Five-year outcome and predictors of success after second-generation cryoballoon ablation for treatment of symptomatic atrial fibrillation

Akkaya, Ersan; Berkowitsch, Alexander; Zaltsberg, Sergej; Greiß, Harald; Hamm, Christian W.; Sperzel, Johannes; Kuniss, Malte; Neumann, Thomas

doi:10.1016/j.ijcard.2018.03.069

Cited by 28 publications

(20 citation statements)

References 26 publications

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“…Several predictors of AF recurrence following AF ablation using CB2 have been described in previous studies. These include AF type, duration of AF history, LA diameter, time to PVI, and early recurrence . Type and duration of AF as markers of atrial remodeling are well‐known predictors of AF recurrence, since longer exposure to arrhythmia results in more significant atrial structural and electrical remodeling, which may also explain the predictive role of LA diameter for AF recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The second‐generation CB (Arctic Front Advance, Medtronic Inc., Minneapolis, MN, USA) (CB2) has several advantages over the first generation in terms of design, enabling better cooling properties, and larger lesion formation . Although there were several studies about 1‐year follow‐up results of CB2, few studies have reported its mid‐ and long‐term satisfactory efficacy like RF ablation . However, all those studies with extended follow‐up data included limited numbers of patients.…”

Section: Introductionmentioning

confidence: 99%

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Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

Canpolat

Koçyiğit²,

Yalçın

et al. 2019

Pacing Clinical Electrophis

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Background: Currently available second-generation cryoballoon (CB2) is accepted as an effective and safe tool for pulmonary vein isolation (PVI). Although much more data exist about 1-year outcomes of CB2 ablation, data on long-term outcomes are scarce. Objective:We aimed to assess the long-term outcomes of PVI using CB2 in a large-scale symptomatic atrial fibrillation (AF) population at our tertiary referral center. Methods:In this nonrandomized prospective observational study, a total of 486 patients with paroxysmal (71%) or persistent (29%) AF who underwent index PVI using CB2 at our hospital between January 2013 and June 2017 were enrolled. Atrial tachyarrhythmia (ATa)-free survival was defined as the absence of AF, atrial flutter, or atrial tachycardia recurrence ≥30 s following a 3 months blanking period. Predictors of recurrence were evaluated by univariate and multivariate Cox proportional hazards regression models. Results:Acute procedural success rate was 99.8% (1898( /1902. Mean procedural and fluoroscopy time were 64.9 ± 9.2 and 12.1 ± 2.6, respectively. At median 39 (interquartile range: 26-56) months follow-up, ATa-free survival was 78.6% after a single procedure (280/345 [81.2%] for paroxysmal AF vs. 102/141 [72.3%] for persistent AF, P = .019) and 84.4% after a mean 1.48 ± 0.42 ablations. Cox regression analysis showed that left atrium diameter, duration of AF history, and early ATa recurrence were found as the independent predictors of late recurrence.Phrenic nerve palsy was observed in 17 (3.5%) patients. Conclusions:CB2-based PVI is effective to maintain sinus rhythm in a significant proportion of paroxysmal and persistent AF patients with an acceptable complication rate at long-term follow-up. K E Y W O R D S atrial fibrillation, complication, cryoballoon, recurrence 1 INTRODUCTION As pulmonary vein (PV) isolation (PVI) is accepted as the cornerstone of all atrial fibrillation (AF) ablation procedures, recent expert consen-sus document recommends to isolate PVs at first either using point-bypoint radiofrequency (RF) or cryoballoon (CB) ablation in all patients, including paroxysmal and nonparoxysmal AF. 1 CB technology has been shown to be as effective as RF technique for AF ablation. 2 910

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

Canpolat

Koçyiğit²,

Yalçın

et al. 2019

Pacing Clinical Electrophis

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“…Catheter ablation is an established therapy for symptomatic patients with AF. Some (Anselmino et al, 2015; Bunch et al, 2015; Akkaya et al, 2018; Budzianowski et al, 2018) but not all (Bogossian et al, 2016; Winkle et al, 2016) studies have suggested that recurrence rates in patients with DM undergoing catheter ablation are higher than in non-diabetic patients. However, in a meta-analysis of 15 studies including 1,464 patients with DM, long term maintenance of sinus rhythm following a redo procedure was similar to rates reported among the general population undergoing catheter ablation.…”

Section: Mechanisms Of Af In Dm: Insights From Experimental Studiesmentioning

confidence: 99%

The Association Between Diabetes Mellitus and Atrial Fibrillation: Clinical and Mechanistic Insights

et al. 2019

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A number of clinical studies have reported that diabetes mellitus (DM) is an independent risk factor for Atrial fibrillation (AF). After adjustment for other known risk factors including age, sex, and cardiovascular risk factors, DM remains a significant if modest risk factor for development of AF. The mechanisms underlying the increased susceptibility to AF in DM are incompletely understood, but are thought to involve electrical, structural, and autonomic remodeling in the atria. Electrical remodeling in DM may involve alterations in gap junction function that affect atrial conduction velocity due to changes in expression or localization of connexins. Electrical remodeling can also occur due to changes in atrial action potential morphology in association with changes in ionic currents, such as sodium or potassium currents, that can affect conduction velocity or susceptibility to triggered activity. Structural remodeling in DM results in atrial fibrosis, which can alter conduction patterns and susceptibility to re-entry in the atria. In addition, increases in atrial adipose tissue, especially in Type II DM, can lead to disruptions in atrial conduction velocity or conduction patterns that may affect arrhythmogenesis. Whether the insulin resistance in type II DM activates unique intracellular signaling pathways independent of obesity requires further investigation. In addition, the relationship between incident AF and glycemic control requires further study.

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“…In both studies, the outcome of PAF patients was superior as compared to NPAF patients. As recently demonstrated, Akkaya et al published that a single CB2-PVI retained a favorable 5-year long-term outcome irrespective of types of AF (PAF 61%, NPAF 52%) [ 19 ]. The present study had a similar proportion of AF/AT recurrence compared to the previous studies, although more than half of the patients had NPAF and initial LA intervention consisted of a single PVI strategy.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of predictive scores for late and very late recurrence after cryoballoon-based ablation of atrial fibrillation

Sano

Heeger

Sciacca

et al. 2020

J Interv Card Electrophysiol

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Purpose Studies on predictive scores for very late recurrence (VLR) (recurrence later than 12 months) after second-generation cryoballoon-based pulmonary vein isolation (CB2-PVI) are sparse. We aimed to evaluate the frequency of late recurrence (LR) (later than 3 months) and VLR, and to validate predictive scores for LR and VLR after initial CB2-PVI. Methods A total of 288 patients undergoing initial CB2-PVI (66 ± 11 years, 46% paroxysmal) were retrospectively enrolled in the LR cohort. In the VLR cohort, 83 patients with recurrence within 3-12 months or with < 12-month follow-up were excluded. The predictive scores of arrhythmia recurrence were assessed, including the APPLE, DR-FLASH, PLAAF, BASE-AF 2 , ATLAS, SCALE-CryoAF, and MB-LATER scores.Results During a mean follow-up of 15.3 ± 7.1 months, 188 of 288 (65.2%) patients remained in sinus rhythm without any recurrences. Thirty-two of 205 (15.6%) patients experienced VLR after a mean of 16.6 ± 5.6 months. Comparing the predictive values of these specific scores, the MB-LATER score showed a reliable trend toward greater risk of both LR and VLR (area under the curve in LR;

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Five-year outcome and predictors of success after second-generation cryoballoon ablation for treatment of symptomatic atrial fibrillation

Cited by 28 publications

References 26 publications

Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

Long‐term outcomes of pulmonary vein isolation using second‐generation cryoballoon during atrial fibrillation ablation

The Association Between Diabetes Mellitus and Atrial Fibrillation: Clinical and Mechanistic Insights

Evaluation of predictive scores for late and very late recurrence after cryoballoon-based ablation of atrial fibrillation

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