Atrial fibrillation cryoballoon ablation in patients with a common pulmonary vein trunk

Abstract

Objective: we aimed to assess the efficacy and safety of pulmonary vein (PV) cryoballoon ablation (CBA) in patients with a common trunk of the pulmonary veins (PVCT).Materials and methods: We performed a retrospective analysis of 596 primary PV CBA procedures using the second-generation cryoballoon (CB) Arctic Front Advance (28 mm). PV anatomy was visualized using direct LA angiography during high-frequency right ventricular pacing. We included forty-nine patients in whom a PVCT was identified. The one-step and sequential ablation approaches with simultaneous recording of biophysical and electrophysiological parameters were used for PVCT isolation. During CBA in the right PVs, high-output (2000 ms, 25 mA) pacing of the right phrenic nerve was performed via a electrode placed in the superior vena cava, and amplitude of diaphragm movement was monitored. In the case of impairment/loss of the diaphragm contraction ablation was immediately stopped.Results: 91.1% (543) patients had the normal drainage of PV. In 4 patients (0.67%), an additional right pulmonary vein was identified. The prevalence of PVCT was 8.2% (49 pts): a left common trunk (LCT) was observed in 43 patients (87.7%), a right common trunk (RCT) - in 6 patients (12.2%). Acute efficacy of PVCT isolation was 95.9% (47/79): in LCT - 95.3%, in RCT - 100%. The feasibility of the one-step antral isolation was 59.1% (n=29). During a median follow up of 12 (3-20) months, the clinical success rate of the procedure was 69.4%. A comparative analysis showed no significant difference between common trunk ablation approaches and clinical efficacy (p=0.346).Conclusion: CBA has been shown effective and safe for symptomatic AF patients with PVCT. The simultaneous and sequential ablation approaches can be performed with comparable efficacy.

Clinical outcomes of combined catheter ablation and left atrial appendage closure in elderly patients with nonvalvular atrial fibrillation

“…LAA occluders were successfully implanted in all patients. Periprocedural complications and adverse events during follow‐up were comparable between patients aged < 75 years and ≥75 years 19 . In a prospective LAAC registry of 638 patients in Germany, 402 (63%) were ≥75 years.…”

“…Periprocedural complications and adverse events during follow‐up were comparable between patients aged < 75 years and ≥75 years. 19 In a prospective LAAC registry of 638 patients in Germany, 402 (63%) were ≥75 years. The success rate of the procedure was high (97.6%).…”

Potential risk factors of atrial fibrillation recurrence after cryoballoon ablation

“…Такие варианты строения могут затруднять надежную обтурацию ЛВ и достижение плотного контакта баллона с эндокардом. В нашем исследовании частота выявления общего коллектора ЛВ составила 27 % (38 пациентов), что сопоставимо с ранее опубликованными наблюдениями (8,2-37 %) [17][18][19]. Кроме того, многофакторный анализ продемонстрировал, что общий коллектор ЛВ был независимым ФР неэффективности КБА.…”