Second‐generation cryoballoon ablation for treatment of persistent atrial fibrillation: Three‐year outcome and predictors of recurrence after a single procedure

Abstract

Sinus rhythm was maintained in a substantial proportion of patients even 3 years after CB ablation. Patients with a nonenlarged left atrium and short AF history had the best outcome.

Five‐year experience with pulmonary vein isolation using the second‐generation cryoballoon for treatment of persistent atrial fibrillation

“…According to our experience with CB ablation, a larger common ostium is a significant drawback for a good occlusion, circumferential tissue contact and lesion formation. We also determined that LA area is a significant predictor of outcome, being in line with recent data . Enlarged left atria may be accompanied by LA remodeling and interstitial fibrosis, which could explain the increased incidence of AFLAT recurrence.…”

“…Finally, we want to point out that we analyzed only patients undergoing PVI alone in this trial. Some of these patients have been previously reported (60 patients with relatively small left atria and “early persistent” AF as well as 63 patients—all of them with a LA area more than 20 cm 2 , considered to be enlarged—undergoing CB‐PVI compared with RF‐PVI) . Although PVI with CB‐Adv is effective and leads to both PVI and LA substrate modification, the use of CB‐Adv might be insufficient in patients with an enlarged left atrium due to larger residual substrate areas.…”

“…Although PVI with CB‐Adv is effective and leads to both PVI and LA substrate modification, the use of CB‐Adv might be insufficient in patients with an enlarged left atrium due to larger residual substrate areas. Possibly an additional LA roof ablation using CB‐Adv as described before may lead to better outcomes as PVI alone, especially in patients with enlarged left atria . Nevertheless, there are no randomized data comparing PVI alone with PVI and additional LA roof ablation in patients with persistent AF using the CB technique.…”

Conversion of atrial fibrillation to sinus rhythm during cryoballoon ablation: A favorable and not unusual phenomenon during second‐generation cryoballoon pulmonary vein isolation

“…As the target of the procedure is defined by effective and permanent PVI, the ablation can be carried out independently of the presenting rhythm, since the restoration of SR during the ablation is not a goal in itself; still, in our experience, this phenomenon occurred in a relevant number of cases (3.7%), showing a high mid‐term success rate in terms of AF recurrence both at 1 year (91.9%) and at 2 year follow‐up (86.5%) in patients in whom termination of AF occurred during cryo‐applications. This result may carry a specific meaning when compared to previous large studies on CB‐A outcomes, eventually implicating that the pulmonary venous electrical activity might have been the main driver for fibrillation in these patients and therefore properly treated with CB‐A PVI. Still, it cannot be excluded that termination of AF simply identifies patients who have lesser electroanatomical remodeling and then more likely to remain in SR.…”

“…Of note, 10 patients (18.9%) in our case group were affected by persistent AF, showing a success rate of 88.9% at 1 year follow‐up; given the borderline LA dimensions in our case group (mean LA diameter 40.5 ± 7.5 mm) and particularly in this subgroup of patients (indexed LA diameter 26.5 mm/mq), these data may further confirm and highlight that the most relevant substrate for AF in our case group was probably confined to PV potentials. The importance of LA dimensions in the settings of CB‐A has been recently confirmed by Akkaya et al, as they showed that left atrial area >21 cm 2 was a significant predictor of recurrence in a population of 101 patients undergoing CB‐A with second‐generation CB. Furthermore, in a recent work from Gramlich et al, the degree of atrial fibrosis was proved to correlate with the risk of AF recurrence at 1 year follow‐up after CB‐A in 60 patients with persistent AF, therefore stressing the relevance of possible residual substrate areas besides PVs in those patients with a large extent of low‐voltage areas and more generally of the LA disease.…”