Outcomes of adjunct posterior wall isolation in atrial fibrillation patients with cardiac implantable electronic devices.
atrial fibrillation
cardiac implantable electronic device
cryoballoon
posterior wall isolation
pulmonary vein isolation
Journal
Pacing and clinical electrophysiology : PACE
ISSN: 1540-8159
Titre abrégé: Pacing Clin Electrophysiol
Pays: United States
ID NLM: 7803944
Informations de publication
Date de publication:
07 2023
07 2023
Historique:
revised:
29
05
2023
received:
10
12
2022
accepted:
11
06
2023
medline:
14
7
2023
pubmed:
28
6
2023
entrez:
28
6
2023
Statut:
ppublish
Résumé
Although pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF), several studies have illustrated clinical benefits associated with PVI with posterior wall isolation (PWI). This retrospective study investigated the outcomes of PVI alone versus PVI+PWI performed using the cryoballoon in patients with cardiac implantable electronic devices (CIEDs) and paroxysmal AF (PAF) or persistent AF (PersAF). Acute PVI was achieved in all patients using cryoballoon ablation. Compared to PVI alone, PVI+PWI was associated with longer cryoablation, fluoroscopy, and total procedure times. Adjunct radiofrequency was required to complete PWI in 29/77 patients (37.7%). Adverse events were similar with PVI alone versus PVI+PWI. But at 24 ± 7 months of follow-up, not only cryoballoon PVI+PWI was associated with improved freedom from recurrent AF (74.3% vs. 46.0%, P = .007) and all atrial tachyarrhythmias (71.4% vs. 38.1%, P = .001) in patients with PersAF, cryoballoon PVI+PWI also yielded greater freedom from AF (88.1% vs. 63.7%, P = .003) and all atrial tachyarrhythmias (83.3% vs. 60.8%, P = .008) in those with PAF. Additionally, PVI+PWI was associated with higher reductions in atrial tachyarrhythmia burden (97.9% vs. 91.6%, P < .001), need for cardioversion (5.2% vs. 23.6%, P < .001) and repeat catheter ablation (10.4% vs. 26.1%, P = .005), and a longer time-to-arrhythmia recurrence (16 ± 6 months vs. 8 ± 5 months, P < .001) in both PersAF and PAF patients. In CIED patients with PersAF or PAF, cryoballoon PVI+PWI is associated with a greater freedom from recurrent AF and atrial tachyarrhythmias, as compared to PVI alone during long-term follow-up.
Sections du résumé
BACKGROUND
Although pulmonary vein isolation (PVI) remains the cornerstone of catheter ablation of atrial fibrillation (AF), several studies have illustrated clinical benefits associated with PVI with posterior wall isolation (PWI).
METHODS
This retrospective study investigated the outcomes of PVI alone versus PVI+PWI performed using the cryoballoon in patients with cardiac implantable electronic devices (CIEDs) and paroxysmal AF (PAF) or persistent AF (PersAF).
RESULTS
Acute PVI was achieved in all patients using cryoballoon ablation. Compared to PVI alone, PVI+PWI was associated with longer cryoablation, fluoroscopy, and total procedure times. Adjunct radiofrequency was required to complete PWI in 29/77 patients (37.7%). Adverse events were similar with PVI alone versus PVI+PWI. But at 24 ± 7 months of follow-up, not only cryoballoon PVI+PWI was associated with improved freedom from recurrent AF (74.3% vs. 46.0%, P = .007) and all atrial tachyarrhythmias (71.4% vs. 38.1%, P = .001) in patients with PersAF, cryoballoon PVI+PWI also yielded greater freedom from AF (88.1% vs. 63.7%, P = .003) and all atrial tachyarrhythmias (83.3% vs. 60.8%, P = .008) in those with PAF. Additionally, PVI+PWI was associated with higher reductions in atrial tachyarrhythmia burden (97.9% vs. 91.6%, P < .001), need for cardioversion (5.2% vs. 23.6%, P < .001) and repeat catheter ablation (10.4% vs. 26.1%, P = .005), and a longer time-to-arrhythmia recurrence (16 ± 6 months vs. 8 ± 5 months, P < .001) in both PersAF and PAF patients.
CONCLUSION
In CIED patients with PersAF or PAF, cryoballoon PVI+PWI is associated with a greater freedom from recurrent AF and atrial tachyarrhythmias, as compared to PVI alone during long-term follow-up.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
563-573Informations de copyright
© 2023 Wiley Periodicals LLC.
Références
Packer DL, Kowal RC, Wheelan KR, et al. STOP AF Cryoablation Investigators. Cryoballoon ablation of pulmonary veins for paroxysmal atrial fibrillation: first results of the North American Arctic Front (STOP AF) pivotal trial. J Am Coll Cardiol. 2013;61:1713-1723.
Kuniss M, Pavlovic N, Velagic V, et al. Cryoballoon ablation vs. antiarrhythmic drugs: first-line therapy for patients with paroxysmal atrial fibrillation. Europace. 2021;23:1033-1041.
Aryana A, Kenigsberg DN, Kowalski M, et al. Cryo-DOSING investigators. verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: results from the cryo-DOSING study (Cryoballoon-ablation DOSING based on the assessment of time-to-effect and pulmonary vein isolation guidance). Heart Rhythm. 2017;14:1319-1325.
Mugnai G, Paparella G, Overeinder I, et al. Long-term clinical outcomes after single freeze cryoballoon ablation for paroxysmal atrial fibrillation: a 5-year follow-up. J Interv Card Electrophysiol. 2021;61:87-93.
Heeger CH, Subin B, Wissner E, et al. Second-generation cryoballoon-based pulmonary vein isolation: lessons from a five-year follow-up. Int J Cardiol. 2020;312:73-80.
Su WW, Reddy VY, Bhasin K, et al. Cryoballoon ablation of pulmonary veins for persistent atrial fibrillation: results from the multicenter STOP Persistent AF trial. Heart Rhythm. 2020;17:1841-1847.
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;15:1121-1129.
Nishimura T, Yamauchi Y, Aoyagi H, et al. The clinical impact of the left atrial posterior wall lesion formation by the cryoballoon application for persistent atrial fibrillation: feasibility and clinical implications. J Cardiovasc Electrophysiol. 2019;30:805-814.
Iacopino S, Paparella G, Capulzini L, et al. Posterior box isolation as an adjunctive ablation strategy during repeat ablation with the second-generation cryoballoon for recurrence of persistent atrial fibrillation: 1-year follow-up. J Interv Card Electrophysiol. 2019;56:1-7.
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 Clin Electrophysiol. 2021;7:187-196.
Ahn J, Shin DG, Han S-J, Lim HE. Does isolation of the left atrial posterior wall using cryoballoon ablation improve clinical outcomes in patients with persistent atrial fibrillation?. A prospective randomized controlled trial. Europace. 2022;24:1093-1101. doi:10.1093/europace/euac005
Elbatran AI, Anderson RH, Mori S, Saba MM. The rationale for isolation of the left atrial pulmonary venous component to control atrial fibrillation: a review article. Heart Rhythm. 2019;16:1392-1398.
Clarke JD, Piccini JP, Friedman DJ. The role of posterior wall isolation in catheter ablation of persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2021;32:2567-2576.
Aryana A, Kenigsberg DN, Kowalski M, et al. Verification of a novel atrial fibrillation cryoablation dosing algorithm guided by time-to-pulmonary vein isolation: results from the Cryo-DOSING Study (Cryoballoon-ablation DOSING Based on the Assessment of Time-to-Effect and Pulmonary Vein Isolation Guidance). Heart Rhythm. 2017;14:1319-1325.
Aryana A, Su W, Kuniss M, et al. Segmental nonocclusive cryoballoon ablation of pulmonary veins and extrapulmonary vein structures: best practices III. Heart Rhythm. 2021;18:1435-1444.
Israel CW. Analysis of mode switching algorithms in dual chamber pacemakers. Pacing Clin Electrophysiol. 2002;25:380-393.
Kistler PM, Chieng D, Sugumar H, et al. Effect of catheter ablation using pulmonary vein isolation with vs without posterior left atrial wall isolation on atrial arrhythmia recurrence in patients with persistent atrial fibrillation: the CAPLA randomized clinical trial. JAMA. 2023;329:127-135.
Aryana A, Saad EB, d'Avila A, DiBiase L, Natale A. The clinical outcomes and success of posterior wall isolation using a “box” approach. JACC Clin Electrophysiol. 2023;9:261-262.
Kumar P, Bamimore AM, Schwartz JD, et al. Challenges and outcomes of posterior wall isolation for ablation of atrial fibrillation. J Am Heart Assoc. 2016;5:e003885.
Markman TM, Hyman MC, Kumareswaran R, et al. Durability of posterior wall isolation after catheter ablation among patients with recurrent atrial fibrillation. Heart Rhythm. 2020;17:1740-1744.
Worck R, Sørensen SK, Johannessen A, Ruwald M, Haugdal M, Hansen J. Posterior wall isolation in persistent atrial fibrillation feasibility, safety, durability, and efficacy. J Cardiovasc Electrophysiol. 2022;33:1667-1674.
Jiang X, Liao J, Ling Z, et al. Adjunctive left atrial posterior wall isolation in treating atrial fibrillation: insight from a large secondary analysis. JACC Clin Electrophysiol. 2022;8:605-618.
Aryana A, Di Biase L, Pujara DK, et al. Long-term durability of posterior wall isolation using the cryoballoon in patients with persistent atrial fibrillation: a multicenter analysis of repeat catheter ablations. J Interv Card Electrophysiol. 2021;62:161-169.
Worck R, Sørensen SK, Johannessen A, et al. Posterior wall isolation in persistent atrial fibrillation. Long-term outcomes of a repeat procedure strategy. J Interv Card Electrophysiol. 2022;66:971-979. doi:10.1007/s10840-022-01402-x
Aryana A, Saad EB, d'Avila A, DiBiase L, Natale A. Brief commentary: regarding ‘‘posterior wall isolation in persistent atrial fibrillation. Long-term outcomes of a repeat procedure strategy. J Interv Card Electrophysiol. 2023;66:829. doi:10.1007/s10840-022-01426-3
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. 2021;61:313-319.
Aryana A, Thiemann AM, Pujara DK, et al. Pulmonary vein isolation with and without posterior wall isolation in paroxysmal atrial fibrillation: IMPPROVE-PAF trial. JACC Clin Electrophysiol. 2023;9:628-637.
Mohanty S, Trivedi C, Horton P, et al. Natural history of arrhythmia after successful isolation of pulmonary veins, left atrial posterior wall, and superior vena cava in patients with paroxysmal atrial fibrillation: a multi-center experience. J Am Heart Assoc. 2021;10:e020563.
Jalife J, Kaur K. Atrial remodeling, fibrosis, and atrial fibrillation. Trends Cardiovasc Med. 2015;25:475-484.
Atienza F, Almendral J, Moreno J, et al. Activation of inward rectifier potassium channels accelerates atrial fibrillation in humans: evidence for a reentrant mechanism. Circulation. 2006;114:2434-2442.
Berenfeld O. Ionic and substrate mechanism of atrial fibrillation: rotors and the excitation frequency approach. Arch Cardiol Mex. 2010;80:301-314.
Jongbloed MR, Schalij MJ, Poelmann RE, et al. Embryonic conduction tissue: a spatial correlation with adult arrhythmogenic areas. J Cardiovasc Electrophysiol. 2004;15:349-355.
Markides V, Schilling RJ, Ho SY, Chow AW, Davies DW, Peters NS. Characterization of left atrial activation in the intact human heart. Circulation. 2003;107:733-739.
Lappe JM, Cutler MJ, Day JD, Bunch TJ. Ablation for persistent atrial fibrillation-Is there a role for more than PVI? Curr Treat Options Cardiovasc Med. 2016;18:15.
Allessie MA, De GrootNMS, Houben RPM, et al. Electropathological substrate of long-standing persistent atrial fibrillation in patients with structural heart disease: longitudinal dissociation. Circ Arrhythm Electrophysiol. 2010;3:606-615.