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Hartl S, Dorwarth U, Pongratz J, Aurich F, Brück B, Tesche C, Ebersberger U, Wankerl M, Hoffmann E, Straube F. Impact of age on the outcome of cryoballoon ablation as the primary approach in the interventional treatment of atrial fibrillation: Insights from a large all-comer study. J Cardiovasc Electrophysiol 2021; 32:949-957. [PMID: 33644913 DOI: 10.1111/jce.14972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/11/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The objective was to analyze the impact of patient age on clinical characteristics, procedural results, safety, and outcome of cryoballoon ablation (CBA) as the primary approach in the interventional treatment of symptomatic atrial fibrillation (AF). METHODS AND RESULTS The single-center prospective observational study investigated consecutive patients who underwent initial left atrial ablation for symptomatic paroxysmal (PAF) or persistent AF (persAF). Age groups (A-F) of less than 40, 40-49, 50-59, 60-69, 70-79 and more than or equal to 80 years were evaluated. Follow-up (FU) included ECG, Holter monitoring and assessment of AF-symptoms. From 2012 to 2016, a total of 786 patients (64 ± 11 years, range 21-85) underwent CBA. With advancing age, more cardiovascular comorbidities and larger LA diameter were observed, more females were included (each p < .001). PAF (57%) and persAF (43%, p = .320) were equally distributed over all age groups. Age was neither related to procedural parameters, nor to the complication rate (3.9%, p = .233). Median FU was 38 months. Two non-procedure related noncardiac deaths occurred late during FU. Freedom from arrhythmia was independent of age at 18 months (p = .210) but decreased for patients more than or equal to 70 years at 24 months (p = .02). At 36 months, freedom from arrhythmia was 66%-74% (groups A-D), 54% (E) and 49% (F), respectively (p = .002). LA diameter and persAF were independent predictors, whereas age was a dependent predictor of recurrence. CONCLUSION CBA as the primary approach in the initial ablation procedure is safe and highly effective in the young, middle aged, and elderly population. LA diameter and persAF, but not ageing, were independent predictors for arrhythmia recurrence.
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Affiliation(s)
- Stefan Hartl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Uwe Dorwarth
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Janis Pongratz
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Florian Aurich
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Benedikt Brück
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Christian Tesche
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany.,Department of Internal Medicine, Cardiology, St. Johannes-Hospital, Dortmund, Germany
| | - Ullrich Ebersberger
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany.,Kardiologie MVZ München Nord, Munich, Germany
| | - Michael Wankerl
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Ellen Hoffmann
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Florian Straube
- Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany.,Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, Munich, Germany
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[Advances in cryoballoon technology: benefits and risks in daily practice]. Herzschrittmacherther Elektrophysiol 2014; 25:230-5. [PMID: 25081597 DOI: 10.1007/s00399-014-0329-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Cryoballoon ablation is nowadays a standard approach for pulmonary vein isolation in symptomatic atrial fibrillation. The second generation cryoballoon was introduced in 2012 and modifications and enhancement to the system promised a higher efficiency. OBJECTIVES, MATERIALS AND METHODS A comprehensive overview of advances in cryoballoon ablation is provided and the consequences for daily practice are described based on a PubMed literature search, taking into account own experiences. RESULTS AND CONCLUSION Advances in cryoballoon ablation result in a significantly higher efficiency. To maintain the overall safety of the procedure and to avoid phrenic nerve palsy and esophageal lesions, special care needs to be taken by following some safety aspects and cut-off criteria. More data are necessary to clarify if recommendations for cryoenergy titration with the new balloon are reasonable. Ongoing prospective studies comparing cryoballoon and radiofrequency (RF) ablation will give answers to the question which energy source is more favorable, and upcoming studies will evaluate the impact of cryoballoon ablation as a first line treatment option.
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Straube F, Dorwarth U, Schmidt M, Wankerl M, Ebersberger U, Hoffmann E. Comparison of the First and Second Cryoballoon. Circ Arrhythm Electrophysiol 2014; 7:293-9. [DOI: 10.1161/circep.113.000899] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Florian Straube
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Uwe Dorwarth
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Martin Schmidt
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Michael Wankerl
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Ulrich Ebersberger
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
| | - Ellen Hoffmann
- From the Department of Cardiology and Internal Intensive Care Medicine, Heart Center Munich-Bogenhausen, Munich Municipal Hospital Group, Munich, Germany
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