multivariate analysis demonstrated that obesity, left atrial diameter, and duration of symptoms before AF ablation were independent predictors of ATas recurrences. Major complications occurred in 2.4% of patients. The present study found a 5-year single-procedure success rate of 57.2% following CB-A ablation procedure. Obesity, higher LA dimensions, and longer duration of symptoms before ablation independently predicted the outcome.
Sections du résumé
BACKGROUND
BACKGROUND
The second-generation cryoballoon ablation (CB-A) has been proven to be safe and effective for pulmonary vein (PV) isolation. Little is known regarding the long-term outcome following CB-A ablation for paroxysmal atrial fibrillation (AF). The aim of the study was to evaluate the freedom from atrial arrhythmias during a 5-year follow-up period among consecutive patients having undergone PV isolation with the CB-A for paroxysmal AF METHODS AND RESULTS: A total of 208 consecutive patients having undergone index PV isolation using CB-A (138 males, 66%; mean age 59.0 ± 12.6 years) were included in our retrospective analysis. Follow-up was based on outpatient clinic visits including Holter electrocardiograms. Recurrence of atrial tachyarrhythmias was defined as a symptomatic or documented episode of > 30 s. At a median follow-up of 62 months, freedom from atrial arrhythmias after a single procedure was achieved in 57.2% of patients. Multivariate analysis demonstrated that obesity, left atrial diameter, and duration of symptoms before AF ablation were independent predictors of ATas recurrences. Major complications occurred in 2.4% of patients.
CONCLUSIONS
CONCLUSIONS
The present study found a 5-year single-procedure success rate of 57.2% following CB-A ablation procedure. Obesity, higher LA dimensions, and longer duration of symptoms before ablation independently predicted the outcome.
Identifiants
pubmed: 32472280
doi: 10.1007/s10840-020-00788-w
pii: 10.1007/s10840-020-00788-w
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
87-93Références
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18:1609–78.
doi: 10.1093/europace/euw295
Kuck KH, Brugada J, Furnkranz A, Metzner A, Ouyang F, Chun KR, et al. Tondo C; FIRE AND ICE Investigators. N Engl J Med. 2016;374:2235–45.
doi: 10.1056/NEJMoa1602014
Hoffmann E, Straube F, Wegscheider K, Kuniss M, Andresen D, Wu LQ, et al. Europace. 2019;21:1313–24.
doi: 10.1093/europace/euz155
Giovanni GD, Wauters K, Chierchia GB, Sieira J, Levinstein M, Conte G, et al. One-year follow-up after single procedure cryoballoon ablation: a comparison between the first and second generation balloon. J Cardiovasc Electrophysiol. 2014;25:834–9.
doi: 10.1111/jce.12409
Akkaya E, Berkowitsch A, Zaltsberg S, Greiss H, Hamm CW, Sperzel J, et al. Five-year outcome and predictors of success after second-generation cryoballoon ablation for treatment of symptomatic atrial fibrillation. Int J Cardiol. 2018;266:106–11.
doi: 10.1016/j.ijcard.2018.03.069
Takarada K, Overeinder I, de Asmundis C, Stroker E, Mugnai G, de Regibus V, et al. Long-term outcome after second-generation cryoballoon ablation for paroxysmal atrial fibrillation – a 3-years follow-up. J Interv Card Electrophysiol. 2017;49:93–100.
doi: 10.1007/s10840-017-0237-7
Heeger CH, Wissner E, Knoll M, Knoop B, Reissmann B, Mathew S, et al. Three-year clinical outcome after 2nd-generation cryoballoon-based pulmonary vein isolation for the treatment of paroxysmal and persistent atrial fibrillation- a 2-center experience. Circ J. 2017;81:974–80.
doi: 10.1253/circj.CJ-16-1334
Knight BP, Novak PG, Sangrigoli R, Champagne J, Dubuc M, Adler SW, et al. Long-term outcomes after ablation for paroxysmal atrial fibrillation using the second-generation cryoballoon: final results from STOP AF post-approval study. JACC Clin Electrophysiol. 2019;5:306–14.
doi: 10.1016/j.jacep.2018.11.006
Gokoglan Y, Mohanty S, Gunes MF, Trivedi C, Santangeli P, Gianni C, Asfour IK, Bai R, Burkhardt JD, Horton R, Sanchez J, Hao S, Hongo R, Beheiry S, Di Biase L, Natale A. Pulmonary vein antrum isolation in patients with paroxysmal atrial fibrillation: more than a decade of follow-up. Circ Arrhythm Electrophysiol 2016: 9(5).
Ouyang F, Tilz R, Chun J, Schmidt B, Wissner E, Zerm T, et al. Long-term results of catheter ablation in paroxysmal atrial fibrillation: lessons from a 5-year follow-up. Circulation. 2010;122:2368–77.
doi: 10.1161/CIRCULATIONAHA.110.946806
Tilz RR, Heeger CH, Wick A, Saguner AM, Metzner A, Rillig A, et al. Ten-year clinical outcome after circumferential pulmonary vein isolation utilizing the Hamburg approach in patients with symptomatic drug-refractory paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol. 2018;11(2):e005250.
doi: 10.1161/CIRCEP.117.005250
Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, et al. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:32–8.
doi: 10.1161/CIRCEP.109.859116
Mugnai G, Irfan G, de Asmundis C, Ciconte G, Saitoh Y, Hunuk B, et al. Complications in the setting of percutaneous atrial fibrillation ablation using radiofrequency and cryoballoon techniques: a single-center study in a large cohort of patients. Int J Cardiol. 2015;196:42–9.
doi: 10.1016/j.ijcard.2015.05.145
D’Ascenzo F, Corleto A, Biondi-Zoccai G, Anselmino M, Ferraris F, Di Biase L, et al. Which are the most reliable predictors of recurrence of atrial fibrillation after transcatheter ablation?: a meta-analysis. Int J Cardiol. 2013;167:1984–9.
doi: 10.1016/j.ijcard.2012.05.008
Jalife J, Kaur K. Atrial remodeling, fibrosis, and atrial fibrillation. Trends Cardiovasc Med. 2015;25:475–84.
doi: 10.1016/j.tcm.2014.12.015
Winkle RA, Mead RH, Engel G, Kong MH, Fleming W, Salcedo J, et al. Impact of obesity on atrial fibrillation ablation: patient characteristics, long-term outcomes, and complications. Heart Rhythm. 2017;14:819–27.
doi: 10.1016/j.hrthm.2017.02.023
Wokhlu A, Hodge DO, Monahan KH, Asirvatham SJ, Friedman PA, Munger TM, et al. Long-term outcome of atrial fibrillation ablation: impact and predictors of very late recurrence. J Cardiovasc Electrophysiol. 2010;21:1071–8.
doi: 10.1111/j.1540-8167.2010.01786.x
Miyazaki S, Kuwahara T, Kobori A, Takahashi Y, Takei A, Sato A, et al. Preprocedural predictors of atrial fibrillation recurrence following pulmonary vein antrum isolation in patients with paroxysmal atrial fibrillation: long-term follow-up results. J Cardiovasc Electrophysiol. 2011;22:621–5.
doi: 10.1111/j.1540-8167.2010.01984.x
Mugnai G, Chierchia GB, de Asmundis C, Julia J, Conte G, Sieira-Moret J, et al. P-wave indice sas predictors of atrial fibrillation recurrence after pulmonary vein isolation in normal left atrial size. J Cardiovasc Med (Hagerstown).