Cool enough? Lessons learned from cryoballoon‐guided catheter ablation for atrial fibrillation in young adults

Abstract

Introduction Cryoballoon (CB)‐guided ablation of atrial fibrillation (AF) is established in symptomatic AF patients. This study sought to determine the safety and efficacy of CB pulmonary vein isolation (PVI) in young adults. Methods and Results A total of 93 consecutive patients aged <45 years referred to our center for AF ablation were included in this observational study. All patients received CB‐guided PVI according to a standardized institutional protocol. Follow‐up was performed in our outpatient clinic using 72‐h Holter monitoring and periodic telephone interview. Recurrence was defined as any AF/atrial tachycardia (AT) episode >30 s following a 3‐month blanking period. A propensity matched control group consisting of patients older than 45 years were used for further evaluation. Mean age was 35 ± 7 years, 22% suffered from persistent AF, 85% were male. Mean follow‐up was 2.6 ± 2 years. At the end of the observational period, 83% of patients were free of any AF/AT episodes. There was an excellent overall 12‐month success rate of 92%. In comparison to a matched group the overall recurrence rate was noticeably lower in the young group (15% vs. 27%). Increasing age was associated with a hazard ratio of 1.16 for recurrence. In a multivariate analysis model, left atrial diameter remained as significant predictor of AF/AT recurrence. The complication rate was low, no permanent phrenic nerve palsy was observed. Conclusion CB‐guided PVI in young adults is safe and effective with favorable long‐term results. It may be considered as first‐line therapy in this relatively healthy population.

News from the Cold Chamber: Clinical Experiences of POLARx versus Arctic Front Advance for Single-Shot Pulmonary Vein Isolation

“…As CB-guided single-shot PVI is associated with shorter procedure times, an improved learning curve and a higher degree of lesion reproducibility it provides a valid alternative to radiofrequency (RF)-guided catheter ablation [1, [4][5][6][7]. Over the past 15 years, much experience has been gained with the established AFA-CB (Arctic Front Advance (Pro), AFA, Medtronic) [1, 5,[8][9][10][11][12][13].…”

Impact of pulmonary vein variant anatomy and cross-sectional orifice area on freedom from atrial fibrillation recurrence after cryothermal single-shot guided pulmonary vein isolation

“…Cryoballoon (CB)-guided pulmonary vein isolation (PVI) is an effective treatment for atrial fibrillation (AF) [1][2][3][4][5]. In addition, it is an alternative to radiofrequency (RF)-guided catheter ablation, due to shorter procedure times, a steep learning curve, and a high degree of lesion reproducibility [1,[6][7][8].…”