Early recurrence of atrial fibrillation after pulmonary vein isolation: a comparative analysis between cryogenic and contact force radiofrequency ablation

Introduction Contact force (CF) guided ablation of paroxysmal atrial fibrillation (PAF) with stable catheter‐tissue contact optimizes clinical success and may increase an operator's ability to achieve pulmonary vein isolation (PVI) in a single encirclement. First pass PVI reduces procedure time but the relationship with long term clinical success is not well understood. This study evaluated patient characteristics and procedural details as predictors of 1‐year clinical success after PAF ablation, including first pass isolation. Methods Consecutive de novo PAF ablations were performed with a porous tip CF catheter in 2017 and 2018. All ablations used wide‐area circumferential ablation, with first pass isolation captured separately for the left and right pulmonary veins (PVs). CF was held between 10 and 20 g and the catheter was moved every 10–20 s. Radiofrequency energy was set at 40–45 W throughout the atrium. Patient characteristics and procedural details were tested for association with clinical success, defined as freedom from recurrent atrial tachyarrhythmia through 1 year. Results A total of 404 patients were included in the study. Clinical success at 1 year was 86.6%. Achieving first pass isolation on at least one ipsilateral PV pair was the most significant predictor of clinical success (p = .0126). After controlling for first pass isolation, only recurrence within the 90‐day blanking period was independently predictive (p = .0015). First pass isolation was not associated with early recurrence (p = .2454). Conclusion In a real‐world setting, first pass isolation was highly predictive of 12‐month clinical success after CF‐guided ablation in a PAF population.

Section: Discussionmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Predictors of clinical success after paroxysmal atrial fibrillation catheter ablation

Osorio

Hunter

Rajendra

et al. 2021

“…A total of 17 articles, with 11 793 adult patients were included in our meta‐analysis as shown in Figure 1 13–30 . Among these patients, 4817 underwent CBA and 6976 patients received RFA.…”

Section: Resultsmentioning

confidence: 99%

“…A total of 17 articles, with 11 793 adult patients were included in our meta-analysis as shown in Figure 1. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Among these patients, 4817 underwent CBA and 6976 patients received RFA. Baseline characteristics among the included studies are as shown in Table 1 and Table S1.…”

Section: Resultsmentioning

confidence: 99%

A systematic review and meta‐analysis comparing second‐generation cryoballoon and contact force radiofrequency ablation for initial ablation of paroxysmal and persistent atrial fibrillation

Ravi

Poudyal

Pulipati

et al. 2020

Introduction: Cryoballoon ablation (CBA) and radiofrequency ablation (RFA) are the preferred modalities for catheter ablation of atrial fibrillation (AF). Technological advances have improved procedural outcomes, warranting an updated comparison. We sought to evaluate the efficacy and safety of CBA-2nd generation (CBA-2G) in comparison to RFA-contact force (RFA-CF) in patients with AF. Methods: MEDLINE, Cochrane, and ClinicalTrials.gov databases were searched until 03/01/2020 for relevant studies comparing CBA-2G versus RFA-CF in patients undergoing initial catheter ablation for AF. Results: A total of 17 studies, involving 11 793 patients were included. There was no difference between the two groups in the outcomes of freedom from atrial arrhythmia (p = .67) and total procedural complications (p = .65). There was a higher incidence of phrenic nerve palsy in CBA-2G (odds ratio: 10.7; 95% confidence interval [CI]: 5.85 to 19.55; p < .001). Procedure duration was shorter (mean difference: −31.32 min; 95% CI: −40.73 to −21.92; p < .001) and fluoroscopy duration was longer (+3.21 min; 95% CI: 1.09 to 5.33; p = .003) in CBA-2G compared to RFA-CF. In the subgroup analyses of patients with persistent AF and >1 freeze lesion delivered per vein, there was no difference in freedom from atrial arrhythmia. Conclusions: In AF patients undergoing initial ablation, CBA-2G and RFA-CF were equally efficacious. The procedure duration was shorter, but with a higher incidence of phrenic nerve palsy in CBA-2G. In patients with persistent AF, there was no difference in the efficacy between CBA-2G or RFA-CF techniques.

“…The electronic database search identified 1105 studies. After screening, a total of 27 studies 11–37 met the inclusion criteria (Figure 1). In particular, 22, 12, and 6 studies were included in the main group, PAF and persistent AF (Pers‐AF) analyses, respectively.…”

Section: Resultsmentioning

confidence: 99%

Early arrhythmia recurrence after cryoballoon ablation in atrial fibrillation: A systematic review and meta‐analysis

Vrachatis

Papathanasiou

Kossyvakis

et al. 2022

Introduction: Early arrhythmia recurrence within the 3-month blanking period is a common event that historically has been attributed to reversible phenomena. While its mechanistic links remain obscure, accumulating evidence support the argument of shortening the blanking period. We aimed to elucidate the association between early and late arrhythmia recurrence after atrial fibrillation cryoablation. Methods:The MEDLINE database, ClinicalTrials. gov, medRxiv, and Cochrane Library were searched for studies evaluating early and late arrhythmia recurrence rates in patients undergoing cryoablation for atrial fibrillation. Data were pooled by meta-analysis using a random-effects model. The primary endpoint was late arrhythmia recurrence.Results: Early arrhythmia recurrence was found predictive of decreased arrhythmiafree survival after evaluating 3975 patients with paroxysmal or persistent atrial fibrillation who underwent cryoablation (odds ratio [OR]: 5.31; 95% confidence interval [