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

Abstract

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

Comparison of standard vs modified “figure‐of‐eight” suture to achieve femoral venous hemostasis after cryoballoon based atrial fibrillation ablation

“…Vascular complications including groin hematoma, retroperitoneal bleeding, local infection, femoral arterial pseudoaneurysm, or femoral arteriovenous fistula are known as the most common complications of AF catheter ablation with varying incidence rates . Uninterrupted OAC use, full dose periprocedural anticoagulation, the necessity of >1 vascular puncturing with large bore sheaths and center volume have been previously reported as risk factors for access site complications during AF ablation .…”

“…Direct OACs were ceased 24‐48 h before the procedure taking the renal function tests into account. The technical details of the second‐generation CB‐based pulmonary vein isolation were defined in detail previously …”

New Results in Catheter Ablation for Atrial Fibrillation

“…A growing evidence suggests that second-generation cryoballoon is also safe and effective in patients with persistent AF [29,30]. In persistent AF the isolation of the left atrial appendage as an adjunct to PVI may improve 1-year outcomes compared with the PVI-only strategy using cryoballoon [31].…”

Strategies to Improve the Outcome of Cryoballoon Ablation in the Treatment of Atrial Fibrillation

“…A prospective cluster cohort study that involved 4,189 patients showed that the recurrence rate of PeAF did not differ between CBA and RFCA during middle-term follow up [8]. A single-center large-scale study also found that the free survival rate for atrial arrhythmias was 78.6% after a single procedure for PaAF and 72.3% for PeAF at a median 39 months follow-up [9]. CBA treatment also achieved a similar success rate without obvious complications compared to RFCA both in elderly AF patients (>75 years old) and patients with PeAF and longstanding PeAF [10,11].…”