Single procedural outcomes in the setting of percutaneous ablation for persistent atrial fibrillation: a propensity-matched score comparison between different strategies.
Cryoballoon
Left atrial posterior wall ablation
Persistent atrial fibrillation
Pulmonary vein isolation
Radiofrequency ablation
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 2022
Jun 2022
Historique:
received:
19
11
2020
accepted:
18
02
2021
pubmed:
26
2
2021
medline:
30
6
2022
entrez:
25
2
2021
Statut:
ppublish
Résumé
Catheter ablation for persistent atrial fibrillation (persAF) is associated with less favorable outcomes than for paroxysmal AF. To improve success rates, left atrial (LA) substrate modification is frequently performed in addition to pulmonary vein isolation (PVI). The purpose of the study was to compare 4 different ablation approaches using radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CB-A) for persAF and to evaluate the respective outcomes on a midterm follow-up of 12 months. We did a propensity score-matched comparison of 30 patients undergoing PVI + LA posterior wall isolation (LAPWI) with CB-A, 30 patients who underwent PVI + linear ablation (roof and mitral lines) using RFCA, 60 patients with PVI alone using CB-A, and 60 patients who had PVI alone using RFCA. The endpoint was recurrence of documented atrial tachyarrhythmias (ATas) > 30 s at 1-year follow-up. After 12 months, freedom from ATas after a single procedure was 83.3% in the PVI + LAPWI group, 46.7% in the PVI + linear ablation group, 58.3% in the PVI-alone CB-A group, and 61.6% PVI-alone RFCA (p = 0.03). Moreover, freedom from ATas was significantly higher comparing the PVI + LAPWI group with each of the other groups. In this propensity-matched comparison of strategies for persAF, LAPW ablation in addition to PVI with CB-A seems to improve 1-year outcome in comparison to PVI + linear ablation using RFCA and to PVI alone using RFCA or CB-A. Randomized comparisons are eagerly awaited.
Sections du résumé
BACKGROUND
BACKGROUND
Catheter ablation for persistent atrial fibrillation (persAF) is associated with less favorable outcomes than for paroxysmal AF. To improve success rates, left atrial (LA) substrate modification is frequently performed in addition to pulmonary vein isolation (PVI). The purpose of the study was to compare 4 different ablation approaches using radiofrequency catheter ablation (RFCA) or cryoballoon ablation (CB-A) for persAF and to evaluate the respective outcomes on a midterm follow-up of 12 months.
METHODS
METHODS
We did a propensity score-matched comparison of 30 patients undergoing PVI + LA posterior wall isolation (LAPWI) with CB-A, 30 patients who underwent PVI + linear ablation (roof and mitral lines) using RFCA, 60 patients with PVI alone using CB-A, and 60 patients who had PVI alone using RFCA. The endpoint was recurrence of documented atrial tachyarrhythmias (ATas) > 30 s at 1-year follow-up.
RESULTS
RESULTS
After 12 months, freedom from ATas after a single procedure was 83.3% in the PVI + LAPWI group, 46.7% in the PVI + linear ablation group, 58.3% in the PVI-alone CB-A group, and 61.6% PVI-alone RFCA (p = 0.03). Moreover, freedom from ATas was significantly higher comparing the PVI + LAPWI group with each of the other groups.
CONCLUSIONS
CONCLUSIONS
In this propensity-matched comparison of strategies for persAF, LAPW ablation in addition to PVI with CB-A seems to improve 1-year outcome in comparison to PVI + linear ablation using RFCA and to PVI alone using RFCA or CB-A. Randomized comparisons are eagerly awaited.
Identifiants
pubmed: 33629193
doi: 10.1007/s10840-021-00968-2
pii: 10.1007/s10840-021-00968-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
9-16Informations de copyright
© 2021. Springer Science+Business Media, LLC, part of Springer Nature.
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. Europace. 2018;20:e1–e160.
doi: 10.1093/europace/eux274
Jannik LP, Gunnar HG, Jim H, et al. Temporal trends in atrial fibrillation recurrence rates after ablation between 2005 and 2014: a nationwide Danish cohort study. Eur Heart J. 2018;39:442–9.
doi: 10.1093/eurheartj/ehx466
Perino AC, Leef GC, Cluckey A, et al. Secular trends in success rate of catheter ablation for atrial fibrillation: the SMASH-AF cohort. Am Heart J. 2019;208:110–9.
doi: 10.1016/j.ahj.2018.10.006
Willems S, Klemm H, Rostock T, et al. Substrate modification combined with pulmonary vein isolation improves outcome of catheter ablation in patients with persistent atrial fibrillation: a prospective randomized comparison. Eur Heart J. 2006;27:2871–8.
doi: 10.1093/eurheartj/ehl093
Yao Y, Zheng L, Zhang S, et al. Stepwise linear approach to catheter ablation of atrial fibrillation. Heart Rhythm. 2007;4:1497–504.
doi: 10.1016/j.hrthm.2007.07.028
Aryana A, Baker JH, Espinosa Ginic MA, et al. Posterior wall isolation using the cryoballoon in conjunction with pulmonary vein ablation is superior to pulmonary vein isolation alone in patients with persistent atrial fibrillation: a multicenter experience. Heart Rhythm. 2018;15:1121–9.
doi: 10.1016/j.hrthm.2018.05.014
Kuniss M, Greiß H, Pajitnev D, et al. Cryoballoon ablation of persistent atrial fibrillation: feasibility and safety of left atrial roof ablation with generation of conduction block in addition to antral pulmonary vein isolation. Europace. 2017;19:1109–15.
pubmed: 27738068
Salih M, Darrat Y, Ibrahim AM, et al. Clinical outcomes of adjunctive posterior wall isolation in persistent atrial fibrillation: a meta-analysis. J Cardiovasc Electrophysiol. 2020;31(6):1394-1402.
Kirchhof P, Benussi S, Kotecha D, 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
Ciconte G, Baltogiannis G, de Asmundis C, et al. Circumferential pulmonary vein isolation as index procedure for persistent atrial fibrillation: a comparison between radiofrequency catheter ablation and second-generation cryoballoon ablation. Europace. 2015;17:559–65.
doi: 10.1093/europace/euu350
Bisignani A, Overeinder I, Kazawa S, et al. Posterior box isolation as an adjunctive ablation strategy with the second-generation cryoballoon for paroxysmal atrial fibrillation: a comparison with standard cryoballoon pulmonary vein isolation. J Interv Card Electrophysiol. 2020. https://doi.org/10.1007/s10840-020-00812-z .
Perez-Lugones A, McMahon JT, Ratliff NB, et al. Evidence of specialized conduction cells in human pulmonaryveins of patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2003;14(8):803–9.
doi: 10.1046/j.1540-8167.2003.03075.x
Jongbloed MRM, Schalij MJ, Poelmann RE, et al. Embryonic conduction tissue: a spatial correlation with adult arrhythmogenic areas. J Cardiovasc Electrophysiol. 2004;15(3):349–55.
doi: 10.1046/j.1540-8167.2004.03487.x
Suenari K, Chen YC, Kao YH, et al. Discrepant electrophysiological characteristics and calcium homeostasis of left atrial anterior and posterior myocytes. Basic Res Cardiol. 2011;106(1):65–74.
doi: 10.1007/s00395-010-0132-1
Ehrlich JR, Cha T, Zhang L, et al. Cellular electrophysiology of canine pulmonary vein cardiomyocytes: action potential and ionic current properties. J Physiol. 2003;551(Pt 3):801–13.
doi: 10.1113/jphysiol.2003.046417
Nanbu T, Yotsukura A, Suzuki G, et al. Important factors in left atrial posterior wall isolation using 28-mm cryoballoon ablation for persistent atrial fibrillation-block line or isolation area? J Cardiovasc Electrophysiol. 2020;31(1):119–27.
doi: 10.1111/jce.14281
Barbhaiya CR, Knotts RJ, Beccarino N, et al. Multiple procedure outcomes for nonparoxysmal atrial fibrillation: left atrial posterior wall isolation versus stepwise ablation. J Cardiovasc Electrophysiol. 2020;31(12):3117–23.
doi: 10.1111/jce.14771
Aryana A, Allen SL, Pujara DK, et al. Concomitant pulmonary vein and posterior wall isolation using cryoballoon with adjunct radiofrequency in persistent atrial fibrillation. JACC: Clinical Electrophysiology. Published online October 28, 2020.
Romero J, et al. Systematic evaluation of ablation techniques for non-paroxysmal atrial fibrillation. ClinicalTrials.gov Identifier: NCT04216667.
Verma A, Jiang CY, Betts TR, et al. Approaches to catheter ablation for persistent atrial fibrillation. N Engl J Med. 2015;372:1812–22.
doi: 10.1056/NEJMoa1408288
Kim TH, Park J, Uhm JS, et al. Challenging achievement of bidirectional block after linear ablation affects the rhythm outcome in patients with persistent atrial fibrillation. J Am Heart Assoc. 2016;5:e003894.
doi: 10.1161/JAHA.116.003894
Anousheh R, Sawhney NS, Panutich M, et al. Effect of mitral isthmus block on development of atrial tachycardia following ablation for atrial fibrillation. Pacing Clin Electrophysiol. 2010;33:460–8.
doi: 10.1111/j.1540-8159.2009.02625.x
Rostock T, O’Neill MD, Sanders P, et al. Characterization of conduction recovery across left atrial linear lesions in patients with paroxysmal and persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2006;17:1106–11.
doi: 10.1111/j.1540-8167.2006.00585.x
Sawhney N, Anousheh R, Chen W, et al. Circumferential pulmonary vein ablation with additional linear ablation results in an increased incidence of left atrial flutter compared with segmental pulmonary vein isolation as an initial approach to ablation of paroxysmal atrial fibrillation. Circ Arrhythm Electrophysiol. 2010;3:243–8. 20.
doi: 10.1161/CIRCEP.109.924878
Shah AJ, Jadidi A, Liu X, et al. Atrial tachycardias arising from ablation of atrial fibrillation: a proarrhythmic bump or an antiarrhythmic turn? Cardiol Res Pract. 2010;2010:950763.
doi: 10.4061/2010/950763
Matsuo S, Wright M, Knecht S, et al. Perimitral atrial flutter in patients with atrial fibrillation ablation. Heart Rhythm. 2010;7:2–8.
doi: 10.1016/j.hrthm.2009.09.067
Andrade JG, Macle L, Khairy P, et al. Incidence and significance of early recurrences associated with different ablation strategies for AF: a STAR-AF substudy. J Cardiovasc Electrophysiol. 2012;23:1295–301.
doi: 10.1111/j.1540-8167.2012.02399.x
Themistoclakis S, Schweikert RA, Saliba WI, et al. Clinical predictors and relationship between early and late atrial tachyarrhythmias after pulmonary vein antrum isolation. Heart Rhythm. 2008;5:679–85.
doi: 10.1016/j.hrthm.2008.01.031
Liang JJ, Dixit S, Santangeli P. Mechanisms and clinical significance of early recurrences of atrial arrhythmias after catheter ablation for atrial fibrillation. World J Cardiol. 2016 Nov 26;8(11):638–46.
doi: 10.4330/wjc.v8.i11.638
Mugnai G, de Asmundis C, Hünük B, et al. Second-generation cryoballoon ablation for paroxysmal atrial fibrillation: predictive role of atrial arrhythmias occurring in the blanking period on the incidence of late recurrences. Heart Rhythm. 2016;13:845–51.
doi: 10.1016/j.hrthm.2015.12.034