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Nekić A, Prepolec I, Pašara V, Bogdanić JE, Posavec JP, Kardum D, Katić Z, Štajduhar A, Nikolić BP, Puljević D, Miličić D, Chierchia GB, de Asmundis C, Velagić V. Treatment of atrial fibrillation with second-generation cryoballoon followed by contact-sensing radiofrequency catheter ablation for arrhythmia recurrences-results of a 5-year follow-up. J Interv Card Electrophysiol 2024; 67:1407-1417. [PMID: 38261100 DOI: 10.1007/s10840-024-01752-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 01/14/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The aim of this study was to report the long-term follow-up results of cryoballoon (CB) ablation in patients with atrial fibrillation. METHODS All consecutive patients who underwent second-generation CB ablation from February 2015 to December 2017 were included in our study. In all procedures, we used a 28-mm CB placed via a single transseptal puncture guided by intracardiac ultrasound. A 20-mm octapolar intraluminal circular catheter was used for intracardiac recordings. A single 180-s freeze strategy was employed. Repeated procedures were performed with a 3D mapping system and radiofrequency catheters. RESULTS A total of 126 patients (69.8% male, mean age 57 ± 11 years), of which 77.0% had paroxysmal atrial fibrillation (PAF), were included in the study. After a 5-year period, 52.4% of patients were in sinus rhythm without AF recurrence, off antiarrhythmic drugs. A total of 61.9% of patients were free of AF recurrence when redo PVI procedures were performed. When accounting for redo pulmonary vein isolation and antiarrhythmic drugs, a total of 73.8% of the patients were without AF recurrence in long-term follow-up. The patients who underwent redo pulmonary vein isolation procedures had statistically significant lower rates of AF recurrence (p = 0.006). In patients with PAF, long-term success rates improved from 62.9 to 79.4% for patients who underwent the redo procedure (p = 0.020). In patients with persistent atrial fibrillation (PersAF), success rates went up from 41.4 to 55.1% for patients with single or repeated PVI procedure (p = 0.071). In the whole cohort, a total of 3 (2.4%) procedure-related major complications occurred which included persistent PNP, arterial pseudoaneurysm, and arteriovenous fistula. CONCLUSION Our data suggest a favorable long-term safety and efficacy profile of second-generation CB ablation. In the mixed paroxysmal and persistent population, up to 73.8% of patients remained free of AF recurrence in the 5-year follow-up, when accounting for redo procedures and AADs. Only 2.4% of patients experienced major complications of the ablation procedure, none with permanent sequelae.
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Affiliation(s)
- Andrija Nekić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
| | - Ivan Prepolec
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Vedran Pašara
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | | | - Domagoj Kardum
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Zvonimir Katić
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | | | - Borka Pezo Nikolić
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Puljević
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - Davor Miličić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia
| | - G B Chierchia
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium
| | | | - Vedran Velagić
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, Croatia.
- Department of Cardiovascular Diseases, University Hospital Center Zagreb, Kišpatićeva 12, 10000, Zagreb, Croatia.
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Song W, Lv T, Zhang N, Li G, Tse G, Liu T. Long-term efficacy and safety of cryoballoon ablation of atrial fibrillation: A systematic review and meta-analysis. Pacing Clin Electrophysiol 2024; 47:49-57. [PMID: 37988273 DOI: 10.1111/pace.14881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/01/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND This meta-analysis evaluated long-term efficacy and safety of cryoballoon ablation (CB) of atrial fibrillation (AF). METHODS PubMed, Cochrane Library, and Web of Science were searched until July 31, 2023, for published works investigating efficacy and safety of CB of AF in which mean/median follow-up time was not less than 36 months. Safety was assessed by adverse events. Efficacy was assessed by AF recurrence, defined as any atrial arrhythmias lasting more than 30 s. RESULTS A total of 19 clinical studies were included. After an average of 58.1 months of follow-up, the overall AF recurrence rate was about 37%. The predictors of recurrence were duration of AF (HR 1.00; 95% CI [1.00 ∼ 1.01]), early recurrence of atrial fibrillation (HR 3.96; 95%CI [1.12 ∼ 14.02]), left atrial diameter (HR 1.04; 95%CI [1.02 ∼ 1.06]), and persistent AF (HR1.47; 95% CI [1.19 ∼ 1.82]). In terms of safety, the incidence of transient phrenic paralysis (PNP) was the highest, about 3%; followed by vascular complications (about 2%); pseudoaneurysm, permanent PNP, and all-cause death was (about 1%); and pericardial effusion and stroke / TIA was very low. CONCLUSION CB is associated with low rates of severe complications and reasonable success rates.
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Affiliation(s)
- Wenhua Song
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Tonglian Lv
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Nan Zhang
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Guangping Li
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
| | - Gary Tse
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
- Cardiac Electrophysiology Unit, Cardiovascular Analytics Group, PowerHealth Limited, Hong Kong, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin, China
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Radauskaite G, Račkauskas G, Danilenko S, Marinskis G, Aidietis A. Results of a 4-Year Follow Up of Patients with Paroxysmal and Persistent Atrial Fibrillation after Cryoablation. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:2036. [PMID: 38004085 PMCID: PMC10673237 DOI: 10.3390/medicina59112036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/13/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
Background and Objectives: Cryoablation is an established treatment method for atrial fibrillation (AF). We present the long-term results of cryoablation in 94 patients with paroxysmal and persistent AF treated in our center. Materials and Methods: This was an observational, retrospective study of 94 patients who underwent a cryoablation procedure for paroxysmal or persistent AF from 2015 to 2017. The follow up was 51 ± 3 months. The absence of arrhythmia was checked at 6, 12, 24, and 48 months after the procedure with 24 h Holter monitoring. We evaluated echocardiography parameters before and 48 months after cryoablation. The quality of life was assessed by calculating EHRA scores at each visit. Results: The mean history of pre-procedural AF duration was 55.3 ± 8.6 months. Paroxysmal AF was present in 42% of patients and persistent AF in 58%. Comparing the EHRA classes, a statistically significant difference was observed between the score assessed before the procedure and the score after one year, as well as when comparing the rates before the procedure and four years after the procedure (p < 0.000). The recurrence of AF was observed in 22.3% of patients 1 year after the procedure, in 26.6% of patients 2 years after the procedure, and in 34% of patients 4 years after the procedure; 9.3% of them were left in permanent AF. During the observation period, 28% of patients underwent a repeated pulmonary vein isolation procedure, and 6% of patients had a permanent pacemaker implanted. Five hematomas (5%) and one instance of phrenic nerve palsy (1%) were observed during the procedure. Conclusions: The rate of arrhythmia recurrence increased every year after cryoablation. Quality of life improved after the procedure, despite the recurrence of AF. A quarter of patients had to undergo a repeat pulmonary vein isolation procedure.
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Affiliation(s)
- Greta Radauskaite
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
| | - Gediminas Račkauskas
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
| | - Svetlana Danilenko
- Department of Mathematical Statistics, Vilnius Gediminas Technical University, 10223 Vilnius, Lithuania;
- Department of Human and Medical Genetics, Vilnius University, 01513 Vilnius, Lithuania
| | - Germanas Marinskis
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
| | - Audrius Aidietis
- Department of Cardiovascular Medicine, Vilnius University, 01513 Vilnius, Lithuania; (G.R.); (G.M.); (A.A.)
- Vilnius University Hospital Santaros Clinics, 08661 Vilnius, Lithuania
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Ngo L, Lee XW, Elwashahy M, Arumugam P, Yang IA, Denman R, Haqqani H, Ranasinghe I. Freedom from atrial arrhythmia and other clinical outcomes at 5 years and beyond after catheter ablation of atrial fibrillation: a systematic review and meta-analysis. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2023; 9:447-458. [PMID: 37336617 PMCID: PMC10658515 DOI: 10.1093/ehjqcco/qcad037] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/13/2023] [Accepted: 06/18/2023] [Indexed: 06/21/2023]
Abstract
AIMS Catheter ablation of atrial fibrillation (AF) is now a mainstream procedure although long-term outcomes are uncertain. We performed a systematic review and meta-analysis of procedural outcomes at 5 years and beyond. METHODS AND RESULTS We searched PubMed and Embase and after the screening, identified 73 studies (67 159 patients) reporting freedom from atrial arrhythmia, all-cause death, stroke, and major bleeding at ≥5 years after AF ablation. The pooled mean age was 59.7y, 71.5% male, 62.2% paroxysmal AF, and radiofrequency was used in 78.1% of studies. Pooled incidence of freedom from atrial arrhythmia at 5 years was 50.6% (95%CI 45.5-55.7%) after a single ablation and 69.7% [95%CI (confidence interval) 63.8-75.3%) after multiple procedures. The incidence was higher among patients with paroxysmal compared with non-paroxysmal AF after single (59.7% vs. 33.3%, p = 0.002) and multiple (80.8% vs. 60.6%, p < 0.001) ablations but was comparable between radiofrequency and cryoablation. Pooled incidences of other outcomes were 6.0% (95%CI 3.2-9.7%) for death, 2.4% (95%CI 1.4-3.7%) for stroke, and 1.2% (95%CI 0.8-2.0%) for major bleeding at 5 years. Beyond 5 years, freedom from arrhythmia recurrence remained largely stable (52.3% and 64.7% after single and multiple procedures at 10 years), while the risk of stroke and bleeding increased over time. CONCLUSION Nearly 70% of patients having multiple ablations remained free from atrial arrhythmia at 5 years, with the incidence slightly decreasing beyond this period. Risk of death, stroke, and major bleeding at 5 years were low but increased over time, emphasizing the importance of long-term thromboembolism prevention and bleeding risk management.
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Affiliation(s)
- Linh Ngo
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Xiang Wen Lee
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | | | - Pooja Arumugam
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
| | - Ian A Yang
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Thoracic Medicine, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Russell Denman
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Haris Haqqani
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
| | - Isuru Ranasinghe
- Greater Brisbane Clinical School, Medical School, The University of Queensland, Chermside, QLD 4032, Australia
- Department of Cardiology, The Prince Charles Hospital, Chermside, QLD 4032, Australia
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Novikov IA, Novikov PS, Mironov NU, Layovich LY, Malkina TA, Shariya MA, Sokolov SF, Maykov EB. [Potential risk factors of atrial fibrillation recurrence after cryoballoon ablation]. KARDIOLOGIIA 2022; 62:23-29. [PMID: 35834338 DOI: 10.18087/cardio.2022.6.n1667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 06/29/2021] [Indexed: 06/15/2023]
Abstract
Aim To identify risk factors for recurrence of atrial fibrillation (AF) following cryoballoon ablation (CBA).Material and methods This prospective study included patients with paroxysmal AF who had undergone CBA (141 patients, median age 60 years, 3% men). The evaluation prior to CBA included clinical instrumental parameters (electrocardiography (ECG), 24-h ECG monitoring, echocardiography, contrast-enhanced cardiac multispiral computed tomography). Also, possible intraoperative indexes that could affect the CBA effectivity, were evaluated. The postoperative follow-up duration was 12 months. Effectivity was assessed during in-person visits at 3, 6, and 12 months, when questioning of patients and 24-h ECG monitoring were performed. CBA was considered ineffective if the patient had recurrences of any atrial tachyarrhythmia longer than 30 sec after the end of the 3-month "blind" period.Results During the 12-month follow-up, recurrences of atrial tachyarrhythmia were observed in 46 (32.6 %) patients. Patients with ineffective CBA more frequently had AF during the first 3 months (71.7 % vs. 11.6 %; р<0.001). Such patients had a history of multiple ineffective treatments with antiarrhythmic drugs (AAD), common pulmonary venous (PV) collector (41.3 % vs. 20.0 %; р=0.008), and stroke/recurrent ischemic attacks (15.2 % vs. 5.2 %; р=0.047). Multifactorial regression analysis showed that the factors of AF recurrence included common PV collector (relative risk (RR) 2.35; 95 % confidence interval (CI) 1.29-4.25; р=0.005), multiple ineffective AADs (RR 1.42; 95 % CI 1.08-1.86; р=0.011), and early AF recurrence (RR 7.57; 95 % CI 3.84-14.90; р<0.001).Conclusion Common PV collector and multiple ineffective AADs are risk factors of ineffective CBA. Early recurrences during the first 3 postoperative months are a significant risk factor of long-term AF recurrences.
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Affiliation(s)
- I A Novikov
- National Medical Research Center of Cardiology, Moscow
| | - P S Novikov
- National Medical Research Center of Cardiology, Moscow
| | - N U Mironov
- National Medical Research Center of Cardiology, Moscow
| | - L Yu Layovich
- National Medical Research Center of Cardiology, Moscow
| | - T A Malkina
- National Medical Research Center of Cardiology, Moscow
| | - M A Shariya
- National Medical Research Center of Cardiology, Moscow
| | - S F Sokolov
- National Medical Research Center of Cardiology, Moscow
| | - E B Maykov
- National Medical Research Center of Cardiology, Moscow
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Chen X, Xia Y, Lin Y, Li X, Wang C, Chen Y, Fang P, Liu J. Cryoballoon Ablation for Treatment of Atrial Fibrillation in a Chinese Population: Five-Year Outcomes and Predictors of Recurrence After a Single Procedure. Front Cardiovasc Med 2022; 9:836392. [PMID: 35571157 PMCID: PMC9091437 DOI: 10.3389/fcvm.2022.836392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe 5-year outcomes and predictors of atrial fibrillation (AF) recurrence following cryoballoon (CB) ablation in Chinese population remain scarce. Our aim was to report 5-year outcomes and predictors of AF recurrence following a single CB ablation procedure in a Chinese population.MethodsFrom December 2013 to August 2016, we included 256 consecutive patients (mean age: 58 ± 10.9 years old; female: 41.0%) with paroxysmal or persistent AF successfully underwent first-generation CB ablation at Fuwai hospital in this prospective study. All patients were followed at least 5 years or when there was recurrent AF. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis.ResultsThe 5-year success rate after pulmonary vein isolation (PVI) by a single procedure was 59.4%. The recurrence rate was the highest (14.5%) within the first year after the index procedure, and then stabilized. Patients with paroxysmal AF had a higher incidence of freedom from AF recurrence than patients with persistent AF (63.2% vs. 36.4%, log-rank P < 0.01). The overall incidence of complications related to CB ablation was 7.8%. Phrenic nerve injury (PNI) was the most common complication, with an incidence of 3.5%, and patients with PNI were recovered within the 1-year follow-up. Only persistent AF (HR 1.72, 95%CI 1.028–2.854, P < 0.05) was significantly and independently associated with an increased risk of AF recurrence after adjusting for other factors.ConclusionPulmonary vein isolation using CB ablation was safe and effective with an acceptable complication and 5-year success rate in a Chinese population with AF, and persistent AF was the independent predictor for 5-year AF recurrence after a single CB ablation procedure.
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Affiliation(s)
- Xiongbiao Chen
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yu Xia
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Yu Xia,
| | - Yuan Lin
- Department of General Practice, School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Xiaofeng Li
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chun Wang
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Yanjun Chen
- Department of Cardiology, Peking University Shenzhen Hospital, Shenzhen, China
| | - Pihua Fang
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Jun Liu,
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Linear lesions for treating the recurrence of persistent atrial tachyarrhythmia after cryoballoon ablation of atrial fibrillation. Arch Cardiovasc Dis 2022; 115:252-263. [DOI: 10.1016/j.acvd.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/25/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022]
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Intermediate-term outcome of cryoballoon ablation of persistent atrial fibrillation and improvements in quality of life of patients. PLoS One 2022; 17:e0261841. [PMID: 35061716 PMCID: PMC8782404 DOI: 10.1371/journal.pone.0261841] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 12/11/2021] [Indexed: 11/28/2022] Open
Abstract
Background Clinical outcome of pulmonary vein isolation (PVI) has been predominantly focused on the reoccurrence of atrial fibrillation (AF) and the maintenance of sinus rhythm. However, there has been a limited intermediate follow-up on health-related quality-of-life (HRQoL) of patients. Given the relatively high recurrence rate of persistent AF after PVI treatment, it is important to follow up with clinical outcomes on symptom improvement as well as health-related quality-of-life. This study was designed to investigate the recurrence rate of atrial tachyarrhythmia (ATa), AF-related symptoms and HRQoL after PVI in patients with persistent AF who were treated with the second generation cryoballoon. Methods Total 148 patients participated in the study who were treated by PVI between 2013 and 2017 for persistent AF. All patients visited the out-patient clinic 2–5 years after PVI. During this visit all patients filled-out an AF Effect on Quality-of-life (AFEQT) questionnaire and a seven-day Holter was applied. All rhythm recordings acquired post ablation were collected and analysed, and the modified European Heart Rhythm Association score (mEHRA) scores were calculated before and after the ablation. Results The average age of patients was 63±9 year old and 44 (27.9%) were female. Mean CHA2DS2 VASc score was 1.9±1.4, and moderate and severe left atrial (LA) dilation was present in 53 (36.1%) and 15 (10.2%) patients, respectively. After a follow-up of 3.7±1.0 years, 81 (54.7%) patients had an ATa recurrence and 35 (23.6%) patients underwent a repeat LA ablation. However, the mEHRA score significantly improved in 80.4% of the patients (p <0.001), with the median overall AFEQT score of 88.9 [70.4–97.2]. Conclusions There is a considerable ATa recurrence rate after PVI of persistent AF at intermediate-term follow-up. However, our data indicate that PVI significantly improved AF-related symptoms and resulted in a high HRQoL for 2–5 years in patients with persistent AF.
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Heeger CH, Sohns C, Pott A, Metzner A, Inaba O, Straube F, Kuniss M, Aryana A, Miyazaki S, Cay S, Ehrlich JR, El-Battrawy I, Martinek M, Saguner AM, Tscholl V, Yalin K, Lyan E, Su W, Papiashvili G, Botros MSN, Gasperetti A, Proietti R, Wissner E, Scherr D, Kamioka M, Makimoto H, Urushida T, Aksu T, Chun JK, Aytemir K, Jędrzejczyk-Patej E, Kuck KH, Dahme T, Steven D, Sommer P, Richard Tilz R. Phrenic Nerve Injury During Cryoballoon-Based Pulmonary Vein Isolation: Results of the Worldwide YETI Registry. Circ Arrhythm Electrophysiol 2022; 15:e010516. [PMID: 34962134 PMCID: PMC8772436 DOI: 10.1161/circep.121.010516] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Cryoballoon-based pulmonary vein isolation (PVI) has emerged as an effective treatment for atrial fibrillation. The most frequent complication during cryoballoon-based PVI is phrenic nerve injury (PNI). However, data on PNI are scarce. METHODS The YETI registry is a retrospective, multicenter, and multinational registry evaluating the incidence, characteristics, prognostic factors for PNI recovery and follow-up data of patients with PNI during cryoballoon-based PVI. Experienced electrophysiological centers were invited to participate. All patients with PNI during CB2 or third (CB3) and fourth-generation cryoballoon (CB4)-based PVI were eligible. RESULTS A total of 17 356 patients underwent cryoballoon-based PVI in 33 centers from 10 countries. A total of 731 (4.2%) patients experienced PNI. The mean time to PNI was 127.7±50.4 seconds, and the mean temperature at the time of PNI was -49±8°C. At the end of the procedure, PNI recovered in 394/731 patients (53.9%). Recovery of PNI at 12 months of follow-up was found in 97.0% of patients (682/703, with 28 patients lost to follow-up). A total of 16/703 (2.3%) reported symptomatic PNI. Only 0.06% of the overall population showed symptomatic and permanent PNI. Prognostic factors improving PNI recovery are immediate stop at PNI by double-stop technique and utilization of a bonus-freeze protocol. Age, cryoballoon temperature at PNI, and compound motor action potential amplitude loss >30% were identified as factors decreasing PNI recovery. Based on these parameters, a score was calculated. The YETI score has a numerical value that will directly represent the probability of a specific patient of recovering from PNI within 12 months. CONCLUSIONS The incidence of PNI during cryoballoon-based PVI was 4.2%. Overall 97% of PNI recovered within 12 months. Symptomatic and permanent PNI is exceedingly rare in patients after cryoballoon-based PVI. The YETI score estimates the prognosis after iatrogenic cryoballoon-derived PNI. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT03645577. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Christian-H. Heeger
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.)
- Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (C.-H.H., R.R.T.)
| | - Christian Sohns
- Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., P.S.)
| | - Alexander Pott
- Department of Cardiology, University of Ulm, Germany (A.P., T.D.)
| | - Andreas Metzner
- Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.)
- Asklepios Klinik Harburg, Hamburg, Germany (A.M.)
- University Heart Center Hamburg, Germany (A.M.)
| | - Osamu Inaba
- Japanese Red Cross Saitama Hospital, Saitama, Japan (O.I.)
| | - Florian Straube
- München Klinik Bogenhausen und Schwabing, Klinik für Kardiologie und Internistische Intensivmedizin, München, Germany (F.S.)
- Ludwig-Maximilians-University, Faculty Munich University Clinic, Germany (F.S.)
| | | | - Arash Aryana
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA (A.A.)
| | | | - Serkan Cay
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Ankara City Hospital, Turkey (S.C.)
| | | | - Ibrahim El-Battrawy
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Germany (I.E.-B.)
| | | | - Ardan M. Saguner
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (A.M.S.)
| | - Verena Tscholl
- Charité Campus Benjamin Franklin, Berlin, Germany (V.T.)
| | - Kivanc Yalin
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey (K.Y.)
| | | | - Wilber Su
- University of Arizona, Phoenix (W.S.)
| | | | | | - Alessio Gasperetti
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.)
- Department of Cardiology, Johns Hopkins University, Baltimore (A.G.)
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital “Umberto I-Lancisi-Salesi”, Marche Polytechnic University, Ancona, IT, Italy (A.G.)
| | - Riccardo Proietti
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom (R.P.)
| | - Erik Wissner
- Division of Cardiology, University of Illinois at Chicago (E.W.)
| | - Daniel Scherr
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.)
- Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., P.S.)
- Department of Cardiology, University of Ulm, Germany (A.P., T.D.)
- Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.)
- Japanese Red Cross Saitama Hospital, Saitama, Japan (O.I.)
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland (E.J.-P.)
- München Klinik Bogenhausen und Schwabing, Klinik für Kardiologie und Internistische Intensivmedizin, München, Germany (F.S.)
- Kerckhoff Klinik, Bad Nauheim, Germany (M.K.)
- Mercy General Hospital and Dignity Health Heart and Vascular Institute, Sacramento, CA (A.A.)
- Tsuchiura Kyodo Hospital, Ibaraki, Japan (S.M.)
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey (K.A.)
- CCB/Med. Klinik III, Kardiologie, Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C.)
- Department of Cardiology, Division of Arrhythmia and Electrophysiology, University of Health Sciences, Ankara City Hospital, Turkey (S.C.)
- Kocaeli Derince Training and Research, Turkey (T.A.)
- Universität zu Köln, Abteilung für Elektrophysiologie, Köln, Germany (D.S.)
- St. Josefs-Hospital, Wiesbaden, Germany (J.R.E.)
- Department of Cardiology and Angiology, Bergmannsheil University Hospitals, Ruhr University of Bochum, Germany (I.E.-B.)
- Hamamatsu University School of Medicine, Japan (T.U.)
- Ordensklinikum Linz Elisabethinen, Austria (M.M.)
- Universitätsklinik Düsseldorf, Abteilung für Kardiologie, Germany (H.M.)
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland (A.M.S.)
- Asklepios Klinik Harburg, Hamburg, Germany (A.M.)
- Charité Campus Benjamin Franklin, Berlin, Germany (V.T.)
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan (M.K.)
- University Heart Center Hamburg, Germany (A.M.)
- University Hospital Graz, Austria (D.S.)
- İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey (K.Y.)
- Herzzentrum Bad Bevensen, Germany (E.L.)
- University of Arizona, Phoenix (W.S.)
- Division of Cardiology, University of Illinois at Chicago (E.W.)
- Helsicore, Israeli-Georgian Medical Research Clinic, Tbilisia (G.P.)
- Critical care department Cairo University, Cairo, Egypt (M.S.N.B.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (C.-H.H., R.R.T.)
- Department of Cardiology, Johns Hopkins University, Baltimore (A.G.)
- Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, University Hospital “Umberto I-Lancisi-Salesi”, Marche Polytechnic University, Ancona, IT, Italy (A.G.)
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom (R.P.)
- LANS Cardio, Hamburg, Germany (K.-H.K.)
- Ludwig-Maximilians-University, Faculty Munich University Clinic, Germany (F.S.)
| | - Masashi Kamioka
- Department of Cardiovascular Medicine, Fukushima Medical University, Japan (M.K.)
| | - Hisaki Makimoto
- Universitätsklinik Düsseldorf, Abteilung für Kardiologie, Germany (H.M.)
| | | | - Tolga Aksu
- Kocaeli Derince Training and Research, Turkey (T.A.)
| | - Julian K.R. Chun
- CCB/Med. Klinik III, Kardiologie, Markuskrankenhaus, Frankfurt am Main, Germany (J.K.R.C.)
| | - Kudret Aytemir
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Hacettepe University, Ankara, Turkey (K.A.)
| | - Ewa Jędrzejczyk-Patej
- Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Zabrze, Poland (E.J.-P.)
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.)
- Asklepios Klinik St. Georg, Hamburg, Germany (C.-H.H., A.M., K.-H.K.)
- LANS Cardio, Hamburg, Germany (K.-H.K.)
| | - Tillman Dahme
- Department of Cardiology, University of Ulm, Germany (A.P., T.D.)
| | - Daniel Steven
- Universität zu Köln, Abteilung für Elektrophysiologie, Köln, Germany (D.S.)
- University Hospital Graz, Austria (D.S.)
| | - Philipp Sommer
- Herz-und Diabeteszentrum NRW, Bad Oeynhausen, Germany (C.S., P.S.)
| | - Roland Richard Tilz
- University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Germany (C.-H.H., A.G., K.-H.K., R.R.T.)
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Germany (C.-H.H., R.R.T.)
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10
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The influence of metabolic syndrome on atrial fibrillation recurrence: five-year outcomes after a single cryoballoon ablation procedure. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:1019-1028. [PMID: 35136397 PMCID: PMC8782764 DOI: 10.11909/j.issn.1671-5411.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) has been reported as a risk factor of atrial fibrillation (AF) recurrence after radiofrequency catheter ablation. This study aimed to investigate the long-term influence of MetS on paroxysmal AF recurrence after a single cryoballoon ablation procedure, which was scarcely investigated yet in Chinese population. METHODS In total, 137 paroxysmal AF patients who had successfully completed a single cryoballoon ablation procedure at Fuwai Hospital, Beijing, China from December 2013 to October 2015 were enrolled. Excepting for patients with AF recurrence, all patients were followed up for no less than five years. Independent predictors of AF recurrence were determined by Cox proportional hazards regression analysis. RESULTS Among 137 paroxysmal AF patients, 91 patients (66.4%) had successfully achieved overall five-year follow-up after a single cryoballoon ablation procedure, and 44 patients (32.1%) had MetS. Patients with MetS had a significant lower incidence of freedom from AF recurrence than those without MetS (50.0% vs. 74.2%, log-rank P < 0.01) during the five-year follow-up. MetS (HR = 1.95, 95% CI: 1.069−3.551, P = 0.030) was an independent predictor of AF recurrence after adjusting for multiple factors. After the second year post cryoballoon ablation procedure, the recurrence rate of AF gradually increased in patients with MetS, in contrast, decreased recurrence rate of AF in patients without MetS.
CONCLUSIONS MetS is an independent predictor for five-year AF recurrence after a single cryoballoon ablation procedure in paroxysmal AF patients. Combination therapy of AF and MetS may improve the long-term outcomes of AF patients.
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11
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Scazzuso F, González JL, Rodríguez G, Coria-Sandoval P, Camargo-Ballestas J, Moreno M, Merriam T, Hemingway L, Muratore C. Latin-American experience in cryoablation of paroxysmal and persistent atrial fibrillation using second generation cryo-balloon. Acute success and 12 months of follow-up. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2021; 91:208-214. [PMID: 33601403 PMCID: PMC8295865 DOI: 10.24875/acm.20000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Catheter ablation has become a usual technique to treat atrial fibrillation (AF). Medium-term results of prospective and multicenter data concerning pulmonary veins cryoablation in Latin America are limited. The objective is to assess the safety and efficacy of ablation by second generation cryoballoon in patients with paroxysmal atrial fibrillation (PAF) or persistent atrial fibrillation (PerAF) in Latin America. Method We evaluate the characteristics of the procedure and the acute and 12-month results. Inclusion criteria include patients over 18 years old with AF who have a planned procedure of pulmonary veins isolation with second generation cryoballoon. Treatment failure was defined as any episode of AF, atrial flutter or atrial tachycardia greater than 30 seconds outside the 90-day blinded period. Results A total of 218 patients (57 ± 11 years, 66.5% men, CHA2DS2-VASc 1.2 ± 1.1) were included in the study. Of these, 83.9% evidenced PAF, 12.8% PerAF, and 2.3% long-standing PerAF. Fifteen with history of atrial flutter. Most patients had failed at least one antiarrhythmic drug (89.4%). The acute success of the procedure was obtained in 211 patients (96.8%). The average procedure time was 73.2 ± 26.7 min, the fluoroscopy time was 21.4 ± 23.9 min, and the total lab occupancy time was 114.6 ± 41.3 min. During the 12-month follow-up, freedom from AF recurrence was 88.6% in PAF, and 73.1% in PerAF. Twenty-one patients experienced device or procedure-related complications (9.6%). Conclusions These results support pulmonary veins electrical isolation with cryoballoon as an effective treatment for AF in Latin America.
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Affiliation(s)
| | - José L. González
- Hospital Universitario Fundación Favaloro, Buenos Aires, Argentina
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12
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El Masri I, Kayali SM, Manolukas T, Levine YC. Role of Catheter Ablation as a First-Line Treatment for Atrial Fibrillation. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00840-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Mugnai G, de Asmundis C, Chierchia GB. Long-term follow up of second-generation cryoballoon-based pulmonary vein isolation: Lights and shadows. Int J Cardiol 2020; 312:71-72. [PMID: 32360214 DOI: 10.1016/j.ijcard.2020.04.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Giacomo Mugnai
- Heart Rhythm Management Center, UZ Brussel-VUB, Brussels, Belgium.
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14
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Sano M, Heeger CH, Sciacca V, Große N, Keelani A, Fahimi BHH, Phan HL, Reincke S, Brüggemann B, Fink T, Liosis S, Vogler J, Eitel C, Tilz RR. Evaluation of predictive scores for late and very late recurrence after cryoballoon-based ablation of atrial fibrillation. J Interv Card Electrophysiol 2020; 61:321-332. [PMID: 32638187 PMCID: PMC8324624 DOI: 10.1007/s10840-020-00778-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 05/08/2020] [Indexed: 11/26/2022]
Abstract
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-AF2, 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; 0.632, 0.637, 0.632, 0.637, 0.604, 0.725, and 0.691 (p = ns), VLR; 0.612, 0.636, 0.644, 0.586, 0.541, 0.633, and 0.680 (p = 0.038, vs. BASE-AF2, respectively)). Kaplan-Meier analysis estimated patients with higher MB-LATER scores which had favorable outcomes (24-month freedom from LR; 26.0% vs. 56.7%, p < 0.0001, VLR; 53.4% vs. 82.1%, p = 0.013). Conclusion The MB-LATER score provided more reliable predictive value for both LR and VLR. Patients with higher MB-LATER scores may benefit from more intensive long-term follow-up.
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Affiliation(s)
- Makoto Sano
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Christian-Hendrik Heeger
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany
| | - Vanessa Sciacca
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Niels Große
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ahmad Keelani
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Behzad Hassan Hosseiny Fahimi
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Huong Lan Phan
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Samuel Reincke
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Ben Brüggemann
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Thomas Fink
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Spyridon Liosis
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Julia Vogler
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Charlotte Eitel
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | - Roland Richard Tilz
- Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Heart Center Lübeck, University Hospital Schleswig-Holstein, Ratzeburger Allee 160, 23538, Lübeck, Germany.
- German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
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15
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Mugnai G, Paparella G, Overeinder I, Ströker E, Sieira J, Bisignani A, Iacopino S, Boveda S, Beckers S, Umbrain V, Bala G, Brugada P, de Asmundis C, Chierchia GB. Long-term clinical outcomes after single freeze cryoballoon ablation for paroxysmal atrial fibrillation: a 5-year follow-up. J Interv Card Electrophysiol 2020; 61:87-93. [DOI: 10.1007/s10840-020-00788-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
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16
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Heeger CH, Subin B, Wissner E, Fink T, Mathew S, Maurer T, Lemes C, Rillig A, Wohlmuth P, Reissmann B, Tilz RR, Ouyang F, Kuck KH, Metzner A. Second-generation cryoballoon-based pulmonary vein isolation: Lessons from a five-year follow-up. Int J Cardiol 2020; 312:73-80. [PMID: 32241572 DOI: 10.1016/j.ijcard.2020.03.062] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 02/29/2020] [Accepted: 03/23/2020] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pulmonary vein isolation (PVI) using the second-generation cryoballoon (CB2) for atrial fibrillation (AF) treatment has demonstrated encouraging procedural success rates and mid-term results. However, long-term follow-up data on outcome is sparse. The current study is reporting on five-year clinical outcomes following CB2-based PVI in patients with paroxysmal AF (PAF) and persistent AF (PersAF). METHODS A total of 139 patients underwent index CB2-based PVI patients (PAF: n = 105, 76% and PersAF: n = 34, 34%) in two electrophysiology centers. Freeze-cycle duration was 240 s. After successful PVI a bonus freeze-cycle of the same duration was applied in the first 71 patients while the bonus-freeze was omitted in 68 following patients. Three patients (2.2%) were lost to follow-up. RESULTS After a median follow-up duration of 60 months (interquartile range: 46, 72 months) 74/136 (54.4%) patients remained in stable sinus rhythm (PAF: 62/104, 59.6%; PersAF: 15/32, 46.9%). Significant differences were observed concerning 5-year clinical outcome between PAF and PersAF patients (p = 0.0315). After a mean of 1.32 ± 0.6 procedures (2nd and 3rd procedure by radiofrequency ablation) and a median follow-up duration of 60 (37, 68) months 90/136 (66.2%) patients remained in stable sinus rhythm (PAF: 72/104 (69.2%), PersAF: 21/32 (65.6%), p = 0.0276). For the comparison of bonus-freeze vs no-bonus-freeze protocols no differences were observed (53.5% vs 57.4%, p = 0.650). CONCLUSIONS The five-year single-procedure success rate for CB2-based PVI was 54.4% and increased to 66.2% following repeat RF-based procedures. No differences were detected comparing bonus-freeze and no-bonus-freeze protocols.
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Affiliation(s)
- Christian-Hendrik Heeger
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany.
| | - Behnam Subin
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Erik Wissner
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; Division of Cardiology, University of Illinois at Chicago, USA
| | - Thomas Fink
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Shibu Mathew
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Tilman Maurer
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Christine Lemes
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Peter Wohlmuth
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Roland Richard Tilz
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany
| | - Feifan Ouyang
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; Fuwai Hospital/National Center of Cardiovascular Diseases, Beijing, China; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Karl-Heinz Kuck
- University Heart Center Lübeck, Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein, Germany; Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Andreas Metzner
- Department of Cardiology, Asklepios Klinik St. Georg, Hamburg, Germany; University Heart Center Hamburg, Hamburg, Germany
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Elvira Ruiz G, Peñafiel Verdú P, Martínez Sánchez J, Sánchez Muñoz JJ, García Almagro FJ, Muñoz Esparza C, García Alberola A. Medium- and long-term outcome after a single second-generation cryoballoon ablation in patients with paroxysmal and persistent atrial fibrillation. Rev Port Cardiol 2020; 38:839-843. [PMID: 32063404 DOI: 10.1016/j.repc.2019.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/07/2018] [Accepted: 05/05/2019] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES To report medium- and long-term results following a single second-generation cryoballoon (CB2)-based ablation procedure in patients with paroxysmal (PAF) and persistent (PeAF) atrial fibrillation. METHODS A retrospective study was performed of consecutive patients undergoing a first CB2-based ablation procedure in a tertiary center. Cryoenergy was applied for 3 min if a time to effect <60 s was documented or 4 min otherwise, with a bonus application in cases of late isolation or suboptimal temperature. Follow-up was obtained from the regional health electronic records system and by telephone or personal interviews. Recurrence was defined as any atrial arrhythmia >30 s beyond a three-month blanking period. The clinical impact of recurrences was classified using a severity score. RESULTS A total of 172 patients (134 PAF and 38 PeAF) were included, of whom 25 (14.5%) had structural heart disease and 120 (69.7%) had a normal or mildly dilated left atrium. Acute success was achieved in 167 (97.1%). After a median follow-up of 27 (14-41) months, 100 patients (58.1%) remained free of atrial arrhythmias (64.2% for PAF and 36.8% for PeAF, p=0.006). Left atrial size (p=0.05) and clinical presentation as PeAF (p=0.006) were predictors of recurrence. Of patients with recurrences, 11.1% did not require further therapies and an additional 16.7% had good control with antiarrhythmic drugs. CONCLUSIONS A single CB2 procedure resulted in 58.1% of patients remaining free of atrial arrhythmias at 27-month follow-up. Conservative management was useful in 27.8% of patients with recurrences.
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Affiliation(s)
- Ginés Elvira Ruiz
- Department of Cardiology, University Hospital Virgen de la Arrixaca, IMIB, Murcia, Spain.
| | - Pablo Peñafiel Verdú
- Department of Cardiology, University Hospital Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Juan Martínez Sánchez
- Department of Cardiology, University Hospital Virgen de la Arrixaca, IMIB, Murcia, Spain
| | | | | | - Carmen Muñoz Esparza
- Department of Cardiology, University Hospital Virgen de la Arrixaca, IMIB, Murcia, Spain
| | - Arcadi García Alberola
- Department of Cardiology, University Hospital Virgen de la Arrixaca, IMIB, Murcia, Spain
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18
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Marashly Q, Chelu MG. Ablation Approaches and Imaging Modalities to Lower Risk of Atrioesophageal Injury During Catheter Ablation for Atrial Fibrillation. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-019-0635-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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19
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Yorgun H, Canpolat U, Gümeler E, Okşul M, Şener YZ, Ateş AH, Akkaya F, Karahan S, Hazırolan T, Aytemir K. Immediate and long-term outcomes of cryoballoon catheter ablation in patients with atrial fibrillation and left common pulmonary vein anatomy. J Interv Card Electrophysiol 2019; 59:57-65. [PMID: 31811460 DOI: 10.1007/s10840-019-00676-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The efficacy of cryoballoon (CB) for atrial fibrillation (AF) ablation is still debatable in case of anatomical variations like left common pulmonary vein (LCPV). We aimed to assess the impact of LCPV trunk on the acute and long-term clinical outcomes in patients with CB based AF ablation. METHODS We compared a total of 82 AF patients (62.5% paroxysmal and 37.5% persistent) who underwent pulmonary vein isolation using CB (LCPV+ group) with a propensity score-matched cohort of 76 AF patients (LCPV- group) (61.8% paroxysmal and 38.2% persistent). Preprocedural computed tomography was performed in all patients and ostial dimensions and trunk distance were measured. Atrial tachyarrhythmia (ATa) recurrence was defined as detection of AF, atrial flutter, or atrial tachycardia (≥ 30 s) after a 3-month blanking period. RESULTS Acute procedural success was similar between the groups (100% and 98.7% for LCPV- and LCPV+, respectively, P = 0.991). Overall, 22/76 (28.9%) patients in LCPV- and 21/82 (25.6%) patients in LCPV+ had ATa recurrence at a mean follow-up of 31 ± 15 months (P = 0.770). A multivariate analysis identified only the left atrial (LA) diameter as a predictor of recurrent ATs (HR, 3.28; 95% CI, 1.67-6.41; P = 0.001). In the LCPV+ group, patients with single application had higher ATa recurrence (8/18 patients) compared with sequential freeze group (13/64 patients) (P = 0.042). CONCLUSIONS Our findings indicated that CB was an effective tool in patients with LCPV and freedom from ATa was similar between LCPV- and LCPV+ groups. Only LA diameter predicted the ATa recurrence during long-term follow-up.
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Affiliation(s)
- Hikmet Yorgun
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey. .,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Uğur Canpolat
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Ekim Gümeler
- Department of Radiology, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
| | - Metin Okşul
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Yusuf Ziya Şener
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Ahmet Hakan Ateş
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Fatih Akkaya
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
| | - Sevilay Karahan
- Department of Biostatistics, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
| | - Tuncay Hazırolan
- Department of Radiology, Faculty of Medicine, Hacettepe University Ankara, Ankara, Turkey
| | - Kudret Aytemir
- Department of Cardiology, Faculty of Medicine, Hacettepe University, 06230, Sıhhıye, Ankara, Turkey
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20
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Elvira Ruiz G, Peñafiel Verdú P, Martínez Sánchez J, Sánchez Muñoz JJ, García Almagro FJ, Muñoz Esparza C, García Alberola A. Medium- and long-term outcome after a single second-generation cryoballoon ablation in patients with paroxysmal and persistent atrial fibrillation. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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21
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Al-Khatib SM, Benjamin EJ, Buxton AE, Calkins H, Chung MK, Curtis AB, Desvigne-Nickens P, Jais P, Packer DL, Piccini JP, Rosenberg Y, Russo AM, Wang PJ, Cooper LS, Go AS. Research Needs and Priorities for Catheter Ablation of Atrial Fibrillation: A Report From a National Heart, Lung, and Blood Institute Virtual Workshop. Circulation 2019; 141:482-492. [PMID: 31744331 DOI: 10.1161/circulationaha.119.042706] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Catheter ablation has brought major advances in the management of patients with atrial fibrillation (AF). As evidenced by multiple randomized trials, AF catheter ablation can reduce the risk of recurrent AF and improve quality of life. In some studies, AF ablation significantly reduced cardiovascular hospitalizations. Despite the existing data on AF catheter ablation, numerous knowledge gaps remain concerning this intervention. This report is based on a recent virtual workshop convened by the National Heart, Lung, and Blood Institute to identify key research opportunities in AF ablation. We outline knowledge gaps related to emerging technologies, the relationship between cardiac structure and function and the success of AF ablation in patient subgroups in whom clinical benefit from ablation varies, and potential platforms to advance clinical research in this area. This report also considers the potential value and challenges of a sham ablation randomized trial. Prioritized research opportunities are identified and highlighted to empower relevant stakeholders to collaborate in designing and conducting effective, cost-efficient, and transformative research to optimize the use and outcomes of AF ablation.
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Affiliation(s)
- Sana M Al-Khatib
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A., J.P.P.)
| | - Emelia J Benjamin
- Cardiovascular Medicine, Department of Medicine, Boston University School of Medicine, and Department of Epidemiology, Boston University School of Public Health, MA (E.J.B.)
| | - Alfred E Buxton
- Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (A.E.B.)
| | - Hugh Calkins
- Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (H.C.)
| | - Mina K Chung
- Department of Cardiovascular Medicine, Cleveland Clinic, OH (M.K.C.)
| | - Anne B Curtis
- Department of Medicine, University at Buffalo School of Medicine and Biomedical Sciences, NY (A.B.C.)
| | - Patrice Desvigne-Nickens
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.D.N., Y.R., L.S.C.)
| | - Pierre Jais
- Cardiology Hospital, University of Bordeaux, France (P.J.)
| | - Douglas L Packer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN (D.L.P.)
| | - Jonathan P Piccini
- Division of Cardiology and Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (S.M.A., J.P.P.)
| | - Yves Rosenberg
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.D.N., Y.R., L.S.C.)
| | - Andrea M Russo
- Division of Cardiology, Cooper University, Camden, NJ (A.M.R.)
| | - Paul J Wang
- Departments of Medicine and Health Research and Policy, Stanford University, CA (P.J.W.)
| | - Lawton S Cooper
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD (P.D.N., Y.R., L.S.C.)
| | - Alan S Go
- Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).,Departments of Epidemiology, Biostatistics, and Medicine, University of California, San Francisco (A.S.G.)
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22
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Liu L, Zhao D, Zhang J, Yang H, Abdu FA, Guo R, Li S, Tang K, Li H, Che W, Xu Y. Impact of Stable Coronary Artery Disease on the Efficacy of Cryoballoon Ablation for the Atrial Fibrillation. Am J Med Sci 2019; 358:204-211. [DOI: 10.1016/j.amjms.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/14/2019] [Accepted: 06/19/2019] [Indexed: 01/15/2023]
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23
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Canpolat U, Kocyigit D, Yalcin MU, Coteli C, Sener YZ, Oksul M, Gürses KM, Evranos B, Yorgun H, Aytemir K. Long-term outcomes of pulmonary vein isolation using second-generation cryoballoon during atrial fibrillation ablation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:910-921. [PMID: 31106431 DOI: 10.1111/pace.13721] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 01/25/2023]
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 PVs). 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.
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Affiliation(s)
- Ugur Canpolat
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Duygu Kocyigit
- Cardiology Clinics, Afyonkarahisar Dinar State Hospital, Afyonkarahisar, Turkey
| | | | - Cem Coteli
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Yusuf Ziya Sener
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Metin Oksul
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Kadri Murat Gürses
- Department of Basic Medical Sciences, Adnan Menderes University, Aydin, Turkey
| | - Banu Evranos
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hikmet Yorgun
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.,Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Kudret Aytemir
- Arrhythmia and Electrophysiology Unit, Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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24
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Long-term outcomes of cryoballoon pulmonary vein isolation for paroxysmal and persistent atrial fibrillation in Chinese patients. J Interv Card Electrophysiol 2019; 57:425-434. [PMID: 31016428 DOI: 10.1007/s10840-019-00542-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/21/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE We aimed to study the long-term outcomes of cryoballoon (CB) pulmonary vein isolation (PVI) in treating Chinese patients with atrial fibrillation (AF). METHODS A total of 122 patients (48 women, mean age 57.4 ± 11.3) underwent CB PVI (first generation CB 44.3%, second generation CB 55.7%) for AF (paroxysmal 65.6%, persistent 10.7% and long-standing persistent 23.8%). RESULTS PVI was achieved in 113 (92.6%) patients with CB alone, and it was achieved in all patients with additional touch-up by 8-mm-tip cryocatheter. The mean procedural and fluoroscopic duration were 171.9 ± 41 and 46.6 ± 14.6 min respectively. The recurrence-free survival for paroxysmal and non-paroxysmal AF was 77% and 59% respectively at 1 year and progressively declined over time to reach a plateau of 52% and 30% for paroxysmal and non-paroxysmal AF respectively at 5 years. In patients undergoing PVI with second-generation CB, the recurrence-free survival was 75% for paroxysmal AF and 45% for non-paroxysmal AF at 5 years. With multivariate Cox regression analysis, the types of CB (use of second-generation CB: HR 0.49; 95% CI 0.28-0.85; p = 0.011) and size of left atrium (LA) (larger LA size: HR 1.52; 95% CI 1-2.14; p = 0.017) independently predicted recurrence. Transient phrenic nerve injury (PNI) occurred in four (3.3%) patients and persistent PNI occurred in four (3.3%) patients. Other complications occurred in 10 (8.2%) patients with no procedure-related death. CONCLUSIONS Long-term success of CB PVI for AF declined over time and reached a plateau at 5 years. CB types and LA size are independent predictors for long-term recurrence.
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25
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Bohne LJ, Johnson D, Rose RA, Wilton SB, Gillis AM. The Association Between Diabetes Mellitus and Atrial Fibrillation: Clinical and Mechanistic Insights. Front Physiol 2019; 10:135. [PMID: 30863315 PMCID: PMC6399657 DOI: 10.3389/fphys.2019.00135] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 02/04/2019] [Indexed: 01/16/2023] Open
Abstract
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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Affiliation(s)
- Loryn J Bohne
- Department of Cardiac Sciences and Department of Physiology and Pharmacology, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Dustin Johnson
- Department of Cardiac Sciences and Department of Physiology and Pharmacology, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Robert A Rose
- Department of Cardiac Sciences and Department of Physiology and Pharmacology, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Stephen B Wilton
- Department of Cardiac Sciences and Department of Physiology and Pharmacology, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
| | - Anne M Gillis
- Department of Cardiac Sciences and Department of Physiology and Pharmacology, University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary, AB, Canada
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