Cryoballoon Ablation for Pulmonary Vein Isolation in Patients With Persistent Atrial Fibrillation

Abstract

Background-Data regarding the freedom from atrial fibrillation (AF) in the follow-up of persistent AF patients is limited.The second-generation cryoballoon has better cooling properties compared with first-generation cryoballon. In this study, we aimed to assess the medium-term efficacy of second-generation cryoballoon in patients with persistent AF. Methods and Results-A total of 100 patients (63±10 years, 80% male) with symptomatic persistent AF, despite ≥1 antiarrhythmic drug(s), who were scheduled for pulmonary vein isolation using second-generation cryoballoon were enrolled in this study. Follow-up was based on outpatient clinic visits, including Holter ECGs. Recurrence was defined as a symptomatic or documented arrhythmia episode of >30 seconds excluding a 3-month blanking period. As a result, 393 pulmonary veins (7 patients with common ostium) were successfully isolated. Mean procedural and fluoroscopy times were 96.2±21.3 and 19.7±6.7 minutes, respectively. Phrenic nerve palsy occurred in 3% (3/100) of the patients. At a mean follow-up duration of 10.6±6.3 months, 67% of the patients were in sinus rhythm. Stepwise multivariable Cox proportional hazard regression analysis showed that early AF recurrence (hazard ratio 3.83, 95% confidence interval 1.91-7.68, P<0.001) was the only independent predictor for late AF recurrence apart from other clinical and echocardiographic variables. Conclusions-Our findings indicated that second-generation cryoballoon use is associated with favorable outcomes in patients with persistent AF. Recurrence at blanking period was the only predictor of long-term AF recurrence.

Pulmonary vein isolation in patients with paroxysmal atrial fibrillation

“…In patients without AF recurrence, a significant improvement in symptomatic status was observed compared with patients who had recurrence. In a recent study, we also demonstrated an improvement in the EHRA score in patients with persistent AF [9]. Thus, in addition to the clinical success rate evaluated by freedom from AF, these findings reflected the favorable effect of CB ablation on quality of life measures in this group of patients.…”

“…The cryoballoon ablation for PVI utilized atthe centerhasbeendescribed elsewhere [9,10]. The ablation was performed with the patients under deep sedation using midazolam, fentanyl, and propofol infusion.…”

Predictors of late atrial fibrillation recurrence after cryoballoon-based pulmonary vein isolation: a meta-analysis

“…Similar to our research, many studies have found that patients with early recurrence could have an increased risk of late recurrence. Using antiarrhythmic drugs immediately after ablation can reduce early recurrence but cannot prevent late recurrence after three months [6,7]. Therefore, many studies have hypothesised that the inflammatory response following cell damage caused by CB increases the susceptibility to arrhythmias.…”

“…After excluding non-compliant documents, only 16 articles were included in this study. In the remaining 16 articles [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], ERAF, LAD, AF duration, and persistent AF were mentioned 14, eight, six, and four times, respectively. There were three retrospective studies, 12 prospective studies, and one case-control study in the final 16 articles.…”

Rotational Angiography Based Three‐Dimensional Left Atrial Reconstruction: A New Approach for Transseptal Puncture

“…All the patients had symptomatic paroxysmal or persistent AF. In patients with persistent AF, only cryoballoon ablation was performed for pulmonary vein isolation similar to paroxysmal AF [9]. In case of LA thrombus, mass on the interatrial septum, an INR value >3 or intense antiplatelet treatment in addition to anticoagulant therapy, contraindication to anticoagulation, thrombocytopenia (<100,000/lL), and serum creatinine value >1.5 mg/dL, TSP was not performed.…”